Pass ACLS Tip of the Day: Recent Episodes
Paul Taylor
I'm Paul from PassACLS.com and I'm here to help you pass ACLS. Like an audio flash card, this podcast is intended to aid any medical professional preparing for an Advanced Cardiovascular Life Support (ACLS) class. Each one-to-nine minute episode covers one of the skills needed to recognize a stroke or cardiac emergency and work as a high performing team to deliver safe, quality patient care. Listening to a tip a day for 14-30 days prior to your ACLS class will help cement the core concepts that have been shown to improve outcomes in patients suffering a heart attack, cardiac arrest, or stroke. In addition to the Chain of Survival, core concepts, and ACLS algorithms; specific information needed to pass the written exam, BLS checks, and megacode following the 2020 guidelines is presented. Healthcare providers that are already ACLS certified, but rarely participate in codes, may find listening a helpful reminder. Disclaimer: This podcast is a supplement to your course's approved text book and videos - not a replacement. The information presented is for educational purposes only, is intended for medical professionals, and is not medical advice. Medical professionals should follow their local laws, agency protocols, and act only within their scope of practice.
Review the mechanism of action and safe administration of Morphine or Fentanyl for patients with myocardial ischemia in ACLS’s Acute Coronary Syndrome (ACS) algorithm.
MONA is the acronym sometimes used to help us remember the interventions to consider for patients with Acute Coronary Syndrome.
Morphine and Fentanyl's use in the Acute Coronary Syndrome (ACS) algorithm.
Why Morphine or Fentanyl is helpful for patients with ACS.
Contraindications and considerations for their safe administration.
Common dosing & administration.
Monitoring of the patient's level of consciousness, pain, blood pressure, and respirations after administration.
Possible side effects.
Narcan as an antidote to Morphine or Fentanyl if needed.
Links:
Pass ACLS: Find ACLS classes near you and discover other podcasts with ACLS-related episodes. https://passacls.com/
Buy Me a Coffee: To support the show. https://buymeacoffee.com/paultaylor
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Thanks for listening. Good luck with your class!
Teamwork and communication tips to help ACLS providers limit interruptions to CPR chest compressions to less than 10 seconds to maintain a CCF above 80%.
Even good CPR is far less efficient at circulating blood than a functioning heart.
The indicators of high-quality CPR that were identified at the 2012 AHA CPR Quality Summit.
Three tips to limit pauses in CPR compressions to 10 seconds or less.
Teams with good communication and follow these actions obtain a CCF of 92% or higher.
Links:
Pass ACLS: Find ACLS classes near you and discover other podcasts with ACLS-related episodes. https://passacls.com/
Buy Me a Coffee: To support the show. https://buymeacoffee.com/paultaylor
Safe Meds VIP: Learn about medication safety and download a free drug discount card to money on your prescription medications. https://safemeds.vip/
A brief review of two commonly used ACLS medications: epinephrine & Dopamine. Their indications, doses, and considerations for safety is discussed.
Epinephrine and Dopamine are adrenergic agonist used in several ACLS algorithms.
The use of epinephrine for severe anaphylaxis and unstable bradycardia.
Review epinephrine’s effects on blood vessels and bronchioles.
Why epinephrine is helpful for patients with anaphylaxis.
Using an epi drip for unstable bradycardia.
Epinephrine administration during cardiac arrest.
Starting an epinephrine or Dopamine drip for patients that have ROSC.
Review the effects of Dopamine based on mcg/kg/min dosing.
Monitoring the patient and titrating epi or Dopamine drips to prevent harm.
For more information on ACLS medications, check out the pod resource page at passacls.com.
Links:
Pass ACLS: Find ACLS classes near you and discover other podcasts with ACLS-related episodes. https://passacls.com/
Buy Me a Coffee: To support the show and help cover the cost of hosting.https://buymeacoffee.com/paultaylor
Safe Meds VIP: Learn about medication safety and download a drug discount card to money on your prescription medications. https://safemeds.vip/
Review of: rescue breathing; advantages of waveform capnography; and delivering artificial ventilations during CPR with and without an advanced airway.
Providing rescue breathing to apneic patients with a palpable pulse.
Normal end tidal CO2 for patients with a pulse.
Identification of cardiac arrest and our immediate actions.
Providing artificial ventilations during CPR without an advanced airway vs with an advanced airway in place.
Using quantitative waveform capnography to confirm placement of an advanced airway, assess the quality of CPR, and identify ROSC.
The effects of hyperventilating patients in cardiac arrest.
Links:
Pass ACLS: Find ACLS classes near you and discover other podcasts with ACLS-related episodes. https://passacls.com/
Buy Me a Coffee: To support the show and help cover the cost of hosting. https://buymeacoffee.com/paultaylor
Safe Meds VIP: Learn about medication safety and download a drug discount card to save money on your prescription medications. https://safemeds.vip/
Accidental hypothermia is one of the Hs in ACLS’s reversible H&T cause of cardiac arrest.
Hypothermic patients aren't dead until they are warm and dead.
As the body’s temperature drops below 36° C, hypothermia may be classified as moderate or severe.
Modifying the ACLS Adult Cardiac Arrest algorithm for patients with severe hypothermia.
Following the ACLS algorithm for patients with a body core temperature above 30° C.
Methods for rewarming patients with moderate vs severe hypothermia.
Continuation of CPR and ACLS efforts until the patient’s body core temp is above 36° C.
Good luck with your ACLS class!
Links: Buy Me a Coffee at https://buymeacoffee.com/paultaylor
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The use of calcium channel blocker medications for tachycardias refractory to Adenosine and to lower the blood pressure of hypertensive stroke patients.
Calcium is one of the ions that move across the cellular membrane during cardiac contraction and relaxation.
The primary use of calcium channel blockers in ACLS.
Use of calcium channel blockers for SVT refractory to Adenosine and A-Fib or A-Flutter with RVR.
Contraindications of calcium channel blockers.
Nicardipine use during the treatment of ischemic strokes.
For more information on ACLS medications, tachycardia, or stroke check out the pod resource page at passacls.com.
Good luck with your ACLS class!
Links: Buy Me a Coffee at https://buymeacoffee.com/paultaylor
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Review the ACLS treatment goals and targeted temperature management (TTM) for post-arrest patients that have return of spontaneous circulation (ROSC).
Post-arrest care and recovery are the final two links in the chain of survival.
Identification of ROSC during CPR.
Initial patient management goals after identifying ROSC.
Indications for starting TTM.
Monitoring the patient’s core temperature.
Good luck with your ACLS class!
Links: Buy Me a Coffee at https://buymeacoffee.com/paultaylor
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Review the indications, contraindications, and safe administration of nitroglycerine to Acute Coronary Syndrome (ACS) patients with ischemic chest pain.
Nitroglycerine’s effects.
Assessment of vital signs prior to administering nitro.
Indications for use of nitroglycerine.
Nitroglycerine's contraindications & considerations for use.
Use of nitro with patients taking PDE inhibitors.
Administration of nitroglycerine to patients with ischemic chest pain.
Considerations for patients that took their home nitroglycerine.
Monitoring patient's pain and vital signs after nitro administration.
Good luck with your ACLS class!
Links: Buy Me a Coffee at https://buymeacoffee.com/paultaylor
Free Prescription Discount Card - Get your free drug discount card to save money on prescription medications for you and your pets: https://nationaldrugcard.com/ndc3506/
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Identification of Atrial Fibrillation (A-Fib) & Atrial Flutter on the ECG and the treatment of unstable and stable SVT patients with A-Fib/Flutter.
The ECG characteristics of A-Fib and A-Flutter.
Recognition and treatment of unstable patients in A-Fib/Flutter with rapid ventricular response (RVR).
Suggested energy settings for synchronized cardioversion of unstable patients with a narrow complex tachycardia.
Team safety when cardioverting an unstable patient in A-FIB/Flutter.
Adenosine’s role for stable SVT patients with underlying atrial rhythms.
Treatment of stable patients in A-Fib/Flutter with RVR.
For other medical podcasts that cover narrow complex tachycardias, visit the pod resource page at passacls.com.
Good luck with your ACLS class!
Links: Buy Me a Coffee at https://buymeacoffee.com/paultaylor
Free Prescription Discount Card - Get your free drug discount card to save money on prescription medications for you and your pets: https://nationaldrugcard.com/ndc3506/
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Review of Tablets & Toxins as an ACLS H &T reversible causes of cardiac arrest with some specific, commonly encountered examples.
The majority of toxins don’t have a specific antidote. There are a few toxins for which we have emergency interventions and ACLS providers should be familiar with.
Reviewing the patient's medical history for indicators that may lead us to suspect a tablet/toxin cause of cardiac arrest.
Administration of Narcan for suspected narcotics overdose following the Opioid Associated Emergency algorithm.
Other common ACLS Tablet Toxin scenarios with possible treatments.
Medications commonly used to treat specific toxins that are regularly stocked on crash carts or carried in EMS med bags.
ACLS providers that suspect a specific toxin should consult with their Pharmacy or call Poison Control for treatment directions.
Good luck with your ACLS class!
Links: Buy Me a Coffee at https://buymeacoffee.com/paultaylor
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Poison Myths and Misconceptions on The Pharmacists Voice podcast:
https://www.thepharmacistsvoice.com/podcast/poison-myths-and-misconceptions-discussion-part-1-of-5-with-angel-bivens-rph-and-wendy-stephan-phd/
Why we use algorithms.
Generally speaking, if there’s a change in a patient’s condition, we should ensure we’re using the correct algorithm.
Three key points to remember when using ACLS algorithms.
Walk through of an example mega code scenario with explanations of when and why we change to a different ACLS algorithm.
Good luck with your ACLS class!
Links: Buy Me a Coffee at https://buymeacoffee.com/paultaylor
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Review of when we should consider beta blocker use in ACLS's Acute Coronary Syndrome (ACS) & Tachycardia algorithms and when they're contraindicated.
Beta blocking medications attach to Beta receptors to inhibit or “block” the effects of epinephrine (adrenaline)and norepinephrine in the body.
The primary locations of Beta I, II, and III receptors.
Effects of epinephrine & norepinephrine stimulation of beta receptors on the heart.
Beta blockers effects on the heart.
When we should consider the use of beta blockers in the Acute Coronary Syndrome (ACS)and Tachycardia algorithms.
Contraindications to the use of beta blocker medications.
More detailed information about beta blocker’s mechanism of action and specific instances for their use can be found on the Pod Resource page at PassACLS.com.
Good luck with your ACLS class!
Links: Buy Me a Coffee at https://buymeacoffee.com/paultaylor
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A review of advanced airway use in ACLS’s Adult Cardiac Arrest algorithm including: advantages, types, insertion, and monitoring ETCO2.
When we should consider insertion of an advanced airway for patients in a shockable vs non-shockable rhythm.
In addition to an endotracheal tube (ETT), other ACLS advanced airways.
The advantages of using an advanced airway over basic airway maneuvers.
Use of end tidal CO2 waveform capnography to confirm placement and assess the adequacy of CPR.
Identification and management of a misplaced ET tube.
Good luck with your ACLS class!
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Indications & use of an antiarrhythmic infusion of Amiodarone or Lidocaine for cardiac arrest patients that have return of spontaneous circulation (ROSC).
Our primary focus immediately following return of spontaneous circulation (ROSC).
Post-arrest goals for O2 saturation, ETCO2, and BP/MAP.
Indications for use of an antiarrhythmic after ROSC.
Determining which antiarrhythmic to use post cardiac arrest.
Administration of Amiodarone or Lidocaine after ROSC.
The use of Amiodarone post arrest if no antiarrhythmics were administered prior to obtaining ROSC.
Links to other medical podcasts that cover antiarrhythmics and other ACLS-related topics are on the Pod Resource page at PassACLS.com.
Good luck with your ACLS class!
Links: Buy Me a Coffee at https://buymeacoffee.com/paultaylor
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Hydrogen ions is on one of the Hs in ACLS's H&T reversible causes of cardiac arrest. When considering hydrogen ions as a cause, what we’re looking at is the patient’s pH, or acid/base balance, and conditions that affect it.
The body's normal pH.
Using patient history, ABGs, & labs to determine acidosis or alkalosis.
Common conditions/causes that may lead us to suspect acidosis.
Common conditions/causes that may lead us to suspect alkalosis.
Correcting acidosis by changing the rate of ventilations.
The indications, dose, and considerations for use of Sodium Bicarbonate.
Treatment of alkalosis.
Other podcasts that cover acid/base balance and conditions that cause acidosis or alkalosis can be found on the Pod Resource Page at PassACLS.com.
Good luck with your ACLS class!
Links: Buy Me a Coffee at https://buymeacoffee.com/paultaylor
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BLS & ACLS's Adult Cardiac Arrest algorithm makes it easier to act as team leader during a code by following an If/Then methodology.
Review of BLS steps for determining if rescue breathing or CPR is needed and use of an AED for patients in cardiac arrest.
If the patient is in a non-shockable rhythm on the ECG such as PEA or asystole, we will go down the right side of the Adult Cardiac Arrest Algorithm.
If the patient is in a shockable rhythm on the ECG such as V-Fib or V-Tach, we will go down the left side of the Adult Cardiac Arrest Algorithm.
An example of a code's flow for shockable rhythms when an antiarrhythmic such as Amiodarone or Lidocaine is administered.
We will follow the algorithm until the patient has ROSC or we call the code.
Good luck with your ACLS class!
Links: Buy Me a Coffee at https://buymeacoffee.com/paultaylor
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Review of aspirin's mechanism of action, indications, contraindications, and administration for patients with acute coronary syndrome (ACS) or stroke.
Aspirin's mechanism of action & benefits for Acute Coronary Syndrome (ACS) patients.
Contraindications and considerations for aspirin’s use.
The dose and route of administration of aspirin for ACS patients.
The use of aspirin in the ACLS Stroke algorithm.
Good luck with your ACLS class!
Links: Buy Me a Coffee at https://buymeacoffee.com/paultaylor
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Review of lead II ECG characteristics, rules to identify first and third degree heart blocks, and treatment following the ACLS Bradycardia algorithm.
To pass ACLS, you will need to be able to identify common rhythms on a monitor during your mega code and ECG strips on your written exam.
Review of normal ECG morphology in lead II.
Characteristics of first-degree heart block.
Characteristics of third-degree (complete) AV block.
Treatment of unstable patients in third degree block following the ACLS Bradycardia algorithm.
Special considerations for use of Atropine when patients are in a third-degree heart block.
The use of TCP, Dopamine, & Epinephrine drip for unstable bradycardic patients refractory to Atropine.
Good luck with your ACLS class!
Links: Buy Me a Coffee at https://buymeacoffee.com/paultaylor
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Review of antiarrhythmic medications Amiodarone & Lidocaine for use in ACLS's Adult Cardiac Arrest, Post Arrest, and Tachycardia algorithms.
The two first-line ACLS antiarrhythmics that are generally used.
Lidocaine dosing and administration to patients in persistent V-Fib or pulseless V-Tach.
Amiodarone dosing and administration to patients in persistent V-Fib or pulseless V-Tach.
Use of antiarrhythmic infusions post-cardiac arrest to suppress ventricular ectopy.
Amiodarone use & dosing for stable patients in V-Tach with a pulse.
Good luck with your ACLS class!
Links: Buy Me a Coffee at https://buymeacoffee.com/paultaylor
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Review the indications, contraindications, sizing, and insertion of the nasopharyngeal airway (NPA) to maintain the airway of patients with a gag reflex.
The tongue is the most common airway obstruction in an unconscious patient.
When the nasopharyngeal airway (NPA) should be used as an alternative to the oropharyngeal airway (OPA).
Examples of when a NPA should be considered.
Contraindications and considerations for nasal airway insertion.
Measuring a nasal airway for appropriate length and diameter.
Insertion of a nasopharyngeal airway into the right vs left nostril.
Patients with a NPA in place can receive supplemental O2, be ventilated with a BVM, have ETCO2 monitored, and have their upper airway suctioned as needed.
Good luck with your ACLS class!
Links: Buy Me a Coffee at https://buymeacoffee.com/paultaylor
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The causes, physiology, signs & symptoms, and treatment of cardiac tamponade as an ACLS H&T reversible cause of cardiac arrest.
When blood, or other fluids, accumulate in the sac around the heart it’s called a cardiac tamponade or pericardial tamponade.
The effects of tamponade on the electrical system and chambers of the heart.
Cardiac tamponade can be acute or chronic and caused by traumatic, iatrogenic, or pathological etiologies.
Common traumatic events, medical procedures, and diseases that can result in a pericardial tamponade.
Signs & symptoms of cardiac tamponade.
Treatment of cardiac tamponade with pericardiocentesis.
For additional information on cardiac tamponade, check out the Pod Resources page at PassACLS.com.
Good luck with your ACLS class!
Links: Buy Me a Coffee at https://buymeacoffee.com/paultaylor
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The role of team leader, code team responsibilities, and the use of reference cards during your ACLS class megacode and written exam.
Two things have changed in recent years to aid students that don't use ACLS in their daily practice.
The team leader’s roles and responsibilities.
Using closed-loop communication and speaking up if there’s any doubt about an order or action.
Use of your course’s approved text book and quick reference cards during the megacode and written exam.
Tips to help you pass the ACLS written exam.
Good luck with your ACLS class!
Links: Buy Me a Coffee at https://buymeacoffee.com/paultaylor
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Early CPR and defibrillation improve cardiac arrest outcomes. Here's why CPR is important and five ACLS tips to reduce CPR interruptions.
Two factors to cardiac arrest survivability that have been clearly shown to make the most difference.
The most common dysrhythmia present during the first few minutes of cardiac arrest.
How our chance of successfully defibrillating a patient into a perfusing rhythm significantly changes when good CPR is delivered vs when it isn't.
Why bystander CPR is important for out-of-hospital cardiac arrest (OHCA) outcomes.
The role of the CPR coach.
Five tips to aid us in limiting CPR interruptions to less than 10 seconds so we can maintain a chest compression fraction (CCF) of at least 80%.
Good luck with your ACLS class!
Links: Buy Me a Coffee at https://buymeacoffee.com/paultaylor
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The use of quantitative waveform capnography in ACLS to confirm good CPR and placement of an ET tube, identify ROSC, and during post-cardiac arrest care.
Waveform capnography use with, and without, an advanced airway in place.
Monitoring end tidal CO2 during rescue breathing.
Use of capnography to objectively measure good CPR.
Capnography is a preferred method of confirming endotracheal tube (ETT) placement over x-ray during a code.
Identifying ROSC during CPR.
Quantitative waveform capnography use in the post-cardiac arrest algorithm.
Good luck with your ACLS class!
Links: Buy Me a Coffee at https://buymeacoffee.com/paultaylor
Free Prescription Discount Card - Get your free drug discount card to save money on prescription medications for you and your pets: https://safemeds.vip/save
Pass ACLS Web Site - Other ACLS-related resources: https://passacls.com
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Review of vagal maneuvers and alternative treatments used in ACLS for stable patients with tachycardia at a rate over 150 bpm.
Narrow complex tachycardia with a rate over 150 BPM.
Unstable patients in SVT, or V-Tach with a pulse, should be cardioverted with a synchronized shock.
Assessment & treatment of stable tachycardic patients.
Commonly used vagal techniques.
A less common technique to stimulate the vagus nerve.
Indications and use of Adenosine.
Possible treatments for patients found to be in A-Fib or A-Flutter with RVR after administration of Adenosine.
Carotid sinus massage.
Additional medical podcasts that have episodes on tachycardia can be found on the pod resources page at passacls.com.
**American Cancer Society (ACS) Fundraiser
This is the seventh year that I'm participating in Men Wear Pink to increase breast cancer awareness and raise money for the American Cancer Society's life-saving mission.
I hope you'll consider contributing.
Every donation makes a difference in the fight against breast cancer!
Paul Taylor's ACS Fundraiser Page: http://main.acsevents.org/goto/paultaylor
THANK YOU for your support!
Good luck with your ACLS class!
Links: Buy Me a Coffee at https://buymeacoffee.com/paultaylor
Free Prescription Discount Card - Get your free drug discount card to save money on prescription medications for you and your pets: https://safemeds.vip/save
Pass ACLS Web Site - Other ACLS-related resources: https://passacls.com
@Pass-ACLS-Podcast on LinkedIn
Review the energy settings needed for defibrillation and/or synchronized cardioversion using an AED, biphasic, or monophasic defibrillator.
Defibrillators three basic categories.
Use of an AED to rapidly deliver a shock.
Advantages & use of biphasic defibrillators.
Energy for monophasic defibrillators to defibrillate V-Fib or pulseless V-Tach.
AED safety.
Cardioversion of patients in unstable SVT or V-Tach with a pulse using biphasic vs monophasic monitor/defibrillators.
Team safety when performing synchronized cardioversion.
Energy needed to cardiovert unstable patients with a narrow vs wide complex tachycardia.
