Analysis of the AHA Year 2000 ACLS Guidelines
ACLS EMS Quick Summary Overview

Persistent VF and Pulseless VT

  Affirm completion of initial ABCD
Initiate Secondary ABCD

Continue defibrillations at one-minute intervals (priority intervention-Class I)

1. Vasopressor

Vasopressin 40U IV push x 1 only (preferred first agent, Class 2b)

or

Epinephrine 1mg q 3-5min   (Class Indeterminant) if vasopressor needed 10-15 minutes after vasopressin administration;

2. Antiarrhythmics

Amiodarone

• 300 mg IV push,
• Can consider repeat 150 mg IV x 1 in 3-5 minutes (Class 2a preferred agent)

or

Lidocaine

• 1.0-1.5 mg/kg  IV
• Can be repeated q 5-10 min up to 3 mg/kg (Class Indeterminate);

3. Continue Defibrillations

Additional Notes

• Bretylium remains acceptable but no longer recommended in ACLS;
• If VF/pulseless VT converts to something else then reoccurs- Procainamide 30 mg/min up to 17mg/kg)—can also be given up to 50 mg/min or 100mg q5 min as alternative delivery during urgent/emergent situations;
• Magnesium 1-2 grams IV only if polymorphic VT or hypomagnesiumic (Class 2b);
• Sodium bicarbonate: prolonged arrest (Class 2b), high K (Class 1), bicarbonate responsive acidosis (2a), tricyclic OD (2a), to alkinalize urine for aspirin OD (2a); not for hypercarbia.
   

*EMS—does not include additional medications such as specific beta-blockers, digoxin, or other calcium channel blockers.
See previous Protocols or use ECC handbook 2000 for further explanation, dosages, and reference

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