BLS and ACLS Updates 2015 - The Malaysian Perspective

A talk that I presented during the Kelantan Resuscitation Updates 2015 (22 Nov 2015) based on the new AHA/ILCOR guidelines. However, I have put in some emphasis on certain aspects which are relevant in the Malaysian setting (for both major referral hospitals as well as smaller, lesser-equipped hospitals/clinics). Basically however, there are no major changes in this year 2015 updates. If you have already been doing well with the Guidelines 2010, you don't really need to waste money for an updated ACLS course. As Justin Morgenstern said it so well

"If I had to take away just 2 learning points, they would be:

1. These guidelines are very similar to the 2010 guidelines. There are no changes important enough to warrant paying for another ACLS course. If you know the 2010 guidelines, just keep providing good patient care.
2. As always, the science is weak. Only 1% of recommendations were “level A”, meaning high quality evidence from more than one RCT. The most common phrase I encountered reading through these guidelines was “may be reasonable”. This phrase is essentially meaningless and can easily be translated into “may not be reasonable”. Tread with care."  (Emphases mine, read more in his blog)

ACLS 2015 Updates - The Malaysian Perspective from Chew Keng Sheng


To download this slide in pdf, go to http://www.slideshare.net/cksheng74/acls-2015 and click 'download'.

Anyway, a number of great resources worth mentioning (much better than I can ever produce):

1) Emergency Medicine Cases Podcast has released a 2-part series on ACLS 2015 Guidelines (episodes no 71 and 72 - click here and here to access)

2) Boring EM Blog has released a series of infographics on the Top Five series - top five BLS changes, top five ACLS changes, etc. Beautifully, beautifully done. Great for visual learners. Trust me, it is not "boring"! Click here to download for FREE.

3) This is THE website, THE front page that you should go to for CONTINUOUS updates on BLS, ACLS, PALS, etc. As the American Heart Association has mentioned, there will no longer be a 5-yearly update.  But it is going to be a continuous web-based updates (e.g. the ROC-ALPS trial, of which, the results will probably be published early 2016 and it may shed some light as to whether amiodarone or lignocaine for shockable rhythms may actually improve survival to discharge). Click here and come back here often.

4)  As mentioned above, Justin Morgenstern's take on the first 10 minutes is worth reading. Click here.

5) R.E.B.E.L Em podcast: Our Top Five AHA 2015 Guideline Updates. Click here to download and listen.

6) And finally, of course, download the entire full text of the AHA Guidelines here in Circulation.


It is interesting to note that the highlights of AHA 2015 Guidelines is now also available in Bahasa Malaysia. Click on the image to go to the website to download:

 

 

Revised Powerpoint Slides on Ethics of Resuscitation 2010

I have just uploaded my revised version of Ethics of Resuscitation slides. The lecture was given during the Master of Medicine Intensive Course on Bioethics & Communication 2010.

Go the the original source where this file is hosted and click on the download link for FREE download. I allow for FREE download for non-commercial use ONLY as long as I am acknowledged as the author of this work, and that no alteration whatsoever is to be done on the slide without the permission of the author.

Ethics In Resuscitation (Revised for 2010)

View more presentations from Chew Keng Sheng.

Ethics of Resuscitation (Revised 2010) by Dr. Chew Keng Sheng is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 2.5 Malaysia License.
Based on a work at www.slideshare.net.

Ethics in Resuscitation

Ethics in Resuscitation

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Other Important Points Not Covered in the Lecture:

The Concept of Patient Autonomy

“Every human being of adult years and sound mind has the right to determine what shall be done with his own body, and a surgeon who performs an operation without his patient’s consent commits an assault, for which he is liable”

- Justice Cardozo in Schloendorff v Society of New York Hospital, 105 NE 92 (NY1914)


Bolam Test and Bolitho Test

Under the Bolam test, a doctor is not negligent if he is acting in accordance with a practice accepted as proper by a responsible body of medical men skilled in that particular art, merely because there is a body of such opinion that takes a contrary view.

In this case, a patient, Mr Bolam, sued the hospital and its doctors for damages, claiming negligence on the part of the doctors in performing electroconvulsive therapy on him which resulted in fractures. The patient also claimed that he did not give informed consent to the hospital doctors.


“. . . (a doctor) is not guilty of negligence if he has acted in accordance with a practice accepted as proper by a responsible body of medical men skilled in that particular art . . . a man is not negligent, if he is acting in accordance with such practice merely because there is a body of opinion who would take a contrary view. At the same time that does not mean that a medical man can obstinately and pigheadedly carry on with some old technique if it has been proved to be contrary to what is really substantially the whole of informed medical opinion . . .”

- Judge McNair


Bolitho case - the court must be satisfied that the exponents of a body of professional opinion have a logical basis and had directed their minds to the comparative risks and benefits in reaching a defensible conclusion. The opinion of the expert witnesses must be founded on logic and good sense. It is now a matter for court & not medical opinion to decide standard of professional care

The ability and willingness of the courts in Bolitho case to consider the correctness of a professional view has been extended beyond information disclosure and into treatment. This case arose out of a failure of a hospital doctor to examine and intubate a child experiencing respiratory distress, leading to brain damage through asphyxia. The plaintiff patient had expert evidence that a reasonably competent doctor would have intubated in those circumstances. The defendant doctor had her own expert witnesses saying that non-intubation was a clinically justifiable response.


Reference:
1. A set of power point slides by Assoc Prof Catherine Tay can be downloaded here.

2. Medico-legal articles by Assoc Prof Catherine Tay:

- Informed Consent To Medical Treatment: What Needs To Be Disclosed? Click here
- Recent developments in informed consent: the basis of modern medical ethics. Click here
- Informed Consent in Obstetrics and Gynecology. Click here
- Recent Developments of Informed Consent in Eye Research. Click here

3. Elements of Informed Consent — A Survey of Medical Professionals
Click here

4. sBMJ series
- Biomedical ethics: The basic principles. Click here
- Biomedical ethics: Patients' right. Click here
- Biomedical ethics: Organ transplantation. Click here
- Biomedical ethics: Genetics. Click here