**American Cancer Society (ACS) Fundraiser
This is the seventh year that I'm participating in Men Wear Pink to increase breast cancer awareness and raise money for the American Cancer Society's life-saving mission.
I hope you'll consider contributing.
Every donation makes a difference in the fight against breast cancer!
Paul Taylor's ACS Fundraiser Page: http://main.acsevents.org/goto/paultaylor
THANK YOU for your support!
Good luck with your ACLS class!
Links: Buy Me a Coffee at https://buymeacoffee.com/paultaylor
Free Prescription Discount Card - Get your free drug discount card to save money on prescription medications for you and your pets: https://safemeds.vip/save
Pass ACLS Web Site - Other ACLS-related resources: https://passacls.com
@Pass-ACLS-Podcast on LinkedIn
Bradycardia review including: stable vs unstable patients; assessment & monitoring; and ACLS treatment with Atropine, TCP, Dopamine, & Epinephrine drips.
Signs & symptoms that indicate a bradycardic patient is unstable.
Monitoring oxygen saturation with pulse oximetry and indications for administration of oxygen.
Calcium channel blockers and beta blocker medication as treatable causes of bradycardia.
The indications and dosage of Atropine.
Precautions for Atropine use in patients with second or third degree AV blocks.
The use of transcutaneous pacing (TCP) for unstable bradycardic patients refractory to Atropine.
The use and dosing of Dopamine and Epinephrine drips.
For additional information about causes and treatment of bradycardia, check out the pod resources page at PassACLS.com.
**American Cancer Society (ACS) Fundraiser
This is the seventh year that I'm participating in Men Wear Pink to increase breast cancer awareness and raise money for the American Cancer Society's life-saving mission.
I hope you'll consider contributing.
Every donation makes a difference in the fight against breast cancer!
Paul Taylor's ACS Fundraiser Page: http://main.acsevents.org/goto/paultaylor
THANK YOU for your support!
Good luck with your ACLS class!
Links: Buy Me a Coffee at https://buymeacoffee.com/paultaylor
Free Prescription Discount Card - Get your free drug discount card to save money on prescription medications for you and your pets: https://safemeds.vip/save
Pass ACLS Web Site - Other ACLS-related resources: https://passacls.com
@Pass-ACLS-Podcast on LinkedIn
Review the ACLS treatment goals and targeted temperature management (TTM) for post-arrest patients that have return of spontaneous circulation (ROSC).
The goal of CPR.
Post-arrest care and recovery are the final two links in the chain of survival.
Identification of ROSC during CPR.
Initial patient management goals after identifying ROSC.
The patient’s GCS/LOC should be evaluated to determine if targeted temperature management (TTM) is indicated.
Recently published studies on TTM and ACLS’s current standard.
Monitoring the patient’s core temperature during TTM.
Patients can undergo EEG, CT, MRI, & PCI while receiving TTM.
**American Cancer Society (ACS) Fundraiser
This is the seventh year that I'm participating in Men Wear Pink to increase breast cancer awareness and raise money for the American Cancer Society's life-saving mission.
I hope you'll consider contributing.
Every donation makes a difference in the fight against breast cancer!
Paul Taylor's ACS Fundraiser Page: http://main.acsevents.org/goto/paultaylor
THANK YOU for your support!
Good luck with your ACLS class!
Links: Buy Me a Coffee at https://buymeacoffee.com/paultaylor
Free Prescription Discount Card - Get your free drug discount card to save money on prescription medications for you and your pets: https://safemeds.vip/save
Pass ACLS Web Site - Other ACLS-related resources: https://passacls.com
@Pass-ACLS-Podcast on LinkedIn
Review the chain of survival for cardiac and stroke emergencies and describe why strong EMS relations and specialized teams have better patient outcomes.
The chain of survival for ACLS is the same as was learned in your BLS class.
The beginning steps of the Cardiac Emergency and Stroke chain of survival.
ACLS's timed goals for first medical contact to PCI for STEMI and door-to-needle for ischemic stroke.
Characteristics of areas that have significantly better stroke and out-of-hospital cardiac arrest outcomes.
**American Cancer Society (ACS) Fundraiser
This is the seventh year that I'm participating in Men Wear Pink to increase breast cancer awareness and raise money for the American Cancer Society's life-saving mission.
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THANK YOU for your support!
Good luck with your ACLS class!
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Review of hypokalemia & hyperkalemia as reversible H&T causes of cardiac arrest including: medical conditions, ECG changes, lab values, and treatment.
Heart muscle contraction and repolarization is dependent on Sodium, Calcium, Magnesium, and Potassium ions crossing cellular membranes.
When a patient’s potassium levels get too low or too high, hypokalemia or hyperkalemia results respectively.
Two things that may lead us to suspect hypo or hyperkalemia.
Medical conditions & medications that can cause potassium imbalance.
ECG changes seen in hypo and hyperkalemia.
Critical lab values that would indicate a need for treatment.
Emergent, ACLS interventions for hypokalemia and hyperkalemia.
Additional information on causes of hypo and hyperkalemia can be found on Ninja Nerd podcast. Check out the pod resources page at passacls.com.
**American Cancer Society (ACS) Fundraiser
This is the seventh year that I'm participating in Men Wear Pink to increase breast cancer awareness and raise money for the American Cancer Society's life-saving mission.
I hope you'll consider contributing.
Every donation makes a difference in the fight against breast cancer!
Paul Taylor's ACS Fundraiser Page: http://main.acsevents.org/goto/paultaylor
THANK YOU for your support!
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Links: Buy Me a Coffee at https://buymeacoffee.com/paultaylor
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Improved stroke outcomes have been shown when EMS transports to a stroke center and patients receive assessment, CT, & thrombolytics within these time frames.
When treating patients having an MI or stroke, more minutes equals more dead cells.
Because the majority of strokes are the ischemic type, the treatment for stroke is similar to an MI – to reestablish perfusion to the ischemic tissues.
The first four steps in the Stroke Chain of Survival.
Time criteria for the administration of tPA (or a similar fibrinolytic medication) or EVT of LVO strokes.
Stroke benchmarks for door to:
- assessment;
- completing a non-contrast CT; and
- administration of fibrinolytic medication such as tPA (door-to-needle).
EMS interaction with stroke teams and destination protocols to reduce time to definitive care.
The difference for timed goals for the identification & treatment of AMI vs Stroke.
Additional information about timed goals for stroke and how EMS affects outcomes, can be found on the PassACLS.com pod resources page.
**American Cancer Society (ACS) Fundraiser
This is the seventh year that I'm participating in Men Wear Pink to increase breast cancer awareness and raise money for the American Cancer Society's life-saving mission.
I hope you'll consider contributing.
Every donation makes a difference in the fight against breast cancer!
Paul Taylor's ACS Fundraiser Page: http://main.acsevents.org/goto/paultaylor
THANK YOU for your support!
Good luck with your ACLS class!
Links: Buy Me a Coffee at https://buymeacoffee.com/paultaylor
Free Prescription Discount Card - Get your free drug discount card to save money on prescription medications for you and your pets: https://safemeds.vip/save
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Review the indications, dosing, & administration of Adenosine for patients in supraventricular tachycardia (SVT) following ACLS's Tachycardia algorithm.
Adenosine is the first IV medication given to stable patients with sustained supraventricular tachycardia (SVT) refractory to vagal maneuvers.
Symptoms indicating a stable vs unstable patient.
Common causes of tachycardia.
Cardiac effects of Adenosine.
Indications for use in the ACLS Tachycardia algorithm.
Considerations and contraindications.
Adenosine as a diagnostic for patients in A-Fib or A-Flutter with RVR.
Dosing and administration.
Other podcasts that cover common ACLS antiarrhythmics in more detail and another covering Brugata Criteria used to differentiate V-Tach from SVT with an aberrancy, can be found on the Pod Resources page at passacls.com.
**American Cancer Society (ACS) Fundraiser
This is the seventh year that I'm participating in Men Wear Pink to increase breast cancer awareness and raise money for the American Cancer Society's life-saving mission.
I hope you'll consider contributing.
Every donation makes a difference in the fight against breast cancer!
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One method of interpreting ECGs to identify the characteristics of second-degree AV blocks and the treatment of unstable bradycardia patients with them.
To pass the written ACLS exam and mega code, students need to be able to identify basic ECG dysrhythmias, including the two types of second-degree heart block.
One method of ECG rhythm identification.
ECG characteristics of a second-degree Mobitz type I (Wenckebach).
Identification of unstable bradycardia and its treatment with Atropine.
ECG characteristics of a second-degree Mobitz type II.
Possible effect of using Atropine on patients with a second-degree type II AV block.
Treatment of unstable bradycardic patients refractory to Atropine using TCP, Dopamine, or Epinephrine drip.
Starting dose and titration of Dopamine and Epinephrine drips.
**American Cancer Society (ACS) Fundraiser
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The Curious Clinicians: History of Doctor Wenckebach & Mobitz
https://curiousclinicians.com/2022/07/06/episode-52-way-back-wenckebach/
Practice ECGs with rationale at Dialed Medics:
https://dialedmedics.com/
Review the indications for oxygen administration and monitoring O2 saturation with pulse oximetry for patients in various ACLS algorithms.
The O in MONA is Oxygen.
When we should administer oxygen to ACS patients.
When O2 administration is unnecessary based on an accurate pulse ox.
Monitoring patient's oxygen saturation (SaO2) using a pulse oximeter.
Review two common ACLS pre-arrest mega code scenarios.
Oxygen administration during CPR and post cardiac arrest.
You can find additional medical podcasts that cover ACLS-related topics, on the Pod Resources page at PassACLS.com
**American Cancer Society (ACS) Fundraiser
This is the seventh year that I'm participating in Men Wear Pink to increase breast cancer awareness and raise money for the American Cancer Society's life-saving mission.
I hope you'll consider contributing.
Every donation makes a difference in the fight against breast cancer!
Paul Taylor's ACS Fundraiser Page: http://main.acsevents.org/goto/paultaylor
THANK YOU for your support!
Good luck with your ACLS class!
Links: Buy Me a Coffee at https://buymeacoffee.com/paultaylor
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@Pass-ACLS-Podcast on LinkedIn
Check out ConveyMed.io for more free online medical education (FOAMed) opportunities.
Objective measures of high-quality CPR and how ACLS providers use waveform capnography and feedback devices to monitor effective chest compressions.
Along with early defibrillation, high quality CPR with minimal interruptions is one of the two factors that has been shown to improve cardiac arrest outcomes.
Objective measures of high-quality CPR.
The role of the CPR Coach on the code team.
The advantages and use of real-time feedback devices to monitor the rate, depth, and chest recoil of CPR compressions.
The use of end tidal waveform capnography. (ETCO2)
A no-tech way to monitor effective CPR if no compression feedback device or ETCO2 capnography isn’t available.
**American Cancer Society (ACS) Fundraiser
This is the seventh year that I'm participating in Men Wear Pink to increase breast cancer awareness and raise money for the American Cancer Society's life-saving mission.
I hope you'll consider contributing.
Every donation makes a difference in the fight against breast cancer!
Paul Taylor's ACS Fundraiser Page: http://main.acsevents.org/goto/paultaylor
THANK YOU for your support!
Good luck with your ACLS class!
Links: Buy Me a Coffee at https://buymeacoffee.com/paultaylor
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Review the 2020 ACLS Atropine and Dopamine guidelines for the treatment of unstable bradycardia, including: dosing, administration, and precautions.
When we should use the bradycardia algorithm.
The signs & symptoms of unstable bradycardia.
Atropine's bradycardic dose and maximum.
The use of atropine when a patient is in a second degree type II or third degree heart block.
ECG changes that indicate subsequent doses of atropine are likely to be ineffective.
The starting dose of Dopamine.
The use of Dopamine for bradycardia as an interim until TCP vs hypotension.
The use of Atropine and Dopamine in patients with myocardial ischemia.
Podcasts with additional (advanced-provider level) information about bradycardia, Atropine, & Dopamine can be found on the Pass ACLS Pod Resources page.
**American Cancer Society (ACS) Fundraiser
This is the seventh year that I'm participating in Men Wear Pink to increase breast cancer awareness and raise money for the American Cancer Society's life-saving mission.
I hope you'll consider contributing.
Every donation makes a difference in the fight against breast cancer!
Paul Taylor's ACS Fundraiser Page: http://main.acsevents.org/goto/paultaylor
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Links: Buy Me a Coffee at https://buymeacoffee.com/paultaylor
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Review the appropriate & safe use of an oropharyngeal airway (OPA) to keep an unresponsive patient's tongue from blocking their airway.
The tongue is the most common airway obstruction in an unconscious patient.
The oropharyngeal airway is sometimes called an OPA or simply an oral airway.
Indications for using an oral airway.
Contraindication for an oral airway and an alternative airway that can be used for patients with an intact gag reflex.
Measuring an OPA and possible complications from inserting one that is too small or too large.
Two techniques to properly insert an OPA.
The use of an oral airway during CPR.
The use of an OPA as a bite block after a patient has an advanced airway placed.
**American Cancer Society (ACS) Fundraiser
This is the seventh year that I'm participating in Men Wear Pink to increase breast cancer awareness and raise money for the American Cancer Society's life-saving mission.
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Every donation makes a difference in the fight against breast cancer!
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Tips for ACLS providers to consider when evaluating hypoxia as a possible cause of cardiac arrest and what we can do to correct it.
Determining hypoxia using a pulse oximeter or arterial blood gasses (ABGs).
A goal of ACLS is to recognize signs of hypoxia and provide timely treatment to prevent an arrest.
Examples of some things that might lead us to think of hypoxia as a cause of cardiac arrest.
Why pulse ox doesn’t give accurate readings during CPR.
Delivering ventilations with near 100% oxygen concentration using a BVM attached to supplemental O2 and a reservoir.
Using end tidal waveform capnography to assess the quality of CPR.
Changes to ventilation rates, tidal volume, and O2 concentration affects a patient's oxygen, carbon dioxide, and pH.
The danger of excessive ventilation of a patient in cardiac arrest.
**American Cancer Society (ACS) Fundraiser
This is the seventh year that I'm participating in Men Wear Pink to increase breast cancer awareness and raise money for the American Cancer Society's life-saving mission.
I hope you'll consider contributing.
Every donation makes a difference in the fight against breast cancer!
Paul Taylor's ACS Fundraiser Page: http://main.acsevents.org/goto/paultaylor
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Links: Buy Me a Coffee at https://buymeacoffee.com/paultaylor
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Review the ECG characteristics of SVT & sinus tachycardia and the treatment of unstable vs stable patients with cardioversion & medications.
Signs & symptoms that indicate a patient is unstable.
Delivery of a synchronized shock for the treatment of unstable SVT using a biphasic vs monophasic defibrillator.
Consideration for team safety while performing synchronized cardioversion.
Actions to take immediately if an unstable patient we’ve cardioverted goes into a pulseless rhythm.
Management of stable patients in SVT.
For more free information on narrow complex tachycardias, check out the pod resource page at passacls.com.
**American Cancer Society (ACS) Fundraiser
This is the seventh year that I'm participating in Men Wear Pink to increase breast cancer awareness and raise money for the American Cancer Society's life-saving mission.
I hope you'll consider contributing.
Every donation makes a difference in the fight against breast cancer!
Paul Taylor's ACS Fundraiser Page: http://main.acsevents.org/goto/paultaylor
THANK YOU for your support!
Good luck with your ACLS class!
Links: Buy Me a Coffee at https://buymeacoffee.com/paultaylor
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When to give the first dose of epinephrine, its route, repeat frequency, & maximum dose following ACLS's Adult Cardiac Arrest algorithm.
Epinephrine is the first IV medication we administer to patients in cardiac arrest.
When we give the first dose of epinephrine depends on whether the patient is in a shockable or non-shockable rhythm.
When to give the first dose of epinephrine and its frequency for patients in asystole or PEA following the right side of the Adult Cardiac Arrest algorithm.
When to give the first dose of epi and its frequency for patients in V-Fib or pulseless V-Tach following the left side of the Adult Cardiac Arrest algorithm.
Example chronology of events for a scenario where a patient is found unresponsive with only gasping/agonal breathing.
Administration of epi via the IO or endotracheal route in the absence of an IV.
The maximum cumulative dose of epinephrine that can be administered to patients in cardiac arrest.
When do we stop administering epinephrine.
**American Cancer Society (ACS) Fundraiser
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Every donation makes a difference in the fight against breast cancer!
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Links: Buy Me a Coffee at https://buymeacoffee.com/paultaylor
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The pros and cons of ACLS medication administration via intraosseous (IO) or endotracheal tube (ETT) route when IV access isn't available.
IO vs ETT as an alternative route.
The locations we should place an IO when running a code.
The ACLS medications that can be given intraosseous.
Where you can find more information about intraosseous access during resuscitation efforts.
In the absence of an IV or IO, some medications may be given down the endotracheal tube.
The disadvantages of medication administration via ETT.
Review of the medications that can be given down the tube and how they should be given.
**American Cancer Society (ACS) Fundraiser
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Every donation makes a difference in the fight against breast cancer!
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Prehospital EMS capabilities and why paramedic-staffed ALS ambulances make a difference in the early identification & treatment of STEMI and stroke.
The chain of survival for a cardiac emergency and stroke.
ALS ambulances are staffed with paramedics who have training in ACLS skills.
Why EMS Destination Protocols for suspected stroke and STEMI make a difference.
ACLS’s timed benchmarks for:
- point of first medical contact to PCI for ST elevation MI;
- door to tPA for ischemic stroke; and
- onset of symptoms to EVT for LVO strokes.
Why EMS should bypass a close hospital to transport a STEMI or suspected stroke patient to a hospital capable of 24/7 PCI or a certified stroke center.
Check out the Pod Resource page at passacls.com for links to the "EMS On Air" podcast for links to episodes that look at EMS's role in stroke outcomes in the rural vs urban area.
**American Cancer Society (ACS) Fundraiser
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Every donation makes a difference in the fight against breast cancer!
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The use of an AED to improve cardiac arrest outcomes including: attaching the pads during CPR; following prompts; and safely administering a shock.
Why we should use an AED.
The general use of AED.
including: indications for use; attaching the AED pads; following verbal prompts; and safely administering a shock.
Following the Adult Cardiac Arrest algorithm while using an AED.
Contraindications to AED use.
General safety considerations to remember.
**American Cancer Society (ACS) Fundraiser
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Review the Asystole/PEA side of the Cardiac Arrest algorithm including: epinephrine administration, advanced airways, causes of PEA, and when to stop.
For apneic patients without a carotid pulse or patients with only gasping/agonal respirations, we will follow the Adult Cardiac Arrest algorithm.
For pulseless patients that the AED doesn't advise a shock, the patient's ECG shows asystole, or a non-perfusing organized rhythm (PEA), we will follow the right side of the Adult Cardiac Arrest algorithm.
Initial steps are aimed at delivery of high-quality CPR to keep the brain and vital organs alive.
Epinephrine administration.
Placement of an advanced airway.
Considering possible reversible H & T causes of cardiac arrest including three common causes of PEA and their emergent interventions.
When we should discontinue resuscitation efforts and call the code.
**American Cancer Society (ACS) Fundraiser
This is the seventh year that I'm participating in Men Wear Pink to increase breast cancer awareness and raise money for the American Cancer Society's life-saving mission.
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Every donation makes a difference in the fight against breast cancer!
Paul Taylor's ACS Fundraiser Page: http://main.acsevents.org/goto/paultaylor
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Good luck with your ACLS class!
Links: Buy Me a Coffee at https://buymeacoffee.com/paultaylor
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Many CPR classes use songs like "Stayin Alive" to help compressors maintain a fast rate.
Advantages, disadvantages, and a selection of good CPR songs.
Providing good, high-quality CPR with minimal interruptions and early defibrillation are two key interventions shown to improved cardiac arrest outcomes.
A training tool used in many CPR and ACLS classes is to use a song (or a song list) to help the person doing chest compressions maintain an adequate rate.
Characteristics of songs that will help us perform good CPR.
Advantages & disadvantages of using a song during CPR.
Selected songs from various genres and time periods from AHA's "Don’t Drop The Beat" playlist on Spotify.
**American Cancer Society (ACS) Fundraiser
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Good luck with your ACLS class!
Links: Buy Me a Coffee at https://buymeacoffee.com/paultaylor
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AHA's CPR Songs on Spotify: https://open.spotify.com/playlist/2mU2FNAhSOtQwW0hBgQMaK
Obtaining a medical history guides clinical decisions so we can provide the safest evidence-based care possible. The SAMPLE-PQRST format is explained.
A patient’s medical history will help us identify things that may be causing (or contributing) to their current condition as well as guide our decisions so we provide the safest evidence-based care possible.
Examples of information obtained in a medical history that will impact the treatment we provide.
There are several mnemonics and memory aids that people use to guide their history taking.
Review the SAMPLE-PQRST medical history mnemonic.
