Most recent public comments by Dan Fletcher https://nowcomment.com/users/136490 https://nowcomment.com/documents/350606?scroll_to=3093626 https://nowcomment.com/documents/350606?scroll_to=3093626 The only way to know if the first shock was unsuccessful would be to get to the end of the second cycle of BLS (after shocking at the end of the first) and then recheck the rhythm. The recommendation would be to shock a second time and then we suggest giving a dose of esmolol. It's a little confusing, but is consistent with the esmolol recommendation. Let me know if that answers your question! Thu, 27 Jul 2023 09:16:19 -0400 https://nowcomment.com/documents/354087?scroll_to=3110909 https://nowcomment.com/documents/354087?scroll_to=3110909 The only way to know if the first shock was unsuccessful would be to get to the end of the second cycle of BLS (after shocking at the end of the first) and then recheck the rhythm. The recommendation would be to shock a second time and then we suggest giving a dose of esmolol. It's a little confusing, but is consistent with the esmolol recommendation. Let me know if that answers your question! Fri, 01 Sep 2023 19:38:39 -0400 https://nowcomment.com/documents/350606?scroll_to=3091464 https://nowcomment.com/documents/350606?scroll_to=3091464 You're thinking that adding a box to the top that says something like "unresponsive, apneic patient"? We decided to take that out because the algorithm is meant to be applied to patients believed to be in CPA as a reminder of the training the rescuers have already received. We thought that very basic aspect would be ok to leave off for simplicity's sake. As a reminder, the intention of these cognitive aids is not to teach the algorithm exhuastively, but to serve as a cognitive aid for folks who have been trained. What do others think about the need for that box at the top? Great to get so many thoughtful suggestions! Thu, 20 Jul 2023 10:19:16 -0400 https://nowcomment.com/documents/354087?scroll_to=3110914 https://nowcomment.com/documents/354087?scroll_to=3110914 You're thinking that adding a box to the top that says something like "unresponsive, apneic patient"? We decided to take that out because the algorithm is meant to be applied to patients believed to be in CPA as a reminder of the training the rescuers have already received. We thought that very basic aspect would be ok to leave off for simplicity's sake. As a reminder, the intention of these cognitive aids is not to teach the algorithm exhuastively, but to serve as a cognitive aid for folks who have been trained. What do others think about the need for that box at the top? Great to get so many thoughtful suggestions! Fri, 01 Sep 2023 19:38:40 -0400 https://nowcomment.com/documents/350606?scroll_to=3091463 https://nowcomment.com/documents/350606?scroll_to=3091463 Good thoughts here. We were trying to address some of the issues that folks see to struggle with during in-person training, specifically the idea that compressions should be done while the defibrillator is charged and then AFTER the shock, a full 2 minute cycle of chest compressions should be done. Would love some more input on whether that's clear on the left side of the algorithm and if there are suggestions for ways to make that clearer. Thu, 20 Jul 2023 10:14:51 -0400 https://nowcomment.com/documents/354087?scroll_to=3110917 https://nowcomment.com/documents/354087?scroll_to=3110917 Good thoughts here. We were trying to address some of the issues that folks see to struggle with during in-person training, specifically the idea that compressions should be done while the defibrillator is charged and then AFTER the shock, a full 2 minute cycle of chest compressions should be done. Would love some more input on whether that's clear on the left side of the algorithm and if there are suggestions for ways to make that clearer. Fri, 01 Sep 2023 19:38:40 -0400 https://nowcomment.com/documents/350606?scroll_to=3091462 https://nowcomment.com/documents/350606?scroll_to=3091462 The only issue is that the "Start BLS" is repeated every 2 minute cycle but "Start ALS" is only done once. This is why we pulled it off to the side in it's own box that just terminates (i.e., doesn't loop back to the main algorithm). We were concerned that having Start ALS in that same box and then looping the algorithm back to it would be confusing. Would love some more input on this. Thu, 20 Jul 2023 10:12:14 -0400 https://nowcomment.com/documents/354087?scroll_to=3110900 https://nowcomment.com/documents/354087?scroll_to=3110900 The only issue is that the "Start BLS" is repeated every 2 minute cycle but "Start ALS" is only done once. This is why we pulled it off to the side in it's own box that just terminates (i.e., doesn't loop back to the main algorithm). We were concerned