FAQ of the Week: One of my colleagues expressed the belief that ventricular tachycardia and ventricular fibrillation should be treated the same way.
One of my colleagues expressed the belief that ventricular tachycardia and ventricular fibrillation should be treated the same way. This does not square with my knowledge of electrophysiology and pharmacology. Please comment.
We wholeheartedly agree with your approach of beginning with basic cardiac electrophysiology; electrical therapy and pharmacology.
Ventricular fibrillation (VF) is fibrillating myocardium. The usual route of therapeutic termination is to simultaneously depolarize a critical mass of fibrillating myocardium (DC counter-shock). Ventricular tachycardia (VT), on the other hand, is a circuitry issue. Unlike VF, which is fatal if not treated quickly, patients in VT are more likely to be clinically stable. Thus, drug therapy may be the best treatment approach.
If a patient with VT is unstable (inadequate perfusion), immediate DC counter-shock is indicated. However, VT rarely requires high therapeutic energy to terminate anomalous circuitry conduction, compared to VF, which routinely requires high energy to depolarize a critical mass of fibrillating myocardium.
Another major difference in treating unstable VT and VF is the appropriateness of the use of epinephrine. While an agent often employed when treating refractory VF, it is pro-arrhythmic and is therefore not a logical drug for VT. Further, VT is virtually never seen being refractory to counter-shock.
The confusion seems to be solved by this approach: “Treat pulseless VT as quickly as VF, not the same.” The common thread is rapid use of electrical therapy.
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FAQ of the Week: I am a paramedic who is a certified ACLS provider. There are several differences between my EMS protocols and what I was taught in ACLS. What should I do?
Your authority to practice is based on your state’s EMS laws. Most EMS systems (local, state or regional) issue system-wide standard operating procedures (SOP’s). These function in many ways like a prospective prescription from the system medical authority authorizing treatment(s) based on defined circumstances.
ACLS algorithms were developed as educational tools, not prospective standing orders. They are not a prescription. Thus, it is essential that you practice according to the guidelines established by your medical authority. If you have questions regarding your system’s standing medical orders (SMO’s), a fact-finding meeting with your medical authority (e.g. your Project Medical Director) may be useful for EMS leadership and field personnel.
FAQ of the Week: My clinic administrator stated that if we are ACLS certified, and simply provide care exactly as listed in the ACLS algorithms, ...
My clinic administrator stated that if we are ACLS certified, and simply provide care exactly as listed in the ACLS algorithms, we will be protected from medical malpractice suits. Is this correct?
The Advanced Cardiovascular Life Support (ACLS) program is a training program. The “algorithms” were developed to assist users in remembering a large body of information. Simply being able to regurgitate dozens of clinical interventions does not assure proper care.
Proper treatment of critically ill patients requires an understanding of anatomy, physiology, pathophysiology, pharmacology, therapeutics, etc. Blindly following a list rather than developing a treatment plan based on the patient’s condition might result in suboptimal care. Furthermore, medical science is dynamic. Practitioners have a duty to stay reasonably informed about current literature and changes in professional practice.
While ACLS training may provide the tools needed to support good practice, no plastic card provides protection from tort litigation based on improper care.
FAQ of the Week: What type of continuing education credit (CE credit) can be claimed for taking AMRI's Advanced Cardiac Life Support (ACLS) or PALS provider course?
AMRI's ACLS and PALS programs have been accredited by the National Board of Emergency Care Certifications (NBECC) for 10.0 Category 1 credit hours. Course participants receive an official CE certificate along with their ACLS or PALS provider card.
Many societies and credentialing bodies accept the Category 1 Credit as the equivalent CE or CEU as long as the accreditation is in the applicant's field or discipline. However, if you are unsure whether or not your participation in our online courses can be used toward certification or re-licensure, you should check with your employer's governing body.
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