**American Cancer Society (ACS) Fundraiser
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The indications and administration of ACLS antiarrhythmics magnesium & Procainamide for treating Torsades de Pointes and stable tachycardias.
Identification of Torsades on the ECG.
Administration of a magnesium infusion for stable patients vs slow IV push for patients in cardiac arrest.
Procainamide use for stable patients with a monomorphic wide-complex tachycardia.
Procainamide dosing and when to stop the infusion.
Tip for determining whether magnesium or Procainamide should be used when treating stable patients with V-Tach.
**American Cancer Society (ACS) Fundraiser
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Paul Taylor's ACS Fundraiser Page: http://main.acsevents.org/goto/paultaylor
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Good luck with your ACLS class!
Links: Buy Me a Coffee at https://buymeacoffee.com/paultaylor
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Review of hypovolemia as a reversible H&T cause of cardiac arrest including: causes, signs & symptoms, and treatment with crystalloid solutions or blood.
When a patient loses excessive amounts of fluids, we say that they are in a state of hypovolemia.
The most obvious cause of hypovolemia is from bleeding.
Bleeding can be internal or external and caused by trauma, pathology, or iatrogenic.
Classic signs & symptoms of hypovolemic shock.
Volume replacement with crystalloids vs blood.
**American Cancer Society (ACS) Fundraiser
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The mechanism of action and safe administration of Morphine for patients with myocardial ischemia in ACLS’s Acute Coronary Syndrome (ACS) algorithm.
MONA is the acronym sometimes used to help us remember the interventions to consider for patients with Acute Coronary Syndrome.
Morphine's use in the Acute Coronary Syndrome (ACS) algorithm.
Why Morphine is helpful for patients with ACS.
Contraindications and considerations for the safe administration of Morphine.
Common dosing & administration of Morphine.
Monitoring of the patient's level of consciousness, pain, blood pressure, and respirations after administration.
Possible side effects of Morphine administration.
Narcan as an antidote to Morphine if needed.
**American Cancer Society (ACS) Fundraiser
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Links: Buy Me a Coffee at https://buymeacoffee.com/paultaylor
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Teamwork and communication tips to help ACLS providers limit interruptions to CPR chest compressions to less than 10 seconds to maintain a CCF of 80%.
Even good CPR is far less efficient at circulating blood than a functioning heart.
The indicators of high-quality CPR that were identified at the 2012 AHA CPR Quality Summit.
Using real-time feedback devices and ETCO2 to assess CPR quality.
Three tips to limit pauses in CPR compressions to 10 seconds or less.
**American Cancer Society (ACS) Fundraiser
This is the seventh year that I'm participating in Men Wear Pink to increase breast cancer awareness and raise money for the American Cancer Society's life-saving mission.
I hope you'll consider contributing.
Every donation makes a difference in the fight against breast cancer!
Paul Taylor's ACS Fundraiser Page: http://main.acsevents.org/goto/paultaylor
THANK YOU for your support!
Good luck with your ACLS class!
Links: Buy Me a Coffee at https://buymeacoffee.com/paultaylor
Free Prescription Discount Card - Get your free drug discount card to save money on prescription medications for you and your pets: https://safemeds.vip/save
Pass ACLS Web Site - Other ACLS-related resources: https://passacls.com
@Pass-ACLS-Podcast on LinkedIn
A brief review of two commonly used ACLS medications: epinephrine & Dopamine. Their indications, doses, and considerations for safety is discussed.
Epinephrine and Dopamine are adrenergic agonist used in several ACLS algorithms.
The use of epinephrine for severe anaphylaxis and unstable bradycardia.
Review epinephrine’s effects on blood vessels and bronchioles.
Why epinephrine is helpful for patients with anaphylaxis.
Using an epi drip for unstable bradycardia.
Epinephrine administration during cardiac arrest.
Starting an epinephrine or Dopamine drip for patients that have ROSC.
Review the effects of Dopamine based on mcg/kg/min dosing.
Monitoring the patient and titrating epi or Dopamine drips to prevent harm.
For more information on ACLS medications, check out the pod resource page at passacls.com.
**American Cancer Society (ACS) Fundraiser
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I hope you'll consider contributing.
Every donation makes a difference in the fight against breast cancer!
Paul Taylor's ACS Fundraiser Page: http://main.acsevents.org/goto/paultaylor
THANK YOU for your support!
Good luck with your ACLS class!
Links: Buy Me a Coffee at https://buymeacoffee.com/paultaylor
Free Prescription Discount Card - Get your free drug discount card to save money on prescription medications for you and your pets: https://safemeds.vip/save
Pass ACLS Web Site - Other ACLS-related resources: https://passacls.com
@Pass-ACLS-Podcast on LinkedIn
Review of: rescue breathing; advantages of waveform capnography; and delivering artificial ventilations during CPR with and without an advanced airway.
Providing rescue breathing to apneic patients with a palpable pulse.
Normal end tidal CO2 for patients with a pulse.
Identification of cardiac arrest and our immediate actions.
Providing artificial ventilations during CPR without an advanced airway vs with an advanced airway in place.
Using quantitative waveform capnography to confirm placement of an advanced airway, assess the quality of CPR, and identify ROSC.
The effects of hyperventilating patients in cardiac arrest.
**American Cancer Society (ACS) Fundraiser
This is the seventh year that I'm participating in Men Wear Pink to increase breast cancer awareness and raise money for the American Cancer Society's life-saving mission.
I hope you'll consider contributing.
Every donation makes a difference in the fight against breast cancer!
Paul Taylor's ACS Fundraiser Page: http://main.acsevents.org/goto/paultaylor
THANK YOU for your support!
Good luck with your ACLS class!
Links: Buy Me a Coffee at https://buymeacoffee.com/paultaylor
Free Prescription Discount Card - Get your free drug discount card to save money on prescription medications for you and your pets: https://safemeds.vip/save
Pass ACLS Web Site - Other ACLS-related resources: https://passacls.com
@Pass-ACLS-Podcast on LinkedIn
Hypothermic patients aren't dead until they are warm and dead.
When a patient’s core body temperature drops below 96.8° F (36° C), they are hypothermic.
As the body’s temperature drops below 36° C, hypothermia may further be classified as moderate or severe.
Modifying the ACLS Adult Cardiac Arrest algorithm for patients with severe hypothermia.
Following the ACLS algorithm for patients with a body core temperature above 30° C.
Methods for rewarming patients with moderate vs severe hypothermia.
Continuation of CPR and ACLS efforts until the patient’s body core temp is above 36° C.
**American Cancer Society (ACS) Fundraiser
This is the seventh year that I'm participating in Men Wear Pink to increase breast cancer awareness and raise money for the American Cancer Society's life-saving mission.
I hope you'll consider contributing.
Every donation makes a difference in the fight against breast cancer!
Paul Taylor's ACS Fundraiser Page: http://main.acsevents.org/goto/paultaylor
THANK YOU for your support!
Good luck with your ACLS class!
Links: Buy Me a Coffee at https://buymeacoffee.com/paultaylor
Free Prescription Discount Card - Get your free drug discount card to save money on prescription medications for you and your pets: https://safemeds.vip/save
Pass ACLS Web Site - Other ACLS-related resources: https://passacls.com
@Pass-ACLS-Podcast on LinkedIn
The use of calcium channel blocker medications for tachycardias refractory to Adenosine and to lower the blood pressure of hypertensive stroke patients.
Calcium is one of the ions that move across the cellular membrane during cardiac contraction and relaxation.
The primary use of calcium channel blockers in ACLS.
Use of calcium channel blockers for SVT refractory to Adenosine and A-Fib or A-Flutter with RVR.
Contraindications of calcium channel blockers.
Nicardipine use during the treatment of ischemic strokes.
For more information on ACLS medications, tachycardia, or stroke check out the pod resource page at passacls.com.
**American Cancer Society (ACS) Fundraiser
This is the seventh year that I'm participating in Men Wear Pink to increase breast cancer awareness and raise money for the American Cancer Society's life-saving mission.
I hope you'll consider contributing.
Every donation makes a difference in the fight against breast cancer!
Paul Taylor's ACS Fundraiser Page: http://main.acsevents.org/goto/paultaylor
THANK YOU for your support!
Good luck with your ACLS class!
Links: Buy Me a Coffee at https://buymeacoffee.com/paultaylor
Free Prescription Discount Card - Get your free drug discount card to save money on prescription medications for you and your pets: https://safemeds.vip/save
Pass ACLS Web Site - Other ACLS-related resources: https://passacls.com
@Pass-ACLS-Podcast on LinkedIn
Review the ACLS treatment goals and targeted temperature management (TTM) for post-arrest patients that have return of spontaneous circulation (ROSC).
Post-arrest care and recovery are the final two links in the chain of survival.
Identification of ROSC during CPR.
Initial patient management goals after identifying ROSC.
Indications for starting TTM.
Monitoring the patient’s core temperature.
**American Cancer Society (ACS) Fundraiser
This is the seventh year that I'm participating in Men Wear Pink to increase breast cancer awareness and raise money for the American Cancer Society's life-saving mission.
I hope you'll consider contributing.
Every donation makes a difference in the fight against breast cancer!
Paul Taylor's ACS Fundraiser Page: http://main.acsevents.org/goto/paultaylor
THANK YOU for your support!
Good luck with your ACLS class!
Links: Buy Me a Coffee at https://buymeacoffee.com/paultaylor
Free Prescription Discount Card - Get your free drug discount card to save money on prescription medications for you and your pets: https://safemeds.vip/save
Pass ACLS Web Site - Other ACLS-related resources: https://passacls.com
@Pass-ACLS-Podcast on LinkedIn
Review the indications, contraindications, and safe administration of nitroglycerine to Acute Coronary Syndrome (ACS) patients with ischemic chest pain.
Nitroglycerine is vasodilator that affects peripheral blood vessels and coronary arteries.
Assessment of vital signs prior to administering nitro.
Indications for use of nitroglycerine.
Nitroglycerine's contraindications & considerations for use.
Effects of nitro on patients taking PDE inhibitors.
Administration of nitroglycerine to patients with ischemic chest pain.
Considerations for patients that took their home nitroglycerine.
Monitoring patient's pain and vital signs after nitro administration.
**American Cancer Society (ACS) Fundraiser
This is the seventh year that I'm participating in Men Wear Pink to increase breast cancer awareness and raise money for the American Cancer Society's life-saving mission.
I hope you'll consider contributing.
Every donation makes a difference in the fight against breast cancer!
Paul Taylor's ACS Fundraiser Page: http://main.acsevents.org/goto/paultaylor
THANK YOU for your support!
Good luck with your ACLS class!
Links: Buy Me a Coffee at https://buymeacoffee.com/paultaylor
Free Prescription Discount Card - Get your free drug discount card to save money on prescription medications for you and your pets: https://safemeds.vip/save
Pass ACLS Web Site - Other ACLS-related resources: https://passacls.com
@Pass-ACLS-Podcast on LinkedIn
Identification of Atrial Fibrillation (A-Fib) & Atrial Flutter on the ECG and the treatment of unstable and stable SVT patients with A-Fib/Flutter.
The ECG characteristics of A-Fib and A-Flutter.
Recognition and treatment of unstable patients in A-Fib/Flutter with rapid ventricular response (RVR).
Suggested energy settings for synchronized cardioversion of unstable patients with a narrow complex tachycardia.
Team safety when cardioverting an unstable patient in A-FIB/Flutter.
Adenosine’s role for stable SVT patients with underlying atrial rhythms.
Treatment of stable patients in A-Fib/Flutter with RVR.
For other medical podcasts that cover narrow complex tachycardias, visit the pod resource page at passacls.com.
**American Cancer Society (ACS) Fundraiser
This is the seventh year that I'm participating in Men Wear Pink to increase breast cancer awareness and raise money for the American Cancer Society's life-saving mission.
I hope you'll consider contributing.
Every donation makes a difference in the fight against breast cancer!
Paul Taylor's ACS Fundraiser Page: http://main.acsevents.org/goto/paultaylor
THANK YOU for your support!
Good luck with your ACLS class!
Links: Buy Me a Coffee at https://buymeacoffee.com/paultaylor
Free Prescription Discount Card - Get your free drug discount card to save money on prescription medications for you and your pets: https://safemeds.vip/save
Pass ACLS Web Site - Other ACLS-related resources: https://passacls.com
@Pass-ACLS-Podcast on LinkedIn
Review of Tablets & Toxins as an ACLS H &T reversible causes of cardiac arrest with some specific, commonly encountered examples.
As an ACLS provider you do not need to be familiar with all of the different signs of various types of poisoning. You should be able to obtain a history and know to order toxicology.
The majority of toxins don’t have a specific antidote. There are a few toxins for which we have emergency interventions and ACLS providers should be familiar with.
Reviewing the patient's medical history for indicators that may lead us to suspect a tablet/toxin cause of cardiac arrest.
Administration of Narcan for suspected narcotics overdose following the Opioid Associated Emergency algorithm.
Other common ACLS Tablet Toxin scenarios with possible treatments.
Medications commonly used to treat specific toxins that are regularly stocked on crash carts or carried in EMS med bags.
ACLS providers that suspect a specific toxin should consult with their Pharmacy or call Poison Control for treatment directions.
**American Cancer Society (ACS) Fundraiser
This is the seventh year that I'm participating in Men Wear Pink to increase breast cancer awareness and raise money for the American Cancer Society's life-saving mission.
I hope you'll consider contributing.
Every donation makes a difference in the fight against breast cancer!
Paul Taylor's ACS Fundraiser Page: http://main.acsevents.org/goto/paultaylor
THANK YOU for your support!
Good luck with your ACLS class!
Links: Buy Me a Coffee at https://buymeacoffee.com/paultaylor
Free Prescription Discount Card - Get your free drug discount card to save money on prescription medications for you and your pets: https://safemeds.vip/save
Pass ACLS Web Site - Other ACLS-related resources: https://passacls.com
@Pass-ACLS-Podcast on LinkedIn
Poison Myths and Misconceptions on The Pharmacists Voice podcast: https://www.thepharmacistsvoice.com/podcast/poison-myths-and-misconceptions-discussion-part-1-of-5-with-angel-bivens-rph-and-wendy-stephan-phd/
Updated guidance for resuscitation of patients with cardiac arrest, respiratory arrest, and refractory shock due to poisoning: https://www.ahajournals.org/doi/10.1161/CIR.0000000000001161
The ACLS algorithms are designed to make it easier to remember the key interventions we should deliver, and the order in which they should be delivered, to provide the best evidence-based care possible.
Generally speaking, if there’s a change in a patient’s condition, we should ensure we’re using the correct algorithm.
Three key points to remember when using ACLS algorithms.
Walk through of an example mega code scenario with explanations of when and why we change to a different ACLS algorithm.
**American Cancer Society (ACS) Fundraiser
This is the seventh year that I'm participating in Men Wear Pink to increase breast cancer awareness and raise money for the American Cancer Society's life-saving mission.
I hope you'll consider contributing.
Every donation makes a difference in the fight against breast cancer!
Paul Taylor's ACS Fundraiser Page: http://main.acsevents.org/goto/paultaylor
THANK YOU for your support!
Good luck with your ACLS class!
Links: Buy Me a Coffee at https://buymeacoffee.com/paultaylor
Free Prescription Discount Card - Get your free drug discount card to save money on prescription medications for you and your pets: https://safemeds.vip/save
Pass ACLS Web Site - Other ACLS-related resources: https://passacls.com
@Pass-ACLS-Podcast on LinkedIn
Review of when we should consider beta blocker use in ACLS's Acute Coronary Syndrome (ACS) & Tachycardia algorithms and when they're contraindicated.
Beta blocking medications attach to Beta receptors to inhibit or “block” the effects of epinephrine (adrenaline)and norepinephrine in the body.
The primary locations of Beta I, II, and III receptors.
Effects of epinephrine & norepinephrine’s stimulation of beta receptors on the heart.
Beta blockers effects on the heart.
When we should consider the use of beta blockers in the Acute Coronary Syndrome (ACS)and Tachycardia algorithms.
Contraindications to the use of beta blocker medications.
More detailed information about beta blocker’s mechanism of action and specific instances for their use can be found on the Pod Resource page at PassACLS.com.
**American Cancer Society (ACS) Fundraiser
This is the seventh year that I'm participating in Men Wear Pink to increase breast cancer awareness and raise money for the American Cancer Society's life-saving mission.
I hope you'll consider contributing.
Every donation makes a difference in the fight against breast cancer!
Paul Taylor's ACS Fundraiser Page: http://main.acsevents.org/goto/paultaylor
THANK YOU for your support!
Good luck with your ACLS class!
Links: Buy Me a Coffee at https://buymeacoffee.com/paultaylor
Free Prescription Discount Card - Get your free drug discount card to save money on prescription medications for you and your pets: https://safemeds.vip/save
Pass ACLS Web Site - Other ACLS-related resources: https://passacls.com
@Pass-ACLS-Podcast on LinkedIn
A review of advanced airway use in ACLS’s Adult Cardiac Arrest algorithm including: advantages, types, insertion, and monitoring ETCO2.
When we should consider insertion of an advanced airway for patients in a shockable vs non-shockable rhythm.
In addition to an endotracheal tube (ETT), other ACLS advanced airways include the Laryngeal Mask Airway (LMA) and the Laryngeal Tube airway.
The advantages of using an advanced airway over basic airway maneuvers.
Use of end tidal CO2 waveform capnography to confirm placement and assess the adequacy of CPR.
Identification and management of a misplaced ET tube.
**American Cancer Society (ACS) Fundraiser
This is the seventh year that I'm participating in Men Wear Pink to increase breast cancer awareness and raise money for the American Cancer Society's life-saving mission.
I hope you'll consider contributing.
Every donation makes a difference in the fight against breast cancer!
Paul Taylor's ACS Fundraiser Page: http://main.acsevents.org/goto/paultaylor
THANK YOU for your support!
Good luck with your ACLS class!
Links: Buy Me a Coffee at https://buymeacoffee.com/paultaylor
Free Prescription Discount Card - Get your free drug discount card to save money on prescription medications for you and your pets: https://safemeds.vip/save
Pass ACLS Web Site - Other ACLS-related resources: https://passacls.com
@Pass-ACLS-Podcast on LinkedIn
Our primary focus immediately following return of spontaneous circulation (ROSC) is aimed at ensuring adequate perfusion of the patient’s vital organs and decreasing cerebral damage.
Post-arrest goals for O2 saturation, ETCO2, and BP/MAP.
Indications for use of an antiarrhythmic after ROSC.
Determining which antiarrhythmic to use post cardiac arrest.
Administration of Amiodarone or Lidocaine to control ventricular ectopy after ROSC.
The use of Amiodarone post arrest if no antiarrhythmics were administered prior to obtaining ROSC.
Links to other medical podcasts that cover antiarrhythmics and other ACLS-related topics are on the Pod Resource page at PassACLS.com.
**American Cancer Society (ACS) Fundraiser
This is the seventh year that I'm participating in Men Wear Pink to increase breast cancer awareness and raise money for the American Cancer Society's life-saving mission.
I hope you'll consider contributing.
Every donation makes a difference in the fight against breast cancer!
Paul Taylor's ACS Fundraiser Page: http://main.acsevents.org/goto/paultaylor
THANK YOU for your support!
Good luck with your ACLS class!
Links: Buy Me a Coffee at https://buymeacoffee.com/paultaylor
Free Prescription Discount Card - Get your free drug discount card to save money on prescription medications for you and your pets: https://safemeds.vip/save
Pass ACLS Web Site - Other ACLS-related resources: https://passacls.com
@Pass-ACLS-Podcast on LinkedIn
Hydrogen ions is on one of the Hs in ACLS's H&T reversible causes of cardiac arrest. When considering hydrogen ions as a cause, what we’re looking at is the patient’s pH, or acid/base balance, and conditions that affect it.
The body's normal pH.
Using patient history, ABGs, & labs to determine acidosis or alkalosis.
Common conditions/causes that may lead us to suspect acidosis.
Common conditions/causes that may lead us to suspect alkalosis.
Correcting acidosis by changing the rate of ventilations.
The indications, dose, and considerations for use of Sodium Bicarbonate.
Treatment of alkalosis depends on the type (metabolic or respiratory) and is aimed at correcting the underlying cause.
Other podcasts that cover acid/base balance and conditions that cause acidosis or alkalosis can be found on the Pod Resource Page at PassACLS.com.
**American Cancer Society (ACS) Fundraiser
This is the seventh year that I'm participating in Men Wear Pink to increase breast cancer awareness and raise money for the American Cancer Society's life-saving mission.
I hope you'll consider contributing.
Every donation makes a difference in the fight against breast cancer!
Paul Taylor's ACS Fundraiser Page: http://main.acsevents.org/goto/paultaylor
THANK YOU for your support!
Good luck with your ACLS class!
