OSUdoc08 said:
Too bad procainamide has been dropped from the ACLS algorithm.
(I'm assuming that since the ECC 2005 was from an international consensus, that it is in fact the best protocol, right?)
Procainamide has most definately NOT been dropped from ACLS. Just because its not in the little algorithm boxes doesn't mean it isn't in the full set of guidelines for the 2005 changes which is very very long document.
The below is pasted from the new 2005 guidelines:
Procainamide
Procainamide hydrochloride suppresses both atrial and ventricular arrhythmias by slowing conduction in myocardial tissue. One randomized trial (LOE 2)47 indicated that procainamide is superior to lidocaine in terminating spontaneously occurring VT. Procainamide may be considered in the following situations:
As one of several drugs that may be used for treatment of stable monomorphic VT in patients with preserved ventricular function (Class IIa)46
One of several equivalent drugs that can be used for control of heart rate in atrial fibrillation or atrial flutter in patients with preserved ventricular function
One of several drugs that can be used for acute control of heart rhythm in atrial fibrillation or atrial flutter in patients with known pre-excitation (WPW) syndrome and preserved ventricular function
One of several drugs that can be used for AV reentrant, narrow-complex tachycardias such as reentry SVT if rhythm is uncontrolled by adenosine and vagal maneuvers in patients with preserved ventricular function
Procainamide hydrochloride for non-VF/VT arrest may be given in an infusion of 20 mg/min until the arrhythmia is suppressed, hypotension ensues, the QRS complex is prolonged by 50% from its original duration, or a total of 17 mg/kg (1.2 g for a 70-kg patient) of the drug has been given. Bolus administration of the drug can result in toxic concentrations and significant hypotension. The maintenance infusion rate of procainamide hydrochloride is 1 to 4 mg/min, diluted in D5W or normal saline. This should be reduced in the presence of renal failure.
Procainamide should be used cautiously in patients with preexisting QT prolongation. In general it should be used with caution if at all in combination with other drugs that prolong the QT interval (consider obtaining expert consultation). Monitor the ECG and blood pressure continuously during administration of procainamide.
Sotalol
Sotalol is not a first-line antiarrhythmic. Sotalol hydrochloride is an antiarrhythmic agent that, like amiodarone, prolongs action potential duration and increases cardiac tissue refractoriness. It also has nonselective ß-blocking properties. One randomized controlled trial (LOE 1)48 indicated that sotalol is significantly more effective than lidocaine for terminating acute sustained VT. This agent may be used in the following circumstances with expert consultation:
To control rhythm in atrial fibrillation or atrial flutter in patients with pre-excitation (WPW) syndrome and preserved ventricular function when the duration of the arrhythmia is 48 hours. But the intervention of choice for this indication is DC cardioversion.
For monomorphic VT.
IV sotalol is usually administered at a dose of 1 to 1.5 mg/kg body weight, then infused at a rate of 10 mg/min. Side effects include bradycardia, hypotension, and arrhythmia. The incidence of torsades de pointes following a single dose of sotalol for treatment of VT is reportedly 0.1%.45 Use of IV sotalol is limited by the need to infuse it relatively slowly.
read the full guidelines.
not just the algorithm boxes.