Chin Med J (Taipei) 1998;61:S145.

What's New in New ACLS Guidelines

Sheng-Chuan Hu

Tzu-Chi Buddhist General Hospital

Abstract

American Heart Association had routinely renewed ACLS textbook every 3 years in 1997. What's new in 1997 edition ACLS guidelines compared to the 1994 edition textbook? This is the most concerned issue by all emergency physicians. There are two new chapters entitled "Acute coronary syndrome (ACS) and Stroke". The chapter of ACS replace the chapter of acute myocardial infarction. The chapter of stroke is an exactly new chapter. The followings are some different concepts in new ACLS guidelines:

1. Patients with chief complaint of chest pain or tightness which are highly suspected of cardiac origin will be allocated into one of three flow charts according to different ECG pattern.

2. ACS include Q wave myocardial infarction, Non Q myocardial infarction, and Unstable angina.

3. More widely use thrombolytic therapy. The new indication include add new or presumably BBB, > 75 years old, > 12 hours, hyperacute T wave and posterior MI. Mentration bleeding and prolonged CPR are not contraindication.

4. More aggressive use beta-blockers. Routinely use beta blockers in ED as long as there is no contraindication.

5. The usage of ACE inhibitors is recognized in acute stage. (Could use in ICU)

6. rPA (Reteplase) is better than tPA.

7. Amiodarone for VT/VF is accepted. 150 mg/10 min IV, then 1 mg/min for 6 hours, then 0.5 mg/min for later maintenance.

8. Beta-blockers is the first drug of choice in atrial fibrillation in AMI.

9. Nitroglycerine IV should be avoided in RV infarction.

10. More aggressive perform primary PTCA in acute stage of AMI as long as the operator has the willingness and the ability.

11. The usage of tPA in ischemic stroke within 3 hours after the onset of symptoms and no evidence of hemorrhage in CT film as well as no contraindication of using thrombolytic agents has been approved in the USA.

[Chin Med J (Taipei) 1998;61:S145.]