Links: Buy Me a Coffee at https://buymeacoffee.com/paultaylor
Free Prescription Discount Card - Get your free drug discount card to save money on prescription medications for you and your pets: https://safemeds.vip/save
Pass ACLS Web Site - Other ACLS-related resources: https://passacls.com
@Pass-ACLS-Podcast on LinkedIn
BLS & ACLS's Adult Cardiac Arrest algorithm makes it easier to act as team leader during a code by following an If/Then methodology.
Review of BLS steps for determining if rescue breathing or CPR is needed and use of an AED for patients in cardiac arrest.
If the patient is in a non-shockable rhythm on the ECG such as PEA or asystole, we will go down the right side of the Adult Cardiac Arrest Algorithm.
If the patient is in a shockable rhythm on the ECG such as V-Fib or V-Tach, we will go down the left side of the Adult Cardiac Arrest Algorithm.
An example of a code's flow for shockable rhythms when an antiarrhythmic such as Amiodarone or Lidocaine is administered.
We will follow the algorithm until the patient has ROSC or we call the code.
**American Cancer Society (ACS) Fundraiser
This is the seventh year that I'm participating in Men Wear Pink to increase breast cancer awareness and raise money for the American Cancer Society's life-saving mission.
I hope you'll consider contributing.
Every donation makes a difference in the fight against breast cancer!
Paul Taylor's ACS Fundraiser Page: http://main.acsevents.org/goto/paultaylor
THANK YOU for your support!
Good luck with your ACLS class!
Links: Buy Me a Coffee at https://buymeacoffee.com/paultaylor
Free Prescription Discount Card - Get your free drug discount card to save money on prescription medications for you and your pets: https://safemeds.vip/save
Pass ACLS Web Site - Other ACLS-related resources: https://passacls.com
@Pass-ACLS-Podcast on LinkedIn
Review of aspirin's mechanism of action, indications, contraindications, and administration for patients with acute coronary syndrome (ACS) or stroke.
Aspirin's mechanism of action & benefits for Acute Coronary Syndrome (ACS) patients.
Contraindications and considerations for aspirin’s use.
The dose and route of administration of aspirin for ACS patients.
The use of aspirin in the ACLS Stroke algorithm.
**American Cancer Society (ACS) Fundraiser
This is the seventh year that I'm participating in Men Wear Pink to increase breast cancer awareness and raise money for the American Cancer Society's life-saving mission.
I hope you'll consider contributing.
Every donation makes a difference in the fight against breast cancer!
Paul Taylor's ACS Fundraiser Page: http://main.acsevents.org/goto/paultaylor
THANK YOU for your support!
Good luck with your ACLS class!
Links: Buy Me a Coffee at https://buymeacoffee.com/paultaylor
Free Prescription Discount Card - Get your free drug discount card to save money on prescription medications for you and your pets: https://safemeds.vip/save
Pass ACLS Web Site - Other ACLS-related resources: https://passacls.com
@Pass-ACLS-Podcast on LinkedIn
Review of lead II ECG characteristics, rules to identify first and third degree heart blocks, and treatment following the ACLS Bradycardia algorithm.
To pass ACLS, you will need to be able to identify common rhythms on a monitor during your mega code and ECG strips on your written exam.
Review of normal ECG morphology in lead II.
Characteristics of first-degree heart block.
Characteristics of third-degree (complete) AV block.
Treatment of unstable patients in third degree block following the ACLS Bradycardia algorithm.
Special considerations for use of Atropine when patients are in a third-degree heart block.
The use of TCP, Dopamine, & Epinephrine drip for unstable bradycardic patients refractory to Atropine.
**American Cancer Society (ACS) Fundraiser
This is the seventh year that I'm participating in Men Wear Pink to increase breast cancer awareness and raise money for the American Cancer Society's life-saving mission.
I hope you'll consider contributing.
Every donation makes a difference in the fight against breast cancer!
Paul Taylor's ACS Fundraiser Page: http://main.acsevents.org/goto/paultaylor
THANK YOU for your support!
Good luck with your ACLS class!
Links: Buy Me a Coffee at https://buymeacoffee.com/paultaylor
Free Prescription Discount Card - Get your free drug discount card to save money on prescription medications for you and your pets: https://safemeds.vip/save
Pass ACLS Web Site - Other ACLS-related resources: https://passacls.com
@Pass-ACLS-Podcast on LinkedIn
Review of antiarrhythmic medications Amiodarone & Lidocaine for use in ACLS's Adult Cardiac Arrest, Post Arrest, and Tachycardia algorithms.
The two first-line ACLS antiarrhythmics that are generally used.
Lidocaine dosing and administration to patients in persistent V-Fib or pulseless V-Tach.
Amiodarone dosing and administration to patients in persistent V-Fib or pulseless V-Tach.
Use of antiarrhythmic infusions post-cardiac arrest to suppress ventricular ectopy.
Amiodarone use & dosing for stable patients in V-Tach with a pulse.
**American Cancer Society (ACS) Fundraiser
This is the seventh year that I'm participating in Men Wear Pink to increase breast cancer awareness and raise money for the American Cancer Society's life-saving mission.
I hope you'll consider contributing.
Every donation makes a difference in the fight against breast cancer!
Paul Taylor's ACS Fundraiser Page: http://main.acsevents.org/goto/paultaylor
THANK YOU for your support!
Good luck with your ACLS class!
Links: Buy Me a Coffee at https://buymeacoffee.com/paultaylor
Free Prescription Discount Card - Get your free drug discount card to save money on prescription medications for you and your pets: https://safemeds.vip/save
Pass ACLS Web Site - Other ACLS-related resources: https://passacls.com
@Pass-ACLS-Podcast on LinkedIn
Calcium is one of the ions that move across the cellular membrane during cardiac contraction and relaxation.
The primary use of calcium channel blockers in ACLS.
Use of calcium channel blockers for SVT refractory to Adenosine and A-Fib or A-Flutter with RVR.
Contraindications of calcium channel blockers.
Nicardipine use during the treatment of ischemic strokes.
For more information on ACLS medications, tachycardia, or stroke check out the pod resource page at passacls.com.
Good luck with your ACLS class!
Links: Buy Me a Coffee at https://buymeacoffee.com/paultaylor
Practice ECG rhythms at Dialed Medics - https://dialedmedics.com/
Free Prescription Discount Card - Download your free drug discount card to save money on prescription medications for you and your pets: https://safemeds.vip
Pass ACLS Web Site - Episode archives & other ACLS-related podcasts: https://passacls.com
@Pass-ACLS-Podcast on LinkedIn
The goal of CPR is to keep the brain and vital organs perfused until return of spontaneous circulation (ROSC) is achieved.
Post-arrest care and recovery are the final two links in the chain of survival.
Identification of ROSC during CPR.
Initial patient management goals after identifying ROSC.
Indications for starting TTM.
Monitoring the patient’s core temperature.
Patients can undergo EEG, CT, MRI, & PCI while receiving TTM.
Good luck with your ACLS class!
Links: Buy Me a Coffee at https://buymeacoffee.com/paultaylor
Practice ECG rhythms at Dialed Medics - https://dialedmedics.com/
Free Prescription Discount Card - Download your free drug discount card to save money on prescription medications for you and your pets: https://safemeds.vip
Pass ACLS Web Site - Episode archives & other ACLS-related podcasts: https://passacls.com
@Pass-ACLS-Podcast on LinkedIn
Nitroglycerine is vasodilator that affects peripheral blood vessels and coronary arteries.
Because of its widespread dilation effects on blood vessels, nitro can quickly lower a patient’s blood pressure, sometimes to the point of making a patient hypotensive.
Assessment of vital signs prior to administering nitro is necessary to ensure patient safety.
Indications for use of nitroglycerine.
Nitroglycerine's contraindications & considerations for use.
Effects of nitro on patients taking PDE inhibitors.
Administration of nitroglycerine to patients with ischemic chest pain.
Considerations for patients that took their home nitroglycerine.
Monitoring patient's pain and vital signs after nitro administration.
Good luck with your ACLS class!
Links: Buy Me a Coffee at https://buymeacoffee.com/paultaylor
Practice ECG rhythms at Dialed Medics - https://dialedmedics.com/
Free Prescription Discount Card - Download your free drug discount card to save money on prescription medications for you and your pets: https://safemeds.vip
Pass ACLS Web Site - Episode archives & other ACLS-related podcasts: https://passacls.com
@Pass-ACLS-Podcast on LinkedIn
In atrial fibrillation (A-Fib) and atrial flutter (A-Flutter) the electrical impulse for cardiac contraction is in the atria but isn't the normal pacemaker of the heart, the SA node.
The ECG characteristics of A-Fib and A-Flutter.
Recognition and treatment of unstable patients in A-Fib/Flutter with rapid ventricular response (RVR).
Suggested energy settings for synchronized cardioversion of unstable patients with a narrow complex tachycardia.
Team safety when cardioverting an unstable patient in A-FIB/Flutter.
Adenosine’s role for stable SVT patients with underlying atrial rhythms.
Treatment of stable patients in A-Fib/Flutter with RVR.
For other medical podcasts that cover narrow complex tachycardias, visit the pod resource page at passacls.com.
Good luck with your ACLS class!
Links: Buy Me a Coffee at https://buymeacoffee.com/paultaylor
Practice ECG rhythms at Dialed Medics - https://dialedmedics.com/
Free Prescription Discount Card - Download your free drug discount card to save money on prescription medications for you and your pets: https://safemeds.vip
Pass ACLS Web Site - Episode archives & other ACLS-related podcasts: https://passacls.com
@Pass-ACLS-Podcast on LinkedIn
As an ACLS provider you do not need to be familiar with all of the different signs of various types of poisoning. You should be able to obtain a history and know to order toxicology.
The majority of toxins don’t have a specific antidote. There are a few toxins for which we have emergency interventions and ACLS providers should be familiar with.
Reviewing the patient's medical history for indicators that may lead us to suspect a tablet/toxin cause of cardiac arrest.
Administration of Narcan for suspected narcotics overdose following the Opioid Associated Emergency algorithm.
Other common ACLS Tablet Toxin scenarios with possible treatments.
Medications commonly used to treat specific toxins that are regularly stocked on crash carts or carried in EMS med bags.
ACLS providers that suspect a specific toxin should consult with their Pharmacy or call Poison Control for treatment directions.
Good luck with your ACLS class!
Links: Buy Me a Coffee at https://buymeacoffee.com/paultaylor
Practice ECG rhythms at Dialed Medics - https://dialedmedics.com/
Free Prescription Discount Card - Download your free drug discount card to save money on prescription medications for you and your pets: https://safemeds.vip
Pass ACLS Web Site - Episode archives & other ACLS-related podcasts: https://passacls.com
@Pass-ACLS-Podcast on LinkedIn
Poison Myths and Misconceptions on The Pharmacists Voice podcast: https://www.thepharmacistsvoice.com/podcast/poison-myths-and-misconceptions-discussion-part-1-of-5-with-angel-bivens-rph-and-wendy-stephan-phd/
The ACLS algorithms are designed to make it easier to remember the key interventions we should deliver, and the order in which they should be delivered, to provide the best evidence-based care possible.
Generally speaking, if there’s a change in a patient’s condition, we should ensure we’re using the correct algorithm.
Three key points to remember when using ACLS algorithms:
-
If a patient’s condition changes, we should do an assessment and use the algorithm that matches the patient’s current state.
-
If an action was already done, we don’t need to repeat it.
-
We only do actions that are clinically appropriate and within our scope of practice.
Walk through of an example mega code scenario with explanations of when and why we change to a different ACLS algorithm.
Good luck with your ACLS class!
Links: Buy Me a Coffee at https://buymeacoffee.com/paultaylor
Practice ECG rhythms at Dialed Medics - https://dialedmedics.com/
Free Prescription Discount Card - Download your free drug discount card to save money on prescription medications for you and your pets: https://safemeds.vip
Pass ACLS Web Site - Episode archives & other ACLS-related podcasts: https://passacls.com
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Beta blocking medications attach to Beta receptors to inhibit or “block” the effects of epinephrine (adrenaline) and norepinephrine in the body.
The primary locations of Beta I, II, and III receptors.
Effects of epinephrine & norepinephrine’s stimulation of beta receptors on the heart.
Beta blockers effects on the heart.
When we should consider the use of beta blockers in the Acute Coronary Syndrome (ACS)and Tachycardia algorithms.
Contraindications to the use of beta blocker medications.
More detailed information about beta blocker’s mechanism of action and specific instances for their use can be found on the Pod Resource page at PassACLS.com.
Good luck with your ACLS class!
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Practice ECG rhythms at Dialed Medics - https://dialedmedics.com/
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This episode we review the use of advanced airways in the adult cardiac arrest algorithm.
When we should consider insertion of an advanced airway for patients in a shockable vs non-shockable rhythm.
In addition to an endotracheal tube (ETT), other ACLS advanced airways include the Laryngeal Mask Airway (LMA) and the Laryngeal Tube airway.
The advantages of using an advanced airway over basic airway maneuvers.
Use of end tidal CO2 waveform capnography to confirm placement and assess the adequacy of CPR.
Identification and management of a misplaced ET tube.
Good luck with your ACLS class!
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Our primary focus immediately following return of spontaneous circulation (ROSC) is aimed at ensuring adequate perfusion of the patient’s vital organs and decreasing cerebral damage.
Post-arrest goals for O2 saturation, ETCO2, and BP/MAP.
Indications for use of an antiarrhythmic after ROSC.
Determining which antiarrhythmic to use post cardiac arrest.
Administration of Amiodarone or Lidocaine to control ventricular ectopy after ROSC.
The use of Amiodarone post arrest if no antiarrhythmics were administered prior to obtaining ROSC.
Links to other medical podcasts that cover antiarrhythmics and other ACLS-related topics are on the Pod Resource page at PassACLS.com.
Good luck with your ACLS class!
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Hydrogen ions is on one of the Hs in ACLS's H&T reversible causes of cardiac arrest. When considering hydrogen ions as a cause, what we’re looking at is the patient’s pH, or acid/base balance, and conditions that affect it.
The body's normal pH.
Using patient history, ABGs, & labs to determine acidosis or alkalosis.
Common conditions/causes that may lead us to suspect acidosis.
Common conditions/causes that may lead us to suspect alkalosis.
Correcting acidosis by changing the rate of ventilations.
The indications, dose, and considerations for use of Sodium Bicarbonate.
Treatment of alkalosis depends on the type (metabolic or respiratory) and is aimed at correcting the underlying cause.
Other podcasts that cover acid/base balance and conditions that cause acidosis or alkalosis can be found on the Pod Resource Page at PassACLS.com.
Good luck with your ACLS class!
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Being the team leader during a cardiac arrest is challenging. Using an algorithm helps by standardizing & prioritizing our interventions using an If/Then methodology.
Review of BLS steps for determining if rescue breathing or CPR is needed and use of an AED for patients in cardiac arrest.
If the patient is in a non-shockable rhythm on the ECG such as PEA or asystole, we will go down the right side of the Adult Cardiac Arrest Algorithm.
If the patient is in a shockable rhythm on the ECG such as V-Fib or V-Tach, we will go down the left side of the Adult Cardiac Arrest Algorithm.
An example of a code's flow for shockable rhythms when an antiarrhythmic such as Amiodarone or Lidocaine is administered.
We will follow the algorithm until the patient has ROSC or we call the code.
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Other Pass ACLS episodes mentioned
Objective Measures of Good CPR https://passacls.com/bls/objective-measures-of-good-cpr
For patients exhibiting symptoms consistent with myocardial ischemia, Aspirin is the first medications we should consider along with morphine, oxygen, and nitroglycerine; if indicated & safe.
Aspirin's mechanism of action & benefits for Acute Coronary Syndrome (ACS) patients.
Contraindications and considerations for aspirin’s use.
The dose and route of administration of aspirin for ACS patients.
The use of aspirin in the ACLS Stroke algorithm.
Good luck with your ACLS class!
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To pass ACLS, you will need to be able to identify common rhythms on a monitor during your mega code and ECG strips on your written exam.
If you don't normally monitor patients as part of your job, I suggest two things:
-
Find a system for ECG interpretation that works well for you; and
-
Practice reading ECGs every day for a few weeks before your class.
Review of normal ECG morphology of P wave, QRS complex, and T wave in lead II.
Characteristics of first degree heart block.
Characteristics of third degree (complete) AV block.
Treatment of unstable patients in third degree block following the ACLS Bradycardia algorithm.
Special considerations for use of Atropine when patients are in a third degree heart block.
The use of TCP, Dopamine, & Epinephrine drip for unstable bradycardic patients refractory to Atropine.
Good luck with your ACLS class!
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In the Adult Cardiac Arrest algorithm, we should administer an antiarrhythmic medication to patients in V-Fib or pulseless ventricular tachycardia approximately two minutes after the first dose of epinephrine.
The two first-line ACLS antiarrhythmics that are generally used are Amiodarone and Lidocaine.
Review of Lidocaine dosing and administration to patients in persistent V-Fib or pulseless V-Tach.
Review of Amiodarone dosing and administration to patients in persistent V-Fib or pulseless V-Tach.
Use of antiarrhythmic infusions post-cardiac arrest to suppress ventricular ectopy.
Amiodarone use & dosing for stable patients in V-Tach with a pulse.
Good luck with your ACLS class!
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The tongue is the most common airway obstruction in an unconscious patient.
For patients with a decreased level of consciousness that can't control their airway, yet have an intact gag reflex, the nasopharyngeal airway (NPA) should be used as an alternative to the oropharyngeal airway (OPA).
Examples of when a NPA should be considered.
Contraindications and considerations for nasal airway insertion.
Measuring a nasal airway for appropriate length and diameter.
Insertion of a nasopharyngeal airway into the right vs left nostril.
Patients with a NPA in place can receive supplemental O2, be ventilated with a BVM, have ETCO2 monitored, and have their upper airway suctioned as needed.
Good luck with your ACLS class!
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When blood, or other fluids, accumulate in the sac around the heart it’s called a cardiac tamponade or pericardial tamponade.
The effects of tamponade on the electrical system and chambers of the heart.
Cardiac tamponade can be acute or chronic and caused by traumatic, iatrogenic, or pathological etiologies.
Common traumatic events, medical procedures, and diseases that can result in a pericardial tamponade.
Signs & symptoms of cardiac tamponade.
Treatment of cardiac tamponade with pericardiocentesis.
For additional information on cardiac tamponade, check out the Pod Resources page at PassACLS.com.
Good luck with your ACLS class!
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Two things have changed in recent years to aid students that don't use ACLS in their daily practice.
-
The role of the team leader; and
-
The ability to use your quick reference cards.
The team leader is responsible for assigning tasks and overall direction of the team but can & should ask team members for help.
Using closed-loop communication to ensure the clarity of orders and speaking up if there’s any doubt about an order or action.
Use of your course’s approved text book and quick reference cards during the megacode and written exam.
Tips to help you pass the ACLS written exam.
Good luck with your ACLS class!
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Two factors to cardiac arrest survivability that have been clearly shown to make the biggest difference is continuous, high-quality CPR and early defibrillation.
The most common dysrhythmia present during the first few minutes of cardiac arrest is ventricular fibrillation.
The chance of successful defibrillation decreases every minute that passes.
How our chance of successfully defibrillating a patient into a perfusing rhythm significantly changes when good CPR is delivered vs when it isn't.
Why bystander CPR is important for out-of-hospital cardiac arrest (OHCA) outcomes.
The role of the CPR coach.
Five tips to aid us in limiting CPR interruptions to less than 10 seconds so we can maintain a chest compression fraction (CCF) of at least 80%.
Good luck with your ACLS class!
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Quantitative waveform capnography is used in ACLS
- to objectively assess good CPR;
- confirm placement of an endotracheal tube;
- identify return of spontaneous circulation; and
- during post-cardiac arrest care.
We can use waveform capnography with, and without, an advanced airway in place.
Monitoring end tidal CO2 during rescue breathing.
Use of capnography to objectively measure good CPR.
Capnography is a preferred method of confirming endotracheal tube (ETT) placement over x-ray during a code.
During CPR, a sudden increase in ETCO2 may indicate ROSC.
Quantitative waveform capnography use in the post-cardiac arrest algorithm.
Good luck with your ACLS class!
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Patients with a narrow complex tachycardia with a rate over 150 BPM are in SVT.
Unstable patients in SVT or V-Tach with a pulse, should be cardioverted with a synchronized shock.
Assessment & treatment of stable tachycardic patients.
Commonly used vagal techniques.
A less common technique to stimulate the vagus nerve.
Indications and use of Adenosine for stable patients in SVT refractory to vagal maneuvers.
Possible treatments for patients found to be in A-Fib or A-Flutter with RVR after administration of Adenosine.
Carotid sinus massage.
Additional medical podcasts that have episodes on tachycardia can be found on the pod resources page at passacls.com.
Good luck with your ACLS class!
