The 2020 ACLS Guidelines were published in October 2020 . This first of 3 blog posts will focus on vasopressor and non-vasopressor medications during cardiac arrest. Part 2 will focus on specific arrhythmia management and Part 3 will focus on toxicologic interventions.
There were no major updates for vasopressors and non-vasopressors used during cardiac arrest. The American Heart Association (AHA) published Highlights of the 2020 Guidelines [PDF] as a clear and concise summary. Now that the AHA is releasing focused updates in the 5-year period between guidelines (like this one on lidocaine), fewer major changes likely will be needed when the full guidelines are published.
Amiodarone or lidocaine
Table: Vasopressors and non-vasopressors used during cardiac arrest (VF: ventricular fibrillation, pVT: pulseless ventricular tachycardia)
Which component of the pictured plant is the cause of gastrointestinal symptoms when ingested?
- Ribosomal inhibiting proteins
- Saponin glycosides
A major development in curbing the opioid epidemic is the introduction of the medication buprenorphine to address opioid addiction. Being able to prescribe this medication, however, requires a special DEA-X Waiver in the United States. Dr. Alister Martin, the Founder of the Get Waivered initiative, is working to reduce the barriers for clinicians to obtain the training and paperwork necessary to obtain this waiver. Dr. Michelle Lin talks with Dr. Martin on this podcast about the backstory of the Get Waivered program, the lowered barriers to obtaining training, and some sneak peaks on what is new on the launching pad for his program.
Interesting fact: Medical students can participate in the free DEA-X waiver training now. The certificate of completion has no expiration date and can be submitted, when eligible for this waiver license.
Podcast with Dr. Alister Martin on the Get Waivered program
Visit the Get Waivered site to learn of their upcoming online training events and hot off the press news.
- A Tale of Two Epidemics: COVID-19 and the Opioid Crisis
ACEP E-QUAL podcasts on the opioid epidemic
- Opioid Use Disorder (OUD) Access in the Time of COVID
- Transitioning to Outpatient Care in OUD
- Substance Use Disorder Chat
- Pain Management for Patients with Opioid Use Disorder
- Opioid Overdose Prevention & Naloxone Distribution
- Opioid Withdrawals & Buprenorphine in the ED
- Buprenorphine after Opiate Overdose Part 1
- Buprenorphine After Opiate Overdose Part 2
- Supercharging Medication Assisted Therapy (MAT) with PAs and APRNs
Disclosure: ALiEM is proud to be a collaborator with the Get Waivered Initiative. This work was funded by the Foundation for Opioid Response Efforts (FORE). The views and conclusions contained in this document are those of the authors and should not be interpreted as representing the official policies or stance, either expressed or implied, of FORE. FORE is authorized to reproduce and distribute reprints for Foundation purposes notwithstanding any copyright notation hereon.
A 38-year-old male presents 8 days after being stung in the left foot while surfing. He reports the sudden onset of sharp pain while walking in the ocean. He was seen initially in the emergency department. The puncture wound on his left foot was anesthetized, explored, and irrigated. No X-ray was obtained, no foreign body was discovered, and he was discharged home.
Two days ago, he noticed worsening heat, itchiness, swelling, and skin changes (red bumps and patches extending from the foot up to the lower calf) in his left foot. His current pain is rated 3/10 and localized to the left foot. The patient is able to walk and bear weight. He has been taking ibuprofen for pain control and is not taking antibiotics. He denies fevers, but reports fatigue and feels more cold than usual.
A 29-year-old female presented to the emergency department for a rash on her right calf. 5 days prior, at her home in Alabama, the patient developed pain and swelling of her right calf following a spider bite while putting on her pants. The patient felt a “burning pain” and found a spider which she then killed. She went to a hospital and received cephalexin, trimethoprim/sulfamethoxazole, and oxycodone. Despite taking these medications she continued having aching pain rated 10/10 in her right calf along with generalized pruritus. The patient stated that the bite evolved from an initial generalized redness into a blue/black lesion with blistering and extensive redness along her leg and torso. She denied fever, chills, lightheadedness, abdominal pain, nausea, vomiting, and hematuria.