24.1 ACLS Guidelines
These guidelines are opinions based on imperfect information. Best example, perhaps, is the study that shows that pts who receive ACLS medications do worse than those who do not (Ann EM 1998;32:544). This is because all people do better if their “code” is related to an arrhythmia treatable with electricity (Jama 1999;281:1175). Even success at early resuscitation still carries a poor ultimate prognosis (Resuscitation 1998;36:95). This is constantly updated, and please refer to the American Heart Association literature for the latest algorithms.
24.2 APGAR Scores
Developed by Patricia Apgar (Ped Dev Pathol 1999;2:292) to quickly stratify neonates and give a prognosis for the first minutes of life (Arch IM 1999;159:125). Traditionally done at one and five min of life (see Table 24.1), has been extended to ten min and other longer time intervals in an attempt to give further prognostic information. A persistently low score (3 or less) from 5 to 20 min of life is an indicator of increased neonatal morbidity/mortality (Arch Ped Adolesc Med 2000;154:294; Nejm 2001;344:467); with a finding of 3 or less at 5 min associated with cerebral palsy (Jama 1984;251:1843).
Table 24.1 APGAR Score