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Practice ECG rhythms at Dialed Medics - https://dialedmedics.com/
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Remembering all the different energy setting needed for synchronized cardioversion and defibrillation used to be confusing for a lot of people.
Defibrillators can be broken down into three basic categories:
-
Automated External Defibrillator (AED);
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Biphasic defibrillators; and
-
Monophasic defibrillators.
Use of an AED to rapidly deliver a shock.
Advantages & use of Biphasic defibrillators.
For monophasic defibrillators, use 360J to defibrillate V-Fib or pulseless V-Tach.
AEDs must not be used on patients with a pulse.
Cardioversion of patients in unstable SVT or V-Tach with a pulse using biphasic vs monophasic monitor/defibrillators.
Team safety when performing synchronized cardioversion.
Energy needed to cardiovert unstable patients with a narrow vs wide complex tachycardia.
Good luck with your ACLS class!
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Practice ECG rhythms at Dialed Medics - https://dialedmedics.com/
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Patients with a heart rate less than 60 are bradycardic. Some people can have a resting heart rate in the 40s without any compromise. For others, a heart rate of 50 or less could signify the need for immediate intervention and warrants additional assessment.
Signs & symptoms that indicate a bradycardic patient is unstable.
Monitoring oxygen saturation with pulse oximetry and indications for administration of oxygen.
Calcium channel blockers and beta blocker medication as treatable causes of bradycardia.
The indications and dosage of Atropine.
Precautions for Atropine use in patients with second or third degree AV blocks.
The use of transcutaneous pacing (TCP) for unstable bradycardic patients refractory to Atropine.
The use and dosing of Dopamine and Epinephrine drips.
For additional information about causes and treatment of bradycardia, check out the pod resources page at PassACLS.com.
Good luck with your ACLS class!
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The goal of CPR is to keep the brain and vital organs perfused until return of spontaneous circulation (ROSC) is achieved.
Post-arrest care and recovery are the final two links in the chain of survival.
Identification of ROSC during CPR.
Initial patient management goals after identifying ROSC.
The patient’s GCS/LOC should be evaluated to determine if targeted temperature management (TTM) is indicated.
Patients that cannot obey simple commands should receive TTM for at least 24 hours.
Recently published studies on TTM and ACLS’s current standard.
Monitoring the patient’s core temperature during TTM.
Patients can undergo EEG, CT, MRI, & PCI while receiving TTM.
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The chain of survival for ACLS is the same as was learned in your BLS class.
The beginning steps of the Cardiac Emergency and Stroke chain of survival.
ACLS's timed goals for first medical contact to PCI for STEMI and door-to-needle for ischemic stroke.
Characteristics of areas that have significantly better stroke and out-of-hospital cardiac arrest outcomes.
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Heart muscle contraction and repolarization is dependent on Sodium, Calcium, Magnesium, and Potassium ions crossing cellular membranes.
When a patient’s potassium levels get too low or too high, hypokalemia or hyperkalemia results respectively.
Two things that may lead us to suspect hypo or hyperkalemia.
Medical conditions & medications that can cause potassium imbalance.
ECG changes seen in hypo and hyperkalemia.
Critical lab values that would indicate a need for treatment.
Emergent, ACLS interventions for hypokalemia and hyperkalemia.
Additional information on causes of hypo and hyperkalemia can be found on Ninja Nerd podcast. Check out the pod resources page at passacls.com.
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When treating patients having an MI or stroke, more minutes equals more dead cells.
Because the majority of strokes are the ischemic type, the treatment for stroke is similar to an MI – to reestablish perfusion to the ischemic tissues.
The first four steps in the Stroke Chain of Survival.
Time criteria for the administration of tPA (or a similar fibrinolytic medication) or EVT of LVO strokes.
Stroke benchmarks for door to:
- assessment;
- completing a non-contrast CT; and
- administration of fibrinolytic medication such as tPA (door-to-needle).
EMS interaction with stroke teams and destination protocols to reduce time to definitive care.
The difference for timed goals for the identification & treatment of AMI vs Stroke.
Additional information about timed goals for stroke and how EMS affects outcomes, can be found on the PassACLS.com pod resources page.
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Adenosine is the first IV medication given to stable patients with sustained supraventricular tachycardia (SVT) refractory to vagal maneuvers.
Symptoms indicating a stable vs unstable patient.
Common causes of tachycardia.
Cardiac effects of Adenosine.
Indications for use in the ACLS Tachycardia algorithm.
Considerations and contraindications.
Adenosine as a diagnostic for patients in A-Fib or A-Flutter with RVR.
Dosing and administration.
Other podcasts that cover common ACLS antiarrhythmics in more detail and another covering Brugata Criteria used to differentiate V-Tach from SVT with an aberrancy, can be found on the Pod Resources page at passacls.com.
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To pass the written ACLS exam and mega code, students need to be able to identify basic ECG dysrhythmias, including the two types of second-degree heart block.
One method of ECG rhythm identification is to ask a series of questions such as:
- What's the rate (<60, 60-100, 101-149, or >150);
- Is the rhythm regular or irregular;
- What's the shape, width, and frequency of P waves and QRS complexes; and
- What's the P-R interval and is it constant?
ECG characteristics of a second-degree Mobitz type I (Wenckebach).
Identification of unstable bradycardia and its treatment with Atropine.
ECG characteristics of a second-degree Mobitz type II.
Possible effect of using Atropine on patients with a second-degree type II AV block.
Treatment of unstable bradycardic patients refractory to Atropine using TCP, Dopamine, or Epinephrine drip.
Starting dose and titration of Dopamine and Epinephrine drips.
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The Curious Clinicians: History of Doctor Wenckebach & Mobitz
https://curiousclinicians.com/2022/07/06/episode-52-way-back-wenckebach/
When treating patients with Acute Coronary Syndrome (ACS), MONA is an acronym sometimes used to help us remember the initial interventions.
The O in MONA is Oxygen.
When we should administer oxygen to ACS patients.
When O2 administration is unnecessary based on an accurate pulse ox.
Monitoring patient's oxygen saturation (SaO2) using a pulse oximeter.
Review two common ACLS pre-arrest mega code scenarios.
Oxygen administration during CPR and post cardiac arrest.
You can find additional medical podcasts that cover ACLS-related topics, on the Pod Resources page at PassACLS.com
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Check out ConveyMed.io for more free online medical education (#FOAMed) opportunities.
Along with early defibrillation, high quality CPR with minimal interruptions is one of the two factors that has been shown to improve cardiac arrest outcomes.
How do we know if high quality, effective CPR is being performed?
Objective measures of high-quality CPR include:
- Compression rate;
- Compression depth & recoil;
- ETCO2; and
- Chest Compression Fraction (CCF).
The role of the CPR Coach on the code team.
The advantages and use of real-time feedback devices to monitor the rate, depth, and chest recoil of CPR compressions.
The use of end tidal waveform capnography. (ETCO2)
A no-tech way to monitor effective CPR if no compression feedback device or ETCO2 capnography isn’t available.
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When we should use the bradycardia algorithm.
The signs & symptoms of unstable bradycardia.
Atropine's bradycardic dose and maximum.
The use of atropine when a patient is in a second degree type II or third degree heart block.
ECG changes that indicate subsequent doses of atropine are likely to be ineffective.
The starting dose of Dopamine.
The use of Dopamine for bradycardia as an interim until TCP vs hypotension.
The use of Atropine and Dopamine in patients with myocardial ischemia.
Podcasts with additional (advanced-provider level) information about bradycardia, Atropine, & Dopamine can be found on the Pass ACLS Pod Resources page.
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The tongue is the most common airway obstruction in an unconscious patient.
Insertion an oropharyngeal airway helps keep the patient’s tongue from falling to the back of the pharynx, causing an airway obstruction.
The oropharyngeal airway is sometimes called an OPA or simply an oral airway.
Indications for using an oral airway.
Contraindication for an oral airway and an alternative airway that can be used for patients with an intact gag reflex.
Measuring an OPA and possible complications from inserting one that's too small or too large.
Two techniques to properly insert an OPA.
The use of an oral airway during CPR.
The use of an OPA as a bite block after a patient has an advanced airway placed.
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Hypoxia is a state of low oxygen levels in the blood.
Determining hypoxia using a pulse oximeter or arterial blood gasses (ABGs).
A goal of ACLS is to recognize signs of hypoxia and provide timely treatment to prevent an arrest.
Examples of some things that might lead us to think of hypoxia as a cause of cardiac arrest.
Why we should not rely on pulse ox to give accurate readings during CPR.
Delivering ventilations with near 100% oxygen concentration using a BVM attached to supplemental O2 and a reservoir.
Using end tidal waveform capnography to assess the quality of CPR.
Changes to ventilation rates, tidal volume, and O2 concentration affects a patient's oxygen, carbon dioxide, and pH.
The danger of excessive ventilation of a patient in cardiac arrest.
Good luck with your ACLS class!
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ECG characteristics of supraventricular tachycardia (SVT) vs. sinus tachycardia.
Signs & symptoms that indicate a patient is unstable.
Delivery of a synchronized shock for the treatment of unstable SVT using a biphasic vs monophasic defibrillator.
Consideration for team safety while performing synchronized cardioversion.
Actions to take immediately if an unstable patient we’ve cardioverted goes into a pulseless rhythm.
Management of stable patients in SVT.
For more free information on narrow complex tachycardias, check out the pod resource page at passacls.com.
Good luck with your ACLS class!
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Practice ECG rhythms at Dialed Medics - https://dialedmedics.com/
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When working to resuscitate a patient in sudden cardiac arrest, Epinephrine is the first IV medication we administer.
When we give the first dose of epinephrine depends on whether the patient is in a shockable or non-shockable rhythm.
When to give the first dose of epinephrine and its frequency for patients in asystole or PEA following the right side of the Adult Cardiac Arrest algorithm.
When to give the first dose of epi and its frequency for patients in V-Fib or pulseless V-Tach following the left side of the Adult Cardiac Arrest algorithm.
Example chronology of events for a scenario where a patient is found unresponsive with only gasping/agonal breathing.
Administration of epi via the IO or endotracheal route in the absence of an IV.
The maximum cumulative dose of epinephrine that can be administered to patients in cardiac arrest.
When do we stop administering epinephrine.
Good luck with your ACLS class!
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Practice ECG rhythms at Dialed Medics - https://dialedmedics.com/
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If a person suddenly develops symptoms such as weakness, slurred or garbled speech, loss of balance, or a massive & severe headache; it’s possible they could be having a stroke.
The Cincinnati Prehospital Stroke Scale.
There are several conditions that can mimic a stroke.
Identification & treatment of hypoglycemia or hyperglycemia.
Identification & treatment of hypoxia using a pulse oximeter.
Some seizures, electrolyte imbalance, sepsis, brain tumors, and Bell’s Palsy can also mimic a stroke.
Prehospital providers should transport suspected stroke patients to a stroke center following their local protocols.
Hospital providers should active their stroke team to ensure rapid assessment and treatment.
Good luck with your ACLS class!
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Practice ECG rhythms at Dialed Medics - https://dialedmedics.com/
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Most ACLS medications are given IV push. But, what happens if we can't get an IV?
Why IO is better than ETT as an alternative route.
The locations we should place an IO when running a code and a location we should avoid.
The ACLS medications that can be given intraosseous.
Where you can find more information about intraosseous access during resuscitation efforts.
In the absence of an IV or IO, some medications may be given down the endotracheal tube.
The disadvantages of medication administration via ETT.
Review of the medications that can be given down the tube and how they should be given.
Medications should not be given down the tube when anything other than an endotracheal tube is used as an advanced airway.
Good luck with your ACLS class!
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Practice ECG rhythms at Dialed Medics - https://dialedmedics.com/
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The chain of survival for a cardiac emergency and stroke start the same:
-
preparedness & recognition of an emergency;
-
activation of EMS;
-
delivery of Advanced Life Support; and
-
transporting to the most appropriate facility.
ALS ambulances are staffed with paramedics who have training in ACLS skills.
Why EMS "Destination Protocols" for suspected stroke and STEMI make a difference.
ACLS’s timed benchmarks for:
- point of first medical contact to PCI for ST elevation MI;
- door to tPA for ischemic stroke; and
- onset of symptoms to EVT for LVO strokes.
Why EMS should bypass a close hospital to transport a STEMI or suspected stroke patient to a hospital capable of 24/7 PCI or a certified stroke center.
Check out the Pod Resource page at passacls.com for links to the "EMS On Air" podcast for links to episodes that look at EMS's role in stroke outcomes in the rural vs urban area.
Good luck with your ACLS class!
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Practice ECG rhythms at Dialed Medics - https://dialedmedics.com/
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Performing good CPR and delivering a shock as soon as possible to a patient in Ventricular Fibrillation or pulseless V-Tach are the two most critical interventions that have been shown to increase survival from sudden cardiac arrest.
Studies have demonstrated significantly better out-of-hospital cardiac arrest survival outcomes in communities with robust public CPR training and public access/first responder AEDs.
The general use of AED including: indications for use; attaching the AED pads; following verbal prompts; and safely administering a shock.
Following the Adult Cardiac Arrest algorithm while using an AED.
Contraindications to AED use.
General safety considerations to remember.
Good luck with your ACLS class!
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Practice ECG rhythms at Dialed Medics - https://dialedmedics.com/
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For apneic patients without a carotid pulse or patients with only gasping/agonal respirations, we will follow the Adult Cardiac Arrest algorithm.
For pulseless patients that the AED doesn't advise a shock, the patient's ECG shows asystole, or a non-perfusing organized rhythm (PEA), we will follow the right side of the Adult Cardiac Arrest algorithm.
Initial steps are aimed at delivery of high-quality CPR to keep the brain and vital organs alive.
Epinephrine administration.
Placement of an advanced airway.
Considering possible reversible H & T causes of cardiac arrest including three common causes of PEA and their emergent interventions.
When we should discontinue resuscitation efforts and call the code.
Good luck with your ACLS class!
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Practice ECG rhythms at Dialed Medics - https://dialedmedics.com/
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Providing good, high-quality CPR with minimal interruptions and early defibrillation are two key interventions shown to improved cardiac arrest outcomes.
A training tool used in many CPR and ACLS classes is to use a song (or a song list) with a tempo of 100 to 120 beats per minute to help the person doing chest compressions maintain an adequate rate.
Characteristics of songs that will help us perform good CPR.
Advantages & disadvantages of using a song during CPR.
Selected songs from various genres and time periods from AHA's "Don’t Drop The Beat" playlist on Spotify.
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Practice ECG rhythms at Dialed Medics - https://dialedmedics.com/
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Don’t Drop The Beat playlist on Spotify: https://open.spotify.com/playlist/2mU2FNAhSOtQwW0hBgQMaK
A patient’s medical history will help us identify things that may be causing (or contributing) to their current condition as well as guide our decisions so we provide the safest evidence-based care possible.
Examples of information obtained in a medical history that will impact the treatment we provide.
There are several mnemonics and memory aids that people use to guide their history taking.
Review the SAMPLE-PQRST medical history format.
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Practice ECG rhythms at Dialed Medics - https://dialedmedics.com/
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Although magnesium can be used in the treatment of other medical conditions such as eclampsia, asthma, & digitalis toxicity; for ACLS, magnesium is primarily used to treat Torsades de Pointes.
Identification of Torsades on the ECG.
Administration of a magnesium infusion for stable patients vs slow IV push for patients in cardiac arrest.
Procainamide use for stable patients with a monomorphic wide-complex tachycardia.
Procainamide dosing and when to stop the infusion.
Tip for determining whether magnesium or Procainamide should be used when treating stable patients with V-Tach.
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Practice ECG rhythms at Dialed Medics - https://dialedmedics.com/
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When a patient loses excessive amounts of fluids, we say that they are in a state of hypovolemia.
The most obvious cause of hypovolemia is from bleeding.
Bleeding can be internal or external and caused by trauma, pathology, or iatrogenic.
Classic signs & symptoms of hypovolemic shock.
Volume replacement with crystalloids vs blood.
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MONA is the acronym sometimes used to help us remember the interventions to consider for patients with Acute Coronary Syndrome.
Morphine's use in the Acute Coronary Syndrome (ACS) algorithm.
Why Morphine is helpful for patients with ACS.
Contraindications and considerations for the safe administration of Morphine.
Morphine as an alternative to nitro for patients with chest pain that take PDE inhibitors.
Common dosing & administration of Morphine.
Monitoring of the patient's level of consciousness, pain, blood pressure, and respirations after administration.
Possible side effects of Morphine administration.
Narcan as an antidote to Morphine if needed.
Good luck with your ACLS class!
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When a patient loses excessive amounts of fluids, we say that they are in a state of hypovolemia.
The most obvious cause of hypovolemia is from bleeding.
Bleeding can be internal or external and caused by trauma, pathology, or iatrogenic.
Classic signs & symptoms of hypovolemic shock.
Volume replacement with crystalloids vs blood.
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MONA is the acronym sometimes used to help us remember the interventions to consider for patients with Acute Coronary Syndrome or ACS.
Morphine's use in the Acute Coronary Syndrome (ACS) algorithm.
Why Morphine is helpful for patients with ACS.
Contraindications and considerations for the safe administration of Morphine.
Morphine as an alternative to nitro for patients with chest pain that take PDE inhibitors.
Common dosing & administration of Morphine.
Monitoring of the patient's level of consciousness, pain, blood pressure, and respirations after administration.
Possible side effects of Morphine administration.
Narcan as an antidote to Morphine if needed.
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Even good CPR is far less efficient at circulating blood than a functioning heart.
The indicators of high-quality CPR that were identified at the 2012 AHA CPR Quality Summit in order of importance include:
- Chest compression fraction (CCF);
- Chest compression rate;
- Chest compression depth;
- Allowing for full recoil; and
- Adequate ventilations.
Using real-time feedback devices and ETCO2 to assess CPR quality.
Three tips to limit pauses in CPR compressions to 10 seconds or less.
Limiting interruptions to chest compressions to less than 10 seconds so we can maintain a CCF of 80% requires teamwork and communication.
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Epinephrine and Dopamine are adrenergic agonist used in several ACLS algorithms.
The use of epinephrine for severe anaphylaxis and unstable bradycardia.
Review epinephrine’s effects on blood vessels and bronchioles.
Why epinephrine is helpful for patients with anaphylaxis.
Using an epi drip for unstable bradycardia.
Epinephrine administration during cardiac arrest.
Starting and epinephrine or Dopamine drip for patients that have ROSC.
Review the effects of Dopamine based on mcg/kg/min dosing.
Monitoring the patient and titrating epi or Dopamine drips to prevent harm.
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Providing rescue breathing to apneic patients with a palpable pulse.
Normal end tidal CO2 for patients with a pulse.
Identification of cardiac arrest and our immediate actions.
Providing artificial ventilations during CPR without an advanced airway vs with an advanced airway in place.
Using quantitative waveform capnography to confirm placement of an advanced airway, assess the quality of CPR, and identify ROSC.
The effects of hyperventilating patients in cardiac arrest.
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Hypothermic patients aren't dead until they are warm and dead.
When a patient’s core body temperature drops below 96.8 F (36 C), they are hypothermic. As the body’s temperature drops below 36 C, hypothermia may further be classified as moderate or severe:
- Moderate if the patient’s body core temp is between 30-34 C; and
- Severe if it's below 30 C.
Modifying the ACLS Adult Cardiac Arrest algorithm for patients with severe hypothermia.
Following the ACLS algorithm for patients with a body core temperature above 30 C.
Methods for rewarming patients with moderate vs severe hypothermia.
Continuation of CPR and ACLS efforts until the patient’s body core temp is above 36 C.
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Calcium is one of the ions that move across the cellular membrane during cardiac contraction and relaxation.
The primary use of calcium channel blockers in ACLS is for the treatment of stable, narrow complex tachycardias refractory to Adenosine and to lower the blood pressure of ischemic stroke patients with severe hypertension.
Use of calcium channel blockers for SVT refractory to Adenosine and A-Fib or A-Flutter with RVR.
Contraindications of calcium channel blockers.
Nicardipine use during the treatment of ischemic strokes.
For more information on ACLS medications, tachycardia, or stroke check out the pod resource page at passacls.com.
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The goal of CPR is to keep the brain and vital organs perfused until return of spontaneous circulation (ROSC) is achieved.
Post-arrest care and recovery are the final two links in the chain of survival.
Identification of ROSC during CPR.
Initial patient management goals after identifying ROSC.
The patient’s GCS/LOC should be evaluated to determine if targeted temperature management (TTM) is indicated.
Patients that cannot obey simple commands should receive TTM for at least 24 hours.
Monitoring the patient’s core temperature during TTM.
Why we should cool unresponsive post-arrest patients.
Patients can undergo EEG, CT, MRI, & PCI while receiving TTM.
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Nitroglycerine is vasodilator that affects peripheral blood vessels and coronary arteries.
Because of its widespread dilation effects on blood vessels, nitro can quickly lower a patient’s blood pressure, sometimes to the point of making a patient hypotensive.
