Current research fails to support the use of high-concentration oxygen therapy in patients who are not showing signs of hypoxemia or hypoxia. Hyperoxemia is associated with vasoconstriction and significant intra-pulmonary shunting, which may lead to increased morbidity.
However, oxygen should always be used when there are clinical signs of hypoxemia or respiratory failure.
One of my colleagues expressed the belief that ventricular tachycardia and ventricular fibrillation should be treated the same way. This does not square with my knowledge of electrophysiology and pharmacology. Please comment. We wholeheartedly agree with your approach of beginning with basic cardiac electrophysiology; electrical therapy and pharmacology.
Your authority to practice is based on your state’s EMS laws. Most EMS systems (local, state or regional) issue system-wide standard operating procedures (SOP’s). These function in many ways like a prospective prescription from the system medical authority authorizing treatment(s) based on defined circumstances. ACLS algorithms were developed as educational tools, not prospective standing orders. They are not a prescription. Thus, it is essential that you practice according to the guidelines established by your medical authority. If you have questions regarding your system’s standing medical orders (SMO’s), a fact-finding meeting with your medical authority (e.g. your Project Medical Director) may be useful for EMS leadership and field personnel.
My clinic administrator stated that if we are ACLS certified, and simply provide care exactly as listed in the ACLS algorithms, we will be protected from medical malpractice suits. Is this correct? The Advanced Cardiovascular Life Support (ACLS) program is a training program. The “algorithms” were developed to assist users in remembering a large body of information. Simply being able to regurgitate dozens of clinical interventions does not assure proper care. Proper treatment of critically ill patients requires an understanding of anatomy, physiology, pathophysiology, pharmacology, therapeutics, etc. Blindly following a list rather than developing a treatment plan based on the patient’s condition might result in suboptimal care. Furthermore, medical science is dynamic. Practitioners have a duty to stay reasonably informed about current literature and changes in professional practice. While ACLS training may provide the tools needed to support good practice, no plastic card provides protection from tort litigation based on improper care.
