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ACLS = 2000=20 Guidelines: Corrections and Updates to published=20 guidelines

ACLS Guidelines Reference=20 Page	*Explanation*	*Corrected = Recommendation*
161-163	Original guidelines = incorrectly noted "NO=20 DC Cardioversion" for treatment of PSVT in = presence of=20 impaired cardiac function.	Paroxysmal SVT with EF < 40%, CHF - DC = cardioversion=20 is recommended
161-163	Clarification of = cardioversion in narrow=20 complex SVT algorithm	Cardioversion is appropriate = treatment of=20 PSVT and is listed first in priority order in=20 algorithm (note: The = large majority=20 of NCSVT patients prove to be PSVT.=20 The large majority of PSVT patients - up to 80% in = some=20 studies - convert by 3 doses of=20 adenosine. Thus few patients with NCSVT ever move past the first treatment box = to=20 require cardioversion.) Also, add the phrase: DC = cardioversion is=20 ineffective in junctional and=20 ectopic atrial tachycardias
160, far right column	For control of rate and rhythm of a.=20 fibrillation/a.flutter, original guidelines note "NO = DC=20 Cardioversion" if duration of rhythm is > 48 hours = or=20 unknown.	Delete=20 "NO DC Cardioversion". Add: Avoid=20 nonemergent cardioversion unless anticoagulation or clot=20 precautions are=20 taken
156	Isoproterenol has=20 been inserted after epinephrine. Isoproterenol is = a=20 "last chance" treatment for = bradycardia.=20 Algorithm update adds = isoproterenol=20 to avoid a perception that it is=20 prohibited. Isoproterenol is recommended for = immediate temporary=20 control of hemodynamically significant bradycardia when atropine and = dobutamine=20 have failed and pacing is = unavailable. If used, = administer=20 with caution at low doses.	Add last bullet in = "Intervention sequence" box: =20 Isoproterenol 2 to 10 = =C2=B5g/min
150	VF/Pulseless VT Algorithm Notes - = Procainamide:=20 Refractory VF divided into separate recommendations = for=20 recurrent VF/VT versus persistent = VF/VT. =20 Persistent VF/VT is a continuous = rhythm=20 (drug infusion less likely to be=20 effective) whereas victims with recurrent VF/VT have intermittent periods of = perfusing=20 rhythm (drug infusion=20 possible).	(Class IIb) 30=20 mg/min in recurrent=20 VF/pulseless VT (maximum total=20 dose: 17 mg/kg). = Procainamide is=20 Class Indeterminate=20 (acceptable but not recommended) for persistent = VF/pulseless=20 VT. Prolonged administration = time=20 is problematic for = both=20 persistent and recurrent=20 VF/VT.=20

Reference:

Currents in Emergency = Cardiovascular=20 Care, Spring 2001 =C2=A92001 American Heart = Association. =20 The complete Update may be found at http://www.cu= rrentsonline.com/adobe/spring2001.pdf

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