Assessment of vital signs prior to administering nitro is necessary to ensure patient safety.
Indications for use of nitroglycerine.
Nitroglycerine's contraindications & considerations for use.
Effects of nitro on patients taking PDE inhibitors.
Administration of nitroglycerine to patients with ischemic chest pain.
Considerations for patients that took their home nitroglycerine.
Monitoring patient's pain and vital signs after nitro administration.
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In atrial fibrillation (A-Fib) and atrial flutter (A-Flutter) the electrical impulse for cardiac contraction is in the atria but isn't the normal pacemaker of the heart, the SA node.
The ECG characteristics of A-Fib and A-Flutter.
Recognition and treatment of unstable patients in A-Fib/Flutter with rapid ventricular response (RVR).
Suggested energy settings for synchronized cardioversion of unstable patients with a narrow complex tachycardia.
Team safety when cardioverting an unstable patient in A-FIB/Flutter.
Adenosine’s role for stable SVT patients with underlying atrial rhythms.
Treatment of stable patients in A-Fib/Flutter with RVR.
For other medical podcasts that cover narrow complex tachycardias, visit the pod resource page at passacls.com.
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As an ACLS provider you do not need to be familiar with all of the different signs of various types of poisoning. You should be able to obtain a history and know to order toxicology.
The majority of toxins don’t have a specific antidote. There are a few toxins for which we have emergency interventions and ACLS providers should be familiar with.
Reviewing the patient's medical history for indicators that may lead us to suspect a tablet/toxin cause of cardiac arrest.
Administration of Narcan for suspected narcotics overdose following the Opioid Associated Emergency algorithm.
Other common ACLS Tablet Toxin scenarios with possible treatments.
Medications commonly used to treat specific toxins that are regularly stocked on crash carts or carried in EMS med bags.
ACLS providers that suspect a specific toxin should consult with their Pharmacy or call Poison Control for treatment directions.
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Poison Myths and Misconceptions on The Pharmacists Voice podcast:
https://www.thepharmacistsvoice.com/podcast/poison-myths-and-misconceptions-discussion-part-1-of-5-with-angel-bivens-rph-and-wendy-stephan-phd/
The ACLS algorithms are designed to make it easier to remember the key interventions we should deliver, and the order in which they should be delivered, to provide the best evidence-based care possible.
Generally speaking, if there’s a change in a patient’s condition, we should ensure we’re using the correct algorithm.
Three key points to remember when using ACLS algorithms:
-
If a patient’s condition changes, we should do an assessment and use the algorithm that matches the patient’s current state.
-
If an action was already done, we don’t need to repeat it.
-
We only do actions that are clinically appropriate and within our scope of practice.
Walk through of an example mega code scenario with explanations of when and why we change to a different ACLS algorithm.
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Beta blocking medications attach to Beta receptors to inhibit or “block” the effects of epinephrine (adrenaline)and norepinephrine in the body.
The primary locations of Beta I, II, and III receptors.
Effects of epinephrine & norepinephrine’s stimulation of beta receptors on the heart.
Beta blockers effects on the heart.
When we should consider the use of beta blockers in the Acute Coronary Syndrome (ACS)and Tachycardia algorithms.
Contraindications to the use of beta blocker medications.
More detailed information about beta blocker’s mechanism of action and specific instances for their use can be found on the Pod Resource page at PassACLS.com.
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This episode we are reviewing the use of advanced airways in the adult cardiac arrest algorithm.
When we should consider insertion of an advanced airway for patients in a shockable vs non-shockable rhythm.
In addition to an endotracheal tube (ETT), other ACLS advanced airways include the Laryngeal Mask Airway (LMA) and the Laryngeal Tube airway.
The advantages of using an advanced airway over basic airway maneuvers.
Use of end tidal CO2 waveform capnography to confirm placement and assess the adequacy of CPR.
Identification and management of a misplaced ET tube.
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Our primary focus immediately following return of spontaneous circulation (ROSC) is aimed at ensuring adequate perfusion of the patient’s vital organs and decreasing cerebral damage.
Post-arrest goals for O2 saturation, ETCO2, and BP/MAP.
Indications for use of an antiarrhythmic after ROSC.
Determining which antiarrhythmic to use post cardiac arrest.
Administration of Amiodarone or Lidocaine to control ventricular ectopy after ROSC.
The use of Amiodarone post arrest if no antiarrhythmics were administered prior to obtaining ROSC.
Links to other medical podcasts that cover antiarrhythmics and other ACLS-related topics are on the Pod Resource page at PassACLS.com.
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Hydrogen ions is on one of the Hs in ACLS's H&T reversible causes of cardiac arrest. When considering hydrogen ions as a cause, what we’re looking at is the patient’s pH, or acid/base balance, and conditions that affect it.
The body's normal pH.
Using patient history, ABGs, & labs to determine acidosis or alkalosis.
Common conditions/causes that may lead us to suspect acidosis.
Common conditions/causes that may lead us to suspect alkalosis.
Correcting acidosis by changing the rate of ventilations.
The indications, dose, and considerations for use of Sodium Bicarbonate.
Treatment of alkalosis depends on the type (metabolic or respiratory) and is aimed at correcting the underlying cause.
Other podcasts that cover acid/base balance and conditions that cause acidosis or alkalosis can be found on the Pod Resource Page at PassACLS.com.
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Being the team leader during a cardiac arrest is challenging. Using an algorithm helps by standardizing & prioritizing our interventions using an If/Then methodology.
Review of BLS steps for determining if rescue breathing or CPR is needed and use of an AED for patients in cardiac arrest.
If the patient is in a non-shockable rhythm on the ECG such as PEA or asystole, we will go down the right side of the Adult Cardiac Arrest Algorithm.
If the patient is in a shockable rhythm on the ECG such as V-Fib or V-Tach, we will go down the left side of the Adult Cardiac Arrest Algorithm.
An example of a code's flow for shockable rhythms when an antiarrhythmic such as Amiodarone or Lidocaine is administered.
We will follow the algorithm until the patient has ROSC or we call the code.
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Other Pass ACLS episodes mentioned
Objective Measures of Good CPR https://passacls.com/bls/objective-measures-of-good-cpr
For patients exhibiting symptoms consistent with myocardial ischemia, Aspirin is the first medications we should consider along with morphine, oxygen, and nitroglycerine; if indicated & safe.
Aspirin's mechanism of action & benefits for Acute Coronary Syndrome (ACS) patients.
Contraindications and considerations for aspirin’s use.
The dose and route of administration of aspirin for ACS patients.
The use of aspirin in the ACLS Stroke algorithm.
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To pass ACLS, you will need to be able to identify common rhythms on a monitor during your mega code and ECG strips on your written exam.
If you don't normally monitor patients as part of your job, I suggest two things:
-
Find a system for ECG interpretation that works well for you; and
-
Practice reading ECGs every day for a few weeks before your class.
Review of normal ECG morphology of P wave, QRS complex, and T wave in lead II.
Characteristics of first degree heart block.
Characteristics of third degree (complete) AV block.
Treatment of unstable patients in third degree block following the ACLS Bradycardia algorithm.
Special considerations for use of Atropine when patients are in a third degree heart block.
The use of TCP, Dopamine, & Epinephrine drip for unstable bradycardic patients refractory to Atropine.
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Practice ECGs at Dialed Medics: https://dialedmedics.com/
In the Adult Cardiac Arrest algorithm, we should administer an antiarrhythmic medication to patients in V-Fib or pulseless ventricular tachycardia approximately two minutes after the first dose of epinephrine.
The two first-line ACLS antiarrhythmics that are generally used are Amiodarone and Lidocaine.
Review of Lidocaine dosing and administration to patients in persistent V-Fib or pulseless V-Tach.
Review of Amiodarone dosing and administration to patients in persistent V-Fib or pulseless V-Tach.
Use of antiarrhythmic infusions post-cardiac arrest to suppress ventricular ectopy.
Amiodarone use & dosing for stable patients in V-Tach with a pulse.
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The tongue is the most common airway obstruction in an unconscious patient.
For patients with a decreased level of consciousness that can't control their airway, yet have an intact gag reflex, the nasopharyngeal airway (NPA) should be used as an alternative to the oropharyngeal airway (OPA).
Examples of when a NPA should be considered.
Contraindications and considerations for nasal airway insertion.
Measuring a nasal airway for appropriate length and diameter.
Insertion of a nasopharyngeal airway into the right vs left nostril.
Patients with a NPA in place can receive supplemental O2, be ventilated with a BVM, have ETCO2 monitored, and have their upper airway suctioned as needed.
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When blood, or other fluids, accumulate in the sac around the heart it’s called a cardiac tamponade or pericardial tamponade.
The effects of tamponade on the electrical system and chambers of the heart.
Cardiac tamponade can be acute or chronic and caused by traumatic, iatrogenic, or pathological etiologies.
Common traumatic events, medical procedures, and diseases that can result in a pericardial tamponade.
Signs & symptoms of cardiac tamponade.
Treatment of cardiac tamponade with pericardiocentesis.
For additional information on cardiac tamponade, check out the Pod Resources page at PassACLS.com.
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Two things have changed in recent years to aid students that don't use ACLS in their daily practice.
-
The role of the team leader; and
-
The ability to use your quick reference cards.
The team leader is responsible for assigning tasks and overall direction of the team but can & should ask team members for help.
Using closed-loop communication to ensure the clarity of orders and speaking up if there’s any doubt about an order or action.
Use of your course’s approved text book and quick reference cards during the megacode and written exam.
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Two factors to cardiac arrest survivability that have been clearly shown to make the biggest difference is continuous, high-quality CPR and early defibrillation.
The most common dysrhythmia present during the first few minutes of cardiac arrest is ventricular fibrillation (VF).
The chance of successful defibrillation decreases every minute that passes.
How our chance of successfully defibrillating a patient into a perfusing rhythm significantly changes when good CPR is delivered vs when it isn't.
Why bystander CPR is important for out-of-hospital cardiac arrest (OHCA) outcomes.
The role of the CPR coach.
Five tips to aid us in limiting CPR interruptions to less than 10 seconds so we can maintain a chest compression fraction (CCF) of at least 80%.
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Quantitative waveform capnography is used in ACLS as a way to confirm good CPR and placement of an endotracheal tube; identify return of spontaneous circulation; and during post-cardiac arrest care.
We can use waveform capnography with, and without, an advanced airway in place.
Monitoring end tidal CO2 during rescue breathing.
Use of capnography to objectively measure good CPR.
Capnography is a preferred method of confirming endotracheal tube (ETT) placement over x-ray during a code.
During CPR, a sudden increase in ETCO2 may indicate ROSC.
Quantitative waveform capnography use in the post-cardiac arrest algorithm.
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Patients with a narrow complex tachycardia with a rate over 150 BPM are in SVT.
Unstable patients in SVT, or V-Tach with a pulse, should be cardioverted with a synchronized shock.
Assessment & treatment of stable tachycardic patients.
Commonly used vagal techniques.
A less common technique to stimulate the vagus nerve is the dive reflex.
Indications and use of Adenosine for stable patients in SVT refractory to vagal maneuvers.
Possible treatments for patients found to be in A-Fib or A-Flutter with RVR after administration of Adenosine.
Carotid sinus massage.
Additional medical podcasts that have episodes on tachycardia can be found on the pod resources page at passacls.com.
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Remembering all the different energy setting needed for synchronized cardioversion and defibrillation used to be confusing for a lot of people.
Defibrillators can be broken down into three basic categories:
-
Automated External Defibrillator (AED);
-
Biphasic defibrillators; and
-
Monophasic defibrillators.
Use of an AED to rapidly deliver a shock.
Advantages & use of Biphasic defibrillators.
For monophasic defibrillators, use 360J to defibrillate V-Fib or pulseless V-Tach.
AEDs must not be used on patients with a pulse.
Cardioversion of patients in unstable SVT or V-Tach with a pulse using biphasic vs monophasic monitor/defibrillators.
Team safety when performing synchronized cardioversion.
Energy needed to cardiovert unstable patients with a narrow vs wide complex tachycardia.
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Patients with a heart rate less than 60 are bradycardic. Some people can have a resting heart rate in the 40s without any compromise. For others, a heart rate of 50 or less could signify the need for immediate intervention and warrants additional assessment.
Signs & symptoms that indicate a bradycardic patient is unstable.
Monitoring oxygen saturation with pulse oximetry and indications for administration of oxygen.
Calcium channel blockers and beta blocker medication as treatable causes of bradycardia.
The indications and dosage of Atropine.
Precautions for Atropine use in patients with second or third degree AV blocks.
The use of transcutaneous pacing (TCP) for unstable bradycardic patients refractory to Atropine.
The use and dosing of Dopamine and Epinephrine drips.
For additional information about causes and treatment of bradycardia, check out the pod resources page at PassACLS.com.
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The goal of CPR is to keep the brain and vital organs perfused until return of spontaneous circulation (ROSC) is achieved.
Post-arrest care and recovery are the final two links in the chain of survival.
Identification of ROSC during CPR.
Initial patient management goals after identifying ROSC.
The patient’s GCS/LOC should be evaluated to determine if targeted temperature management (TTM) is indicated.
Patients that cannot obey simple commands should receive TTM for at least 24 hours.
Recently published studies on TTM and ACLS’s current standard.
Monitoring the patient’s core temperature during TTM.
Patients can undergo EEG, CT, MRI, & PCI while receiving TTM.
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The chain of survival for ACLS is the same as was learned in your BLS class.
The beginning steps of the Cardiac Emergency and Stroke chain of survival.
ACLS's timed goals for first medical contact to PCI for STEMI and door-to-needle for ischemic stroke.
Characteristics of areas that have significantly better stroke and out-of-hospital cardiac arrest outcomes.
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Heart muscle contraction and repolarization is dependent on Sodium, Calcium, Magnesium, and Potassium ions crossing cellular membranes.
When a patient’s potassium levels get too low or too high, hypokalemia or hyperkalemia results respectively.
Two things that may lead us to suspect hypo or hyperkalemia.
Medical conditions & medications that can cause potassium imbalance.
ECG changes seen in hypo and hyperkalemia.
Critical lab values that would indicate a need for treatment.
Emergent, ACLS interventions for hypokalemia and hyperkalemia.
Additional information on causes of hypo and hyperkalemia can be found on Ninja Nerd podcast. Check out the pod resources page at passacls.com.
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When treating patients having an MI or stroke, more minutes equals more dead cells.
Because the majority of strokes are the ischemic type, the treatment for stroke is similar to an MI – to reestablish perfusion to the ischemic tissues.
Review the first four steps in the Stroke Chain of Survival.
Time criteria for the administration of tPA (or a similar fibrinolytic medication) or EVT of LVO strokes.
Stroke benchmarks for door to:
- assessment;
- completing a non-contrast CT; and
- administration of fibrinolytic medication such as tPA (door-to-needle).
EMS interaction with stroke teams and destination protocols to reduce time to definitive care.
The difference for timed goals for the identification & treatment of AMI vs Stroke.
Additional information about timed goals for stroke and how EMS affects outcomes, can be
found on the PassACLS.com pod resources page.
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Adenosine is the first IV medication given to stable patients with sustained supraventricular tachycardia (SVT) refractory to vagal maneuvers.
Symptoms indicating a stable vs unstable patient.
Common causes of tachycardia.
Cardiac effects of Adenosine.
Indications for use in the ACLS Tachycardia algorithm.
Considerations and contraindications.
Adenosine as a diagnostic for patients in A-Fib or A-Flutter with RVR.
Dosing and administration.
Other podcasts that cover common ACLS antiarrhythmics in more detail and another covering Brugata Criteria used to differentiate V-Tach from SVT with an aberrancy, can be found on the Pod Resources page at passacls.com.
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To pass the written ACLS exam and mega code, students need to be able to identify basic ECG dysrhythmias, including the two types of second-degree heart block.
One method of ECG rhythm identification is to ask a series of questions such as:
- What's the rate (<60, 60-100, 101-149, or >150);
- Is the rhythm regular or irregular;
- What's the shape, width, and frequency of P waves and QRS complexes; and
- What's the P-R interval and is it constant?
ECG characteristics of a second-degree Mobitz type I (Wenckebach).
Identification of unstable bradycardia and its treatment with Atropine.
ECG characteristics of a second-degree Mobitz type II.
Possible effect of using Atropine on patients with a second-degree type II AV block.
Treatment of unstable bradycardic patients refractory to Atropine using TCP, Dopamine, or Epinephrine drip.
Starting dose and titration of Dopamine and Epinephrine drips.
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The Curious Clinicians: History of Doctor Wenckebach & Mobitz: https://curiousclinicians.com/2022/07/06/episode-52-way-back-wenckebach/
Practice ECGs with rationale at Dialed Medics: https://dialedmedics.com/
When treating patients with Acute Coronary Syndrome (ACS), MONA is an acronym sometimes used to help us remember the initial interventions.
The O in MONA is Oxygen.
When we should administer oxygen to ACS patients.
When O2 administration is unnecessary based on an accurate pulse ox.
Monitoring patient's oxygen saturation (SaO2) using a pulse oximeter.
Review two common ACLS pre-arrest mega code scenarios.
Oxygen administration during CPR and post cardiac arrest.
You can find additional medical podcasts that cover ACLS-related topics, on the Pod Resources page at PassACLS.com
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Check out ConveyMed.io for more free online medical education (FOAMed) opportunities.
Along with early defibrillation, high quality CPR with minimal interruptions is one of the two factors that has been shown to improve cardiac arrest outcomes.
How do we know if high quality, effective CPR is being performed?
Objective measures of good, high-quality CPR include:
- Compression rate;
- Compression depth & recoil;
- ETCO2; and
- Chest Compression Fraction (CCF).
The role of the CPR Coach on the code team.
The advantages and use of real-time feedback devices to monitor the rate, depth, and chest recoil of CPR compressions.
The use of end tidal waveform capnography. (ETCO2)
A no-tech way to monitor effective CPR if no compression feedback device or ETCO2 capnography isn’t available.
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When we should use the bradycardia algorithm.
The signs & symptoms of unstable bradycardia.
Atropine's bradycardic dose and maximum.
The use of atropine when a patient is in a second degree type II or third degree heart block.
ECG changes that indicate subsequent doses of atropine are likely to be ineffective.
The starting dose of Dopamine.
The use of Dopamine for bradycardia as an interim until TCP vs hypotension.
The use of Atropine and Dopamine in patients with myocardial ischemia.
Podcasts with additional (advanced-provider level) information about bradycardia, Atropine, & Dopamine can be found on the Pass ACLS Pod Resources page.
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The tongue is the most common airway obstruction in an unconscious patient.
Insertion an oropharyngeal airway helps keep the patient’s tongue from falling to the back of the pharynx, causing an airway obstruction.
The oropharyngeal airway is sometimes called an OPA or simply an oral airway.
Indications for using an oral airway.
Contraindication for an oral airway and an alternative airway that can be used for patients with an intact gag reflex.
Measuring an OPA and possible complications from inserting one that's too small or too large.
Two techniques to properly insert an OPA.
The use of an oral airway during CPR.
The use of an OPA as a bite block after a patient has an advanced airway placed.
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Hypoxia is a state of low oxygen levels in the blood.
Determining hypoxia using a pulse oximeter or arterial blood gasses (ABGs).
A goal of ACLS is to recognize signs of hypoxia and provide timely treatment to prevent an arrest.
Examples of some things that might lead us to think of hypoxia as a cause of cardiac arrest.
Why we should not rely on pulse ox to give accurate readings during CPR.
Delivering ventilations with near 100% oxygen concentration using a BVM attached to supplemental O2 and a reservoir.
Using end tidal waveform capnography to assess the quality of CPR.
Changes to ventilation rates, tidal volume, and O2 concentration affects a patient's oxygen, carbon dioxide, and pH.
The danger of excessive ventilation of a patient in cardiac arrest.
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ECG characteristics of supraventricular tachycardia (SVT) vs. sinus tachycardia.
Signs & symptoms that indicate a patient is unstable.
Delivery of a synchronized shock for the treatment of unstable SVT using a biphasic vs monophasic defibrillator.
Consideration for team safety while performing synchronized cardioversion.
Actions to take immediately if an unstable patient we’ve cardioverted goes into a pulseless rhythm.
Management of stable patients in SVT.
For more FOAMed on narrow complex tachycardias, check out the pod resource page at passacls.com.
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When working to resuscitate a patient in sudden cardiac arrest, Epinephrine is the first IV medication we administer.
When we give the first dose of epinephrine depends on whether the patient is in a shockable or non-shockable rhythm.
When to give the first dose of epinephrine and its frequency for patients in asystole or PEA following the right side of the Adult Cardiac Arrest algorithm.
When to give the first dose of epi and its frequency for patients in V-Fib or pulseless V-Tach following the left side of the Adult Cardiac Arrest algorithm.
Example chronology of events for a scenario where a patient is found unresponsive with only gasping/agonal breathing.