that having Start ALS in that same box and then looping the algorithm back to it would be confusing. Would love some more input on this. Fri, 01 Sep 2023 19:38:38 -0400 https://nowcomment.com/documents/354087?scroll_to=3110903 https://nowcomment.com/documents/354087?scroll_to=3110903 For small teams, there are times when all of the ALS initiation steps don't get done before the end of the first 2 minute cycle, so we thought pulling that out to the side made sense so it didn't get confusing (they should stop at 2 minutes). It's also important that the CPR training will focus on teaching the algorithm, so although it is a bit complicated (as is CPR!), this is meant just as a reminder, not as something that would be used by folks who have not been trained in CPR. As for the BLS details, the issue is space on the algorithm and fitting everything in, but we could definitely look at widening that BLS box to pull the details in. We'll send that suggestion to the graphic designer and see what she can come up with. Fri, 01 Sep 2023 19:38:39 -0400 https://nowcomment.com/documents/350606?scroll_to=3091461 https://nowcomment.com/documents/350606?scroll_to=3091461 For small teams, there are times when all of the ALS initiation steps don't get done before the end of the first 2 minute cycle, so we thought pulling that out to the side made sense so it didn't get confusing (they should stop at 2 minutes). It's also important that the CPR training will focus on teaching the algorithm, so although it is a bit complicated (as is CPR!), this is meant just as a reminder, not as something that would be used by folks who have not been trained in CPR. As for the BLS details, the issue is space on the algorithm and fitting everything in, but we could definitely look at widening that BLS box to pull the details in. We'll send that suggestion to the graphic designer and see what she can come up with. Thu, 20 Jul 2023 10:09:59 -0400 https://nowcomment.com/documents/350606?scroll_to=3091460 https://nowcomment.com/documents/350606?scroll_to=3091460 Thu, 20 Jul 2023 10:06:04 -0400 https://nowcomment.com/documents/354087?scroll_to=3110906 https://nowcomment.com/documents/354087?scroll_to=3110906 Fri, 01 Sep 2023 19:38:39 -0400 https://nowcomment.com/documents/350733?scroll_to=3090345 https://nowcomment.com/documents/350733?scroll_to=3090345 Tue, 18 Jul 2023 09:34:22 -0400 https://nowcomment.com/documents/350756?scroll_to=3090252 https://nowcomment.com/documents/350756?scroll_to=3090252 Of these first 50 questions, this was probably the one the committee (Domain Chairs and Co-Chairs) debated the most. While many of the studies involved pre-treatment, there were multiple experimental studies and one human study (Lee, 2016) that showed a benefit with treatment with esmolol for refractory VF during CPR. There was almost no evidence of harm. This led us to feel that we could offer a weak recommendation for the use of esmolol for refractory VF/pVT. Would love to hear what others think! Tue, 18 Jul 2023 06:26:17 -0400 https://nowcomment.com/documents/350780?scroll_to=3090120 https://nowcomment.com/documents/350780?scroll_to=3090120 Great! Glad to hear it, and thank you for all of your hard work. Mon, 17 Jul 2023 22:42:16 -0400 https://nowcomment.com/documents/350756?scroll_to=3090119 https://nowcomment.com/documents/350756?scroll_to=3090119 Good point! We did hedge a little on this, but will need to specify a dose and it will likely be esmolol that is recommended. Thanks for pointing this out! Mon, 17 Jul 2023 22:40:38 -0400 https://nowcomment.com/documents/350731?scroll_to=3090102 https://nowcomment.com/documents/350731?scroll_to=3090102 Hey Rebecca! The term we used before was "flat-chested", but there were some concerns about that term and we felt that "wide-chested" was probably more descriptive of the conformation. Would love to hear other feedback on this term, and other ideas. Mon, 17 Jul 2023 22:16:35 -0400 https://nowcomment.com/documents/350755?scroll_to=3090101 https://nowcomment.com/documents/350755?scroll_to=3090101 Hi Rebecca! Can you please clarify what you mean by "the previous comment?" ALS-01 suggests that lidocaine can be used in dogs but probably shouldn't be used in cats. This PICO suggests that if lidocaine is not available, you could use amiodarone in dogs, but lidocaine is preferred. Please let us know what you mean here. Thanks! Mon, 17 Jul 2023 21:57:09 -0400 https://nowcomment.com/documents/350530?scroll_to=3088382 https://nowcomment.com/documents/350530?scroll_to=3088382 I don't understand why you even asked this question! Wed, 12 Jul 2023 19:57:29 -0400 https://nowcomment.com/documents/350530?scroll_to=3088381 https://nowcomment.com/documents/350530?scroll_to=3088381 Not sure about this one! Thu, 13 Jul 2023 19:45:03 -0400