A New Year, New Resuscitation Guidelines

 Happy New Year!

In her first editorial of the new year, the BMJ editor chose to wish everyone 'a rational new year'. The emphasis is definitely placed on promoting rational healthcare decisions which are based on the best available evidence. A good example of using evidence to change medical practice is shown in the changes to resuscitation guidelines released towards the end of last year:


New Guidelines on Resuscitation - Student BMJ, January 2011. In October last year, a large review of available literature on resuscitation guidelines was carried out and there have been new recommendations made following this.

• Chest compression only CPR is recommended if a rescuer is not trained in CPR.
• Compressions should now be delivered to a depth of 5-6cm, not 4-5cm as was previously recommended.
• Rescuers (wearing gloves) should continue compressions while the defibrillator is charging.
• Use of three consecutive shocks may be considered in VF/VT during cardiac catheterisation, in the early post-op period after cardiac surgery, and in a witnessed VF/VT cardiac arrest when the patient is already connected to a manual defibrillator.
• Every patient in hospital should have a documented care plan for monitoring vital signs including criteria for escalation of care to prevent cardiac arrest.
• If IV access is not available, the intraosseous route should be used.
• When treating a VF/VT cardiac arrest, adrenaline 1mg and amiodarone 300mg are given after delivery of the third shock once chest compressions have restarted. Adrenaline is otherwise administered during alternate cycles of CPR.
• Atropine is no longer recommended for routine use in asystole or PEA.
• Real time use of echocardiography increases chance of diagnosis of potentially reversible causes of cardiac arrest eg.cardiac tamponade or pulmonary embolism.
• Oxygen saturation rates of 94% - 98% should be targeted when spontaneous circulation has been re-established.
• There are also slight changes to the paediatric guidelines.

Links to the new guidelines are available here: http://www.resus.org.uk/pages/guide.htm
 Doctors in Scotland recommend radical cuts to medical school intakes (Student BMJ News December 2010) - Doctors in Scotland have called on the government to reduce the numbers of medical students in the forthcoming years in order to stop the oversupply of doctors applying for registrar positions. In an article in the Student BMJ News, the current projections for specialty training numbers from 2011 to 2015 indicate that 21 percent of Scottish foundation doctors are unlikely to progress further in Scotland.

Registration cuts fees for foundation years (Student BMJ News January 2011)  - Some good news! The GMC has agreed to cut down registration fees for junior doctors. According to the student BMJ in January, FY1s will now pay £100 for provisional registration (down from £145), and in FY2 will pay £210 (down from almost double this amount). Perhaps this is a positive sign that some attention is being taken the BMA about the high costs for training in medicine.