Administration of epi via the IO or endotracheal route in the absence of an IV.
The maximum cumulative dose of epinephrine that can be administered to patients in cardiac arrest.
When do we stop administering epinephrine.
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If a person suddenly develops symptoms such as weakness, slurred or garbled speech, loss of balance, or a massive & severe headache; it’s possible they could be having a stroke.
The Cincinnati Prehospital Stroke Scale.
There are several conditions that can mimic a stroke.
Identification & treatment of hypoglycemia or hyperglycemia.
Identification & treatment of hypoxia using a pulse oximeter.
Some seizures, electrolyte imbalance, sepsis, brain tumors, and Bell’s Palsy can also mimic a stroke.
Prehospital providers should transport suspected stroke patients to a stroke center following their local protocols.
Hospital providers should active their stroke team to ensure rapid assessment and treatment.
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Most ACLS medications are given IV push. But, what happens if we can't get an IV?
Why IO is better than ETT as an alternative route.
The locations we should place an IO when running a code and a location we should avoid.
The ACLS medications that can be given intraosseous.
Where you can find more information about intraosseous access during resuscitation efforts.
In the absence of an IV or IO, some medications may be given down the endotracheal tube.
The disadvantages of medication administration via ETT.
Review of the medications that can be given down the tube and how they should be given.
Medications should not be given down the tube when anything other than an endotracheal tube is used as an advanced airway.
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The chain of survival for a cardiac emergency and stroke start the same:
- preparedness & recognition of an emergency;
- activation of EMS;
- delivery of Advanced Life Support; and
- transporting to the most appropriate facility.
ALS ambulances are staffed with paramedics who have training in ACLS skills.
Why EMS "Destination Protocols" for suspected stroke and STEMI make a difference.
ACLS’s timed benchmarks for:
- point of first medical contact to PCI for ST elevation MI;
- door to tPA for ischemic stroke; and
- onset of symptoms to EVT for LVO strokes.
Why EMS should bypass a close hospital to transport a STEMI or suspected stroke patient to a hospital capable of 24/7 PCI or a certified stroke center.
Check out the Pod Resource page at passacls.com for links to the "EMS On Air" podcast for links to episodes that look at EMS's role in stroke outcomes in the rural vs urban area.
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Performing good CPR and delivering a shock as soon as possible to a patient in Ventricular Fibrillation or pulseless V-Tach are the two most critical interventions that have been shown to increase survival from sudden cardiac arrest.
Studies have demonstrated significantly better out-of-hospital cardiac arrest survival outcomes in communities with robust public CPR training and public access/first responder AEDs.
The general use of AED including: indications for use; attaching the AED pads; following verbal prompts; and safely administering a shock.
Following the Adult Cardiac Arrest algorithm while using an AED.
Contraindications to AED use.
General safety considerations to remember.
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For apneic patients without a carotid pulse or patients with only gasping/agonal respirations, we will follow the Adult Cardiac Arrest algorithm.
For pulseless patients that the AED doesn't advise a shock, the patient's ECG shows asystole, or a non-perfusing organized rhythm (PEA), we will follow the right side of the Adult Cardiac Arrest algorithm.
Initial steps are aimed at delivery of high-quality CPR to keep the brain and vital organs alive.
Epinephrine administration.
Placement of an advanced airway.
Considering possible reversible H & T causes of cardiac arrest including three common causes of PEA and their emergent interventions.
When we should discontinue resuscitation efforts and call the code.
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Providing good, high-quality CPR with minimal interruptions and early defibrillation are two key interventions shown to improved cardiac arrest outcomes.
A training tool used in many CPR and ACLS classes is to use a song (or a song list) with a tempo of 100 to 120 beats per minute to help the person doing chest compressions maintain an adequate rate.
Characteristics of good songs that will help us.
Advantages & disadvantages of using a song during CPR.
Selected songs from various genres and time periods from AHA's "Don’t Drop The Beat" playlist on Spotify.
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AHA's "Don’t Drop The Beat" playlist on Spotify: https://open.spotify.com/playlist/2mU2FNAhSOtQwW0hBgQMaK
A patient’s medical history will help us identify things that may be causing (or contributing) to their current condition as well as guide our decisions so we provide the safest evidence-based care possible.
Examples of information obtained in a medical history that will impact the treatment we provide.
There are several mnemonics and memory aids that people use to guide their history taking.
Review the SAMPLE-PQRST medical history format.
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Although magnesium can be used in the treatment of other medical conditions such as eclampsia, asthma, & digitalis toxicity; for ACLS, magnesium is primarily used to treat Torsades de Pointes.
Identification of Torsades on the ECG.
Administration of a magnesium infusion for stable patients vs slow IV push for patients in cardiac arrest.
Procainamide use for stable patients with a monomorphic wide-complex tachycardia.
Procainamide dosing and when to stop the infusion.
Tip for determining whether magnesium or Procainamide should be used when treating stable patients with V-Tach.
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When a patient loses excessive amounts of fluids, we say that they are in a state of hypovolemia.
The most obvious cause of hypovolemia is from bleeding.
Bleeding can be internal or external and caused by trauma, pathology, or iatrogenic.
Classic signs & symptoms of hypovolemic shock.
Volume replacement with crystalloids vs blood.
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MONA is the acronym sometimes used to help us remember the interventions to consider for patients with Acute Coronary Syndrome or ACS.
Morphine's use in the Acute Coronary Syndrome (ACS) algorithm.
Why Morphine is helpful for patients with ACS.
Contraindications and considerations for the safe administration of Morphine.
Morphine as an alternative to nitro for patients with chest pain that take PDE inhibitors.
Common dosing & administration of Morphine.
Monitoring of the patient's level of consciousness, pain, blood pressure, and respirations after administration.
Possible side effects of Morphine administration.
Narcan as an antidote to Morphine if needed.
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Even good CPR is far less efficient at circulating blood than a functioning heart.
The indicators of high-quality CPR that were identified at the 2012 AHA CPR Quality Summit in order of importance include:
- Chest compression fraction (CCF);
- Chest compression rate;
- Chest compression depth;
- Allowing for full recoil; and
- Adequate ventilations.
Using real-time feedback devices and ETCO2 to assess CPR quality.
Three tips to limit pauses in CPR compressions to 10 seconds or less.
Limiting interruptions to chest compressions to less than 10 seconds so we can maintain a CCF of 80% requires teamwork and communication.
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Epinephrine and Dopamine are adrenergic agonist used in several ACLS algorithms.
The use of epinephrine for severe anaphylaxis and unstable bradycardia.
Review epinephrine’s effects on blood vessels and bronchioles.
Why epinephrine is helpful for patients with anaphylaxis.
Using an epi drip for unstable bradycardia.
Epinephrine administration during cardiac arrest.
Starting and epinephrine or Dopamine drip for patients that have ROSC.
Review the effects of Dopamine based on mcg/kg/min dosing.
Monitoring the patient and titrating epi or Dopamine drips to prevent harm.
For more information on ACLS medications, check out the pod resource page at passacls.com.
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Providing rescue breathing to apneic patients with a palpable pulse.
Normal end tidal CO2 for patients with a pulse.
Identification of cardiac arrest and our immediate actions.
Providing artificial ventilations during CPR without an advanced airway vs with an advanced airway in place.
Using quantitative waveform capnography to confirm placement of an advanced airway, assess the quality of CPR, and identify ROSC.
The effects of hyperventilating patients in cardiac arrest.
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Hypothermic patients aren't dead until they are warm and dead.
When a patient’s core body temperature drops below 96.8 F (36 C), they are hypothermic.
As the body’s temperature drops below 36 C, hypothermia may further be classified as moderate or severe:
- Moderate if the patient’s body core temp is between 30-34 C; and
- Severe if it's below 30 C.
Modifying the ACLS Adult Cardiac Arrest algorithm for patients with severe hypothermia.
Following the ACLS algorithm for patients with a body core temperature above 30 C.
Methods for rewarming patients with moderate vs severe hypothermia.
Continuation of CPR and ACLS efforts until the patient’s body core temp is above 36 C.
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Calcium is one of the ions that move across the cellular membrane during cardiac contraction and relaxation.
The primary use of calcium channel blockers in ACLS is for the treatment of stable, narrow complex tachycardias refractory to Adenosine and to lower the blood pressure of ischemic stroke patients with severe hypertension.
Use of calcium channel blockers for SVT refractory to Adenosine and A-Fib or A-Flutter with RVR.
Contraindications of calcium channel blockers.
Nicardipine use during the treatment of ischemic strokes.
For more information on ACLS medications, tachycardia, or stroke check out the pod resource page at passacls.com.
Thank you and shout out!
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The goal of CPR is to keep the brain and vital organs perfused until return of spontaneous circulation (ROSC) is achieved.
Post-arrest care and recovery are the final two links in the chain of survival.
Identification of ROSC during CPR.
Initial patient management goals after identifying ROSC.
The patient’s GCS/LOC should be evaluated to determine if targeted temperature management (TTM) is indicated.
Patients that cannot obey simple commands should receive TTM for at least 24 hours.
Monitoring the patient’s core temperature during TTM.
Why we should cool unresponsive post-arrest patients.
Patients can undergo EEG, CT, MRI, & PCI while receiving TTM.
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Nitroglycerine is vasodilator that affects peripheral blood vessels and coronary arteries.
Because of its widespread dilation effects on blood vessels, nitro can quickly lower a patient’s blood pressure, sometimes to the point of making a patient hypotensive.
Assessment of vital signs prior to administering nitro is necessary to ensure patient safety.
Indications for use of nitroglycerine.
Nitroglycerine's contraindications & considerations for use.
Effects of nitro on patients taking PDE inhibitors.
Administration of nitroglycerine to patients with ischemic chest pain. (ACS)
Considerations for patients that took their home nitroglycerine.
Monitoring patient's pain and vital signs after nitro administration.
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In atrial fibrillation (A-Fib) and atrial flutter (A-Flutter) the electrical impulse for cardiac contraction is in the atria but isn't the normal pacemaker of the heart, the SA node.
The ECG characteristics of A-Fib and A-Flutter.
Recognition and treatment of unstable patients in A-Fib/Flutter with rapid ventricular response (RVR).
Suggested energy settings for synchronized cardioversion of unstable patients with a narrow complex tachycardia.
Team safety when cardioverting an unstable patient in A-FIB/Flutter.
Adenosine’s role for stable SVT patients with underlying atrial rhythms.
Treatment of stable patients in A-Fib/Flutter with RVR.
For other medical podcasts that cover narrow complex tachycardias, visit the pod resource page at passacls.com.
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As an ACLS provider you do not need to be familiar with all of the different signs of various types of poisoning. You should be able to obtain a history and know to order toxicology.
The majority of toxins don’t have a specific antidote. There are a few toxins for which we have emergency interventions and ACLS providers should be familiar with.
Reviewing the patient's medical history for indicators that may lead us to suspect a tablet/toxin cause of cardiac arrest.
Administration of Narcan for suspected narcotics overdose following the Opioid Associated Emergency algorithm.
Other common ACLS Tablet Toxin scenarios with possible treatments.
Medications commonly used to treat specific toxins that are regularly stocked on crash carts or carried in EMS med bags.
ACLS providers that suspect a specific toxin should consult with their Pharmacy or call Poison Control for treatment directions.
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"Poison Myths and Misconceptions" Discussion with Pharmacist Kim Newlove: https://www.thepharmacistsvoice.com/podcast/poison-myths-and-misconceptions-discussion-part-1-of-5-with-angel-bivens-rph-and-wendy-stephan-phd/
The ACLS algorithms are designed to make it easier to remember the key interventions we should deliver, and the order in which they should be delivered, to provide the best evidence-based care possible.
Generally speaking, if there’s a change in a patient’s condition, we should ensure we’re using the correct algorithm.
Three key points to remember when using ACLS algorithms:
-
If a patient’s condition changes, we should do an assessment and use the algorithm that matches the patient’s current state.
-
If an action was already done, we don’t need to repeat it.
-
We only do actions that are clinically appropriate and within our scope of practice.
Walk through of an example mega code scenario with explanations of when and why we change to a different ACLS algorithm.
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Beta blocking medications attach to Beta receptors to inhibit or “block” the effects of epinephrine (adrenaline)and norepinephrine in the body.
The primary locations of Beta I, II, and III receptors.
Effects of epinephrine & norepinephrine’s stimulation of beta receptors on the heart.
Beta blockers effects on the heart.
When we should consider the use of beta blockers in the Acute Coronary Syndrome (ACS) and Tachycardia algorithms.
Contraindications to the use of beta blocker medications.
More detailed information about beta blocker’s mechanism of action and specific instances for their use can be found on the Pod Resource page at PassACLS.com.
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This episode we are reviewing the use of advanced airways in the adult cardiac arrest algorithm.
When we should consider insertion of an advanced airway for patients in a shockable vs non-shockable rhythm.
In addition to an endotracheal tube (ETT), other ACLS advanced airways include the Laryngeal Mask Airway (LMA) and the Laryngeal Tube airway.
The advantages of using an advanced airway over basic airway maneuvers.
Use of end tidal CO2 waveform capnography to confirm placement and assess the adequacy of CPR.
Identification and management of a misplaced ET tube.
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Hydrogen ions is on one of the Hs in ACLS's H&T reversible causes of cardiac arrest.
When considering hydrogen ions as a cause, what we’re looking at is the patient’s pH, or acid/base balance, and conditions that affect it.
The body's normal pH.
Using patient history, ABGs, & labs to determine acidosis or alkalosis.
Common conditions/causes that may lead us to suspect acidosis.
Common conditions/causes that may lead us to suspect alkalosis.
Correcting acidosis by changing the rate of ventilations.
The indications, dose, and considerations for use of Sodium Bicarbonate.
Treatment of alkalosis depends on the type (metabolic or respiratory) and is aimed at correcting the underlying cause.
Other FOAMed podcasts that cover acid/base balance and conditions that cause acidosis or alkalosis can be found on the Pod Resource Page at PassACLS.com.
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Being the team leader during a cardiac arrest is challenging. Using an algorithm helps by standardizing & prioritizing our interventions using an If/Then methodology.
Review of BLS steps for determining if rescue breathing or CPR is needed and use of an AED for patients in cardiac arrest.
If the patient is in a non-shockable rhythm on the ECG such as PEA or asystole, we will go down the right side of the Adult Cardiac Arrest Algorithm.
If the patient is in a shockable rhythm on the ECG such as V-Fib or V-Tach, we will go down the left side of the Adult Cardiac Arrest Algorithm.
An example of a code's flow for shockable rhythms when an antiarrhythmic such as Amiodarone or Lidocaine is administered.
We will follow the algorithm until the patient has ROSC or we call the code.
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Other Pass ACLS episodes mentioned
Objective Measures of Good CPR https://passacls.com/bls/objective-measures-of-good-cpr
For patients exhibiting symptoms consistent with myocardial ischemia, Aspirin is the first medications we should consider along with morphine, oxygen, and nitroglycerine; if indicated & safe.
Aspirin's mechanism of action & benefits for Acute Coronary Syndrome (ACS) patients.
Contraindications and considerations for aspirin’s use.
The dose and route of administration of aspirin for ACS patients.
The use of aspirin in the ACLS Stroke algorithm.
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To pass ACLS, you will need to be able to identify common rhythms on a monitor during your mega code and ECG strips on your written exam.
If you don't normally monitor patients as part of your job, I suggest two things:
-
Find a system for ECG interpretation that works well for you; and
-
Practice reading ECGs every day for a few weeks before your class.
Review of normal ECG morphology of P wave, QRS complex, and T wave in lead II.
Characteristics of first degree heart block.
Characteristics of third degree (complete) AV block.
Treatment of unstable patients in third degree block following the ACLS Bradycardia algorithm.
Special considerations for use of Atropine when patients are in a third degree heart block.
The use of TCP, Dopamine, & Epinephrine drip for unstable bradycardic patients refractory to Atropine.
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Visit Dialed medics for online practice ECGs at: https://dialedmedics.com/
In the Adult Cardiac Arrest algorithm, we should administer an antiarrhythmic medication to patients in V-Fib or pulseless ventricular tachycardia approximately two minutes after the first dose of epinephrine.
The two first-line ACLS antiarrhythmics that are generally used are Amiodarone and Lidocaine.
Review of Lidocaine dosing and administration to patients in persistent V-Fib or pulseless V-Tach.
Review of Amiodarone dosing and administration to patients in persistent V-Fib or pulseless V-Tach.
Use of antiarrhythmic infusions post-cardiac arrest to suppress ventricular ectopy.
Amiodarone use & dosing for stable patients in V-Tach with a pulse.
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The tongue is the most common airway obstruction in an unconscious patient.
For patients with a decreased level of consciousness that can't control their airway, yet have an intact gag reflex, the nasopharyngeal airway (NPA) should be used as an alternative to the oropharyngeal airway (OPA).
Examples of when a NPA should be considered.
Contraindications and considerations for nasal airway insertion.
Measuring a nasal airway for appropriate length and diameter.
Insertion of a nasopharyngeal airway.
Patients with a NPA in place can receive supplemental O2, be ventilated with a BVM, have ETCO2 monitored, and have their upper airway suctioned as needed.
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When blood, or other fluids, accumulate in the sac around the heart it’s called a cardiac tamponade or pericardial tamponade.
The effects of tamponade on the electrical system and chambers of the heart.
Cardiac tamponade can be acute or chronic and caused by traumatic, iatrogenic, or pathological etiologies.
Common traumatic events, medical procedures, and diseases that can result in a pericardial tamponade.
Signs & symptoms of cardiac tamponade.
Treatment of cardiac tamponade with pericardiocentesis.
For additional information on cardiac tamponade, check out the Pod Resources page at PassACLS.com.
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Two things have changed in recent years to aid students that don't use ACLS in their daily practice.
- The role of the team leader; and
- The ability to use your quick reference cards.
The team leader is responsible for assigning tasks and overall direction of the team but can & should ask team members for help.
Using closed-loop communication to ensure the clarity of orders and speaking up if there’s any doubt about an order or action.
Use of your course’s approved text book and quick reference cards during the megacode and written exam.
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Two factors to cardiac arrest survivability that have been clearly shown to make the biggest difference is continuous, high-quality CPR and early defibrillation.
The most common dysrhythmia present during the first few minutes of cardiac arrest is ventricular fibrillation.
The chance of successful defibrillation decreases every minute that passes.
How our chance of successfully defibrillating a patient into a perfusing rhythm significantly changes when good CPR is delivered vs when it isn't.
Why bystander CPR is important for out-of-hospital cardiac arrest (OHCA) outcomes.
The role of the CPR coach.
Five tips to aid us in limiting CPR interruptions to less than 10 seconds so we can maintain a chest compression fraction (CCF) of at least 80%.
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Quantitative waveform capnography is used in ACLS as a way to confirm good CPR and placement of an endotracheal tube; identify return of spontaneous circulation; and during post-cardiac arrest care.
We can use waveform capnography with, and without, an advanced airway in place.
Monitoring end tidal CO2 during rescue breathing.
Use of capnography to objectively measure good CPR.
Capnography is a preferred method of confirming endotracheal tube (ETT) placement over x-ray during a code.
During CPR, a sudden increase in ETCO2 may indicate ROSC.
Quantitative waveform capnography use in the post-cardiac arrest algorithm.
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Patients with a narrow complex tachycardia with a rate over 150 BPM are in SVT.
Unstable patients in SVT, or V-Tach with a pulse, should be cardioverted with a synchronized shock.
Assessment & treatment of stable tachycardic patients.
Commonly used vagal techniques.
A less common technique to stimulate the vagus nerve is the dive reflex.
Indications and use of Adenosine for stable patients in SVT refractory to vagal maneuvers.
Possible treatments for patients found to be in A-Fib or A-Flutter with RVR after administration of Adenosine.
Carotid sinus massage.
Additional medical podcasts that have episodes on tachycardia can be found on the pod resources page at passacls.com.
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Remembering all the different energy setting needed for synchronized cardioversion and defibrillation used to be confusing for a lot of people.
Defibrillators can be broken down into three basic categories:
-
Automated External Defibrillator (AED);
-
Biphasic defibrillators; and
-
Monophasic defibrillators.
Use of an AED to rapidly deliver a shock.
Advantages & use of Biphasic defibrillators.
For monophasic defibrillators, use 360J to defibrillate V-Fib or pulseless V-Tach.
AEDs must not be used on patients with a pulse.
Cardioversion of patients in unstable SVT or V-Tach with a pulse using biphasic vs monophasic monitor/defibrillators.
Team safety when performing synchronized cardioversion.
Energy needed to cardiovert unstable patients with a narrow vs wide complex tachycardia.
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Patients with a heart rate less than 60 are bradycardic. Some people can have a resting heart rate in the 40s without any compromise. For others, a heart rate of 50 or less could signify the need for immediate intervention and warrants additional assessment.
Signs & symptoms that indicate a bradycardic patient is unstable.
Monitoring oxygen saturation with pulse oximetry and indications for administration of oxygen.
Calcium channel blockers and beta blocker medication as treatable causes of bradycardia.
The indications and dosage of Atropine.
Precautions for Atropine use in patients with second or third degree AV blocks.
The use of transcutaneous pacing (TCP) for unstable bradycardic patients refractory to Atropine.
The use and dosing of Dopamine and Epinephrine drips.
For additional information about causes and treatment of bradycardia, check out the pod resources page at PassACLS.com.
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The goal of CPR is to keep the brain and vital organs perfused until return of spontaneous circulation (ROSC) is achieved.
Post-arrest care and recovery are the final two links in the chain of survival.
Identification of ROSC during CPR.
Initial patient management goals after identifying ROSC.
The patient’s GCS/LOC should be evaluated to determine if targeted temperature management (TTM) is indicated.
Patients that cannot obey simple commands should receive TTM for at least 24 hours.
Recently published studies on TTM and ACLS’s current standard.
Monitoring the patient’s core temperature during TTM.
Patients can undergo EEG, CT, MRI, & PCI while receiving TTM.
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The chain of survival for ACLS is the same as was learned in your BLS class.
The beginning steps of the Cardiac Emergency and Stroke chain of survival.
ACLS's timed goals for first medical contact to PCI for STEMI and door-to-needle for ischemic stroke.
Characteristics of areas that have significantly better stroke and out-of-hospital cardiac arrest outcomes.
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Heart muscle contraction and repolarization is dependent on Sodium, Calcium, Magnesium, and Potassium ions crossing cellular membranes.
When a patient’s potassium levels get too low or too high, hypokalemia or hyperkalemia results respectively.
Two things that may lead us to suspect hypo or hyperkalemia.
Medical conditions & medications that can cause potassium imbalance.
ECG changes seen in hypo and hyperkalemia.
Critical lab values that would indicate a need for treatment.
Emergent, ACLS interventions for hypokalemia and hyperkalemia.
Additional information on causes of hypo and hyperkalemia can be found on Ninja Nerd podcast. Check out the pod resources page at passacls.com.
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When treating patients having an MI or stroke, more minutes equals more dead cells. Because the majority of strokes are the ischemic type, the treatment for stroke is similar to an MI; to reestablish perfusion to the ischemic tissues.
Review the first four steps in the Stroke Chain of Survival.
Time criteria for the administration of tPA or EVT of LVO strokes.
Stroke benchmarks for door to:
- assessment;
- completing a non-contrast CT; and
- administration of tPA (door-to-needle).
EMS interaction with stroke teams and destination protocols to reduce time to definitive care.
The difference for timed goals for the identification & treatment of AMI vs Stroke.
Additional information about timed goals for stroke and how EMS affects outcomes, can be found on the PassACLS.com pod resources page.
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Adenosine is the first IV medication given to stable patients with sustained supraventricular tachycardia (SVT) refractory to vagal maneuvers.
Symptoms indicating a stable vs unstable patient.
Common causes of tachycardia.
Cardiac effects of Adenosine.
Indications for use in the ACLS Tachycardia algorithm.
Considerations and contraindications.
Adenosine as a diagnostic for patients in A-Fib or A-Flutter with RVR.
Dosing and administration.
Other podcasts that cover common ACLS antiarrhythmics in more detail and another covering Brugata Criteria used to differentiate V-Tach from SVT with an aberrancy can be found on the Pod Resources page at passacls.com.
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Adenosine is the first IV medication given to stable patients with sustained supraventricular tachycardia (SVT) refractory to vagal maneuvers.
Symptoms indicating a stable vs unstable patient.
Common causes of tachycardia.
Cardiac effects of Adenosine.
Indications for use in the ACLS Tachycardia algorithm.
Considerations and contraindications.
Adenosine as a diagnostic for patients in A-Fib or A-Flutter with RVR.
Dosing and administration.
Other podcasts that cover common ACLS antiarrhythmics in more detail and another covering Brugata Criteria used to differentiate V-Tach from SVT with an aberrancy can be found on the Pod Resources page at passacls.com.
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To pass the written ACLS exam and mega code, students need to be able to identify basic ECG dysrhythmias, including the two types of second-degree heart block.
One method of ECG rhythm identification is to ask a series of questions such as:
- What's the rate (<60, 60-100, 101-149, or >150);
- Is the rhythm regular or irregular;
- What's the shape, width, and frequency of P waves and QRS complexes; and
- What's the P-R interval and is it constant?
ECG characteristics of a second-degree Mobitz type I (Wenckebach).
Identification of unstable bradycardia and its treatment with Atropine.
ECG characteristics of a second-degree Mobitz type II.
Possible effect of using Atropine on patients with a second-degree type II AV block.
Treatment of unstable bradycardic patients refractory to Atropine using TCP, Dopamine, or Epinephrine drip.
Starting dose and titration of Dopamine and Epinephrine drips.
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The Curious Clinicians: History of Doctor Wenckebach & Mobitz
Practice ECGs with rationale at Dialed Medics
When treating patients with Acute Coronary Syndrome (ACS), MONA is an acronym sometimes used to help us remember the initial interventions.
The O in MONA is Oxygen.
When we should administer oxygen to ACS patients.
When O2 administration is unnecessary based on an accurate pulse ox.
Monitoring patient's oxygen saturation (SaO2) using a pulse oximeter.
Review two common ACLS pre-arrest mega code scenarios.
Oxygen administration during CPR and post cardiac arrest.
You can find additional medical podcasts that cover ACLS-related topics, on the Pod Resources page at PassACLS.com.
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FOAMed
Along with early defibrillation, high quality CPR with minimal interruptions is one of the two factors that has been shown to improve cardiac arrest outcomes.
How do we know if high quality, effective CPR is being performed?
Objective measures of high-quality CPR include:
- Compression rate;
- Compression depth & recoil;
- ETCO2; and
- Chest Compression Fraction (CCF).
The role of the CPR coach on the code team.
The advantages and use of real-time feedback devices to monitor the rate, depth, and chest recoil of CPR compressions.
The use of end tidal waveform capnography.
A no-tech way to monitor effective CPR if no compression feedback device or ETCO2 capnography isn’t available.
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When we should consider using the bradycardia algorithm.
The signs & symptoms of unstable bradycardia.
Atropine's dose and maximum.
The use of atropine when a patient is in a second degree type II or third degree heart block.
ECG changes that indicate subsequent doses of atropine are likely to be ineffective.
The dose of Dopamine.
The use of Dopamine for bradycardia as an interim until TCP vs hypotension.
The use of Atropine and Dopamine in patients with myocardial ischemia.
Podcasts with additional (advanced-provider level) information about bradycardia, Atropine, & Dopamine can be found on the PassACLS.com Pod Resources page.
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The tongue is the most common airway obstruction in an unconscious patient.
Insertion an oropharyngeal airway helps keep the patient’s tongue from falling to the back of the pharynx, causing an airway obstruction.
The oropharyngeal airway is sometimes called an OPA or simply an oral airway.
Indications for using an oral airway.
Contraindication for an oral airway and an alternative airway that can be used for patients with an intact gag reflex.
Measuring an OPA and possible complications from inserting one that's too small or too large.
Two techniques to properly insert an OPA.
The use of an oral airway during CPR.
The use of an OPA as a bite block after a patient has an advanced airway placed.
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Hypoxia is a state of low oxygen levels in the blood.
Determining hypoxia using a pulse oximeter or arterial blood gasses (ABGs).
A goal of ACLS is to recognize signs of hypoxia and provide timely treatment to prevent an arrest.
Examples of some things that might lead us to think of hypoxia as a cause of cardiac arrest.
Why we should not rely on pulse ox to give accurate readings during CPR.
Delivering ventilations with near 100% oxygen concentration using a BVM attached to supplemental O2 and a reservoir.
Using end tidal waveform capnography to assess the quality of CPR.
Changes to ventilation rates, tidal volume, and O2 concentration affects a patient's oxygen, carbon dioxide, and pH.
The danger of excessive ventilation of a patient in cardiac arrest.
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ECG characteristics of supraventricular tachycardia (SVT) vs. sinus tachycardia.
Signs & symptoms that indicate a patient is unstable.
Delivery of a synchronized shock for the treatment of unstable SVT using a biphasic vs monophasic defibrillator.
Consideration for team safety while performing synchronized cardioversion.
Actions to take immediately if an unstable patient we’ve cardioverted goes into a pulseless rhythm.
Management of stable patients in SVT.
For more on narrow complex tachycardias, check out the pod resource page at passacls.com.
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When working to resuscitate a patient in sudden cardiac arrest, Epinephrine is the first IV medication we administer.
When we give the first dose of epinephrine depends on whether the patient is in a shockable or non-shockable rhythm.
When to give the first dose of epinephrine and its frequency for patients in asystole or PEA following the right side of the Adult Cardiac Arrest algorithm.
When to give the first dose of epi and its frequency for patients in V-Fib or pulseless V-Tach following the left side of the Adult Cardiac Arrest algorithm.
Example chronology of events for a scenario where a patient is found unresponsive with only gasping/agonal breathing.
Administration of epi via the IO or endotracheal route in the absence of an IV.
The maximum cumulative dose of epinephrine that can be administered to patients in cardiac arrest.
When do we stop administering epinephrine.
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If a person suddenly develops symptoms such as weakness, slurred or garbled speech, loss of balance, or a massive & severe headache; it’s possible they could be having a stroke.
The Cincinnati Prehospital Stroke Scale.
There are several conditions that can mimic a stroke.
Identification & Treatment of hypoglycemia or hyperglycemia.
Identification & Treatment of hypoxia using a pulse oximeter.
Some seizures, electrolyte imbalance, sepsis, brain tumors, and Bell’s Palsy can also mimic a stroke.
Prehospital providers should transport suspected stroke patients to a stroke center following their local protocols.
Hospital providers should active their stroke team to ensure rapid assessment and treatment.
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Most ACLS medications are given IV push. But, what happens if we can't get an IV?
Why IO is better than ETT as an alternative route.
The locations we should place an IO when running a code and a location we should avoid.
The ACLS medications that can be given intraosseous.
Where you can find more information about intraosseous access during resuscitation efforts.
In the absence of an IV or IO, some medications may be given down the endotracheal tube.
The disadvantages of medication administration via ETT.
Review of the medications that can be given down the tube and how they should be given.
Medications should not be given down the tube when anything other than an endotracheal tube is used as an advanced airway.
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The chain of survival for a cardiac emergency and stroke start the same:
-
preparedness & recognition of an emergency;
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activation of EMS;
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delivery of Advanced Life Support; and
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transporting to the most appropriate facility.
ALS ambulances are staffed with paramedics who have training in ACLS skills.
Why EMS "Destination Protocols" for suspected stroke and STEMI make a difference.
ACLS’s timed benchmarks for:
- point of first medical contact to PCI for ST elevation MI;
- door to tPA for ischemic stroke; and
- onset of symptoms to EVT for LVO strokes.
Why EMS should bypass a close hospital to transport a STEMI or suspected stroke patient to a hospital capable of 24/7 PCI or a certified stroke center.
Check out the Pod Resource page at passacls.com for links to the "EMS On Air" podcast for links to episodes that look at EMS's role in stroke outcomes in the rural vs urban area.
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Performing good CPR and delivering a shock as soon as possible to a patient in Ventricular Fibrillation or pulseless V-Tach are the two most critical interventions that have been shown to increase survival from sudden cardiac arrest.
Studies have demonstrated significantly better out-of-hospital cardiac arrest survival outcomes in communities with robust public CPR training and public access/first responder AEDs.
The general use of AED including: indications for use; attaching the AED pads; following verbal prompts; and safely administering a shock.
Following the Adult Cardiac Arrest algorithm while using an AED.
Contraindications to AED use.
General safety considerations to remember.
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For apneic patients without a carotid pulse or patients with only gasping/agonal respirations, we will follow the Adult Cardiac Arrest algorithm.
For pulseless patients that the AED doesn't advise a shock, the patient's ECG shows asystole, or a non-perfusing organized rhythm (PEA), we will follow the right side of the Adult Cardiac Arrest algorithm.
Initial steps are aimed at delivery of high-quality CPR to keep the brain and vital organs alive.
Epinephrine administration.
Placement of an advanced airway.
Considering possible reversible H & T causes of cardiac arrest including three common causes of PEA and their emergent interventions.
When we should discontinue resuscitation efforts and call the code.
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Providing good, high-quality CPR with minimal interruptions and early defibrillation are two key interventions shown to improved cardiac arrest outcomes.
A training tool used in many CPR and ACLS classes is to use a song (or a song list) with a tempo of 100 to 120 beats per minute to help the person doing chest compressions maintain an adequate rate.
Characteristics of good songs that will help us.
Advantages & disadvantages of using a song during CPR.
Selected songs from various genres and time periods from AHA's "Don’t Drop The Beat" playlist on Spotify. (https://open.spotify.com/playlist/2mU2FNAhSOtQwW0hBgQMaK)
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A patient’s medical history will help us identify things that may be causing (or contributing) to their current condition as well as guide our decisions so we provide the safest evidence-based care possible.
Examples of information obtained in a medical history that will impact the treatment we provide.
There are several mnemonics and memory aids that people use to guide their history taking.
Review the SAMPLE-PQRST medical history format.
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Although magnesium can be used in the treatment of other medical conditions such as eclampsia, asthma, & digitalis toxicity; for ACLS, magnesium is primarily used to treat Torsades de Pointes.
Identification of torsades on the ECG.
Administration of a magnesium infusion for stable patients vs slow IV push for patients in cardiac arrest.
Procainamide use for stable patients with a monomorphic wide-complex tachycardia.
Procainamide dosing and when to stop the infusion.
Tip for determining whether magnesium or Procainamide should be used when treating stable patients with V-Tach.
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When a patient loses excessive amounts of fluids, we say that they are in a state of hypovolemia.
The most obvious cause of hypovolemia is from bleeding.
Bleeding can be internal or external and caused by trauma, pathology, or iatrogenic.
Classic signs & symptoms of hypovolemic shock.
Volume replacement with crystalloids vs blood.
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MONA is the acronym sometimes used to help us remember the interventions to consider for patients with Acute Coronary Syndrome or ACS.
Morphine's use in the Acute Coronary Syndrome (ACS) algorithm.
Why Morphine is helpful for patients with ACS.
Contraindications and considerations for the safe administration of Morphine.
Morphine as an alternative to nitro for patients with chest pain that take PDE inhibitors.
Common dosing & administration of Morphine.
Monitoring of the patient's level of consciousness, pain, blood pressure, and respirations after administration.
Possible side effects of Morphine administration.
Narcan as an antidote to Morphine if needed.
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Even good CPR is far less efficient at circulating blood than a functioning heart.
The indicators of high-quality CPR that were identified at the 2012 AHA CPR Quality Summit in order of importance include:
- Chest compression fraction (CCF);
- Chest compression rate;
- Chest compression depth;
- Allowing for full recoil; and
- Adequate ventilations.
Using real-time feedback devices and ETCO2 to assess CPR quality.
Three tips to limit pauses in CPR compressions to 10 seconds or less.
Limiting interruptions to chest compressions to less than 10 seconds so we can maintain a CCF of 80% requires teamwork and communication.
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Epinephrine and Dopamine are adrenergic agonist used in several ACLS algorithms.
The use of epinephrine for severe anaphylaxis or unstable bradycardia.
Review epinephrine’s effects on blood vessels and bronchioles.
Why epinephrine is helpful for patients with anaphylaxis.
Using an epi drip for unstable bradycardia.
Epinephrine administration during cardiac arrest.
Starting and epinephrine or Dopamine drip for patients that have ROSC.
Review the effects of Dopamine based on mcg/kg/min dosing.
Monitoring the patient and titrating epi or Dopamine drips to prevent harm.
For more information on ACLS medications, check out passacls.com.
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Providing rescue breathing to apneic patients with a palpable pulse.
Normal end tidal CO2 for patients with a pulse.
Identification of cardiac arrest and our immediate actions.
Providing artificial ventilations during CPR without an advanced airway vs with an advanced airway in place.
Using quantitative waveform capnography to confirm placement of an advanced airway, assess the quality of CPR, and identify ROSC.
The effects of hyperventilating patients in cardiac arrest.
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Hypothermic patients aren't dead until they are warm and dead.
When a patient’s core body temperature drops below 96.8 F (36 C), they are hypothermic. As the body’s temperature drops below 36 C, hypothermia may further be classified as moderate or severe:
- Moderate if the patient’s body core temp is between 30-34 C; and
- Severe if it's below 30 C.
Modifying the ACLS Adult Cardiac Arrest algorithm for patients with severe hypothermia.
Following the ACLS algorithm for patients with a body core temperature above 30 C.
Methods for rewarming patients with moderate vs severe hypothermia.
Continuation of CPR and ACLS efforts until the patient’s body core temp is above 36 C.
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Calcium is one of the ions that move across the cellular membrane during cardiac contraction and relaxation.
The primary use of calcium channel blockers in ACLS is for the treatment of stable, narrow complex tachycardias refractory to Adenosine and to lower the blood pressure of ischemic stroke patients with severe hypertension.
Use of calcium channel blockers for SVT refractory to Adenosine and A-Fib or A-Flutter with RVR.
Contraindications of calcium channel blockers.
Nicardipine use during the treatment of ischemic strokes.
For more information on ACLS medications, tachycardia, or stroke check out the pod resource page at passacls.com.
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The goal of CPR is to keep the brain and vital organs perfused until return of spontaneous circulation (ROSC) is achieved.
Post-arrest care and recovery are the final two links in the chain of survival.
Identification of ROSC during CPR.
Initial patient management goals after identifying ROSC.
The patient’s GCS/LOC should be evaluated to determine if targeted temperature management (TTM) is indicated.
Patients that cannot obey simple commands should receive TTM for at least 24 hours.
Monitoring the patient’s core temperature during TTM.
Why we should cool unresponsive post-arrest patients.
Patients can undergo EEG, CT, MRI, & PCI while receiving TTM.
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Nitroglycerine is vasodilator that affects peripheral blood vessels and coronary arteries.
Because of its widespread dilation effects on blood vessels, nitro can quickly lower a patient’s blood pressure, sometimes to the point of making a patient hypotensive.
Assessment of vital signs prior to administering nitro is necessary to ensure patient safety.
Indications for use of nitroglycerine.
Nitroglycerine's contraindications & considerations for use.
Effects of nitro on patients taking PDE inhibitors.
Administration of nitroglycerine to patients with ischemic chest pain.
Considerations for patients that took their home nitroglycerine.
Monitoring patient's pain and vital signs after nitro administration.
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In atrial fibrillation (A-Fib) and atrial flutter (A-Flutter) the electrical impulse for cardiac contraction is in the atria but isn't the normal pacemaker of the heart, the SA node.
The ECG characteristics of A-Fib and A-Flutter.
Recognition and treatment of unstable patients in A-Fib/Flutter with rapid ventricular response (RVR).
Suggested energy settings for synchronized cardioversion of unstable patients with a narrow complex tachycardia.
Team safety when cardioverting an unstable patient in A-FIB/Flutter.
Adenosine’s role for stable SVT patients with atrial rhythms.
Treatment of stable patients in A-Fib/Flutter with RVR.
For other medical podcasts that cover narrow complex tachycardias, visit the pod resource page at passacls.com.
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As an ACLS provider you do not need to be familiar with all of the different signs of various types of poisoning. You should be able to obtain a history and know to order toxicology.
The majority of toxins don’t have a specific antidote. There are a few toxins for which we have emergency interventions and ACLS providers should be familiar with.
Reviewing the patient's medical history for indicators that may lead us to suspect a tablet/toxin cause of cardiac arrest.
Administration of Narcan for suspected narcotics overdose following the Opioid Associated Emergency algorithm.
Other common ACLS Tablet Toxin scenarios with possible treatments.
Medications commonly used to treat specific toxins that are regularly stocked on crash carts or carried in EMS med bags.
ACLS providers that suspect a specific toxin should consult with their Pharmacy or call Poison Control for treatment directions.
Poison Myths and Misconceptions Discussion
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The Pharmacist’s Voice ® Podcast: https://www.thepharmacistsvoice.com/podcast/
The ACLS algorithms are designed to make it easier to remember the key interventions we should deliver, and the order in which they should be delivered, to provide the best evidence-based care possible.
Generally speaking, if there’s a change in a patient’s condition, we should ensure we’re using the correct algorithm.
Three key points to remember when using ACLS algorithms:
- If a patient’s condition changes, we should do an assessment and use the algorithm that matches the patient’s current state.
- If an action was already done, we don’t need to repeat it.
- We only do actions that are clinically appropriate and within our scope of practice.
Walk through of an example mega code scenario with explanations of when and why we change to a different ACLS algorithm.
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Beta blocking medications attach to Beta receptors to inhibit or “block” