ACLS and Vasopressin |


  1. Dr. Alebil A says

    I have an expirment in the ICU for a young patient who had Road trafic accident suffer of fractures in the head , loss of conciouss , anyway he was slight bradycardic , hypotensive , we gave R/l , D5NS, epiniphrine , but we had only tachycardic and hypotensive with cold peripheris , so we had to add Dopamin 20, which absolutely worked very good in controlling the hypotension , pressure back to normal , we then withdrawn the epi , and he is now stable ..
    Trust in Dopamine , it works ..

  2. Ignatius R says

    Excellent and very helpful discussions
    Love this website
    My thought : At the back of my mind I know Vasopressin is still available at my disposal let alone
    simplifying the algorithm does not put an X to it totally.

  3. Ryan says

    I think there should be two separate guidelines for asystole and PEA. PEA itself can be divided into traumatic and non traumatic arrests seeing as patients with traumatic PEA from penetrating cardiac injury for example, require an entirely different approach than what the algorithms state. Giving compressions to these patients may do more harm than good and the use of epinephrine can actually be detrimental. Obviously in this setting emergency thoracotomy would be indicated but I think the ACLS guidlines should state that specifically. You would not treat traumatic PEA the same as non traumatic PEA and asystole therefore the guidelines should state that.

    Also I’ve read multiple papers where vasopressin is superior to epinephrine in the treatment of asystole and can increase survival to discharge by as much as 3%. I’m superised the guidlines haven’t already implemented the use of vasopressin specifically for the treatment of asystole given that patients who are in asystole are already facing dismal outcomes and if vasopressin can change those odds even by a small amount then surely it should be in the algorithm. The fact that vasopressin was removed in order to simplify the algorithm does not make any sense to me. This is why I think ACLS should have separate guidlines for asystole and for traumatic and non traumatic PEA as you would not treat all three the same way.

  4. Jake says

    Has anyone come across and indefinite reason for the time change for adrenaline administration in regards to pre hospital cardiac arrest management?
    If so what resource.

  5. ibonumber1 says

    I still allow it as an option for my paramedics in the field. The problem lately is that epinephrine is sometimes not available due to the drug companies manipulating cost.

  6. Dr. Ashraf Memon says

    What will be 3Rd dose of inj. Amiodarone if vf persist,
    We can give inj. Amiodarone 150mg or infusion according to guideline…


    • Jeff with admin. says

      AHA does not give any recommendations for bolus dosing after the dose of 300mg and then the dose of 150mg. It is my experience that 150mg has been repeated a 2nd time, but there is no definitive recommendation. By the time that you reach the 6th shock and are ready to give a 3rd dose of amiodarone, it is unlikely that the patient will still persist in a shockable rhythm. The patient will most likely degrade into asystole. Kind regards, Jeff

  7. Tom Johnson says

    Hi, Jeff.

    Immediately following the vasopressin removal notice is the comment, “Vasopressin…has been shown to be more effective than epinephrine in the treatment of asystolic cardiac arrest.” That would appear to be contradictory, to say the least, or did I miss something? Vasopressin has come through for me more often than not, and I hate to see it go. Thanks. Tom, RN

    • Jeff with admin. says

      The study referenced was for out of hospital cardiac arrest. As far as I know most in hospital cardiac arrest comparisons have shown basically no difference in survival to hospital discharge. The removal was done to simplify treatment and I suppose that a provider could, at his own discretion, give vasopressin if it was available.
      I also liked having the option of given vasopressin along with epinephrine, and I hate to see it go as well.
      Kind regards,

      • Duane Wright says

        I understand simplification of algorithms. However ACLS-EP still recommends vasopressin in presence of septic shock cardiac arrest. It has its place when properly utilized. Dummied down ACLS is ok so people feel better about assisting in cardiac arrest situations. ACLS-EP is an excellent option for those seeking more detailed and higher level of patient care and intervention.

    • Jeff with admin. says

      The removal was due to the fact that there is no added benefit from administering both epinephrine and vasopressin as compared with administering epinephrine alone, and in order to simplify the algorithm, vasopressin was removed.

    • Jeff with admin. says

      Yes epinephrine and amiodarone can be used together (they are compatible). Amiodarone does not replace epinephrine. After the first dose of epinephrine, it is given every 3-5 minutes.

      Kind regards,

  8. mharris says

    Jeff to give 40 units of vasopressin in an arrest situation what volume should it be diluted in when given IV push? Thanks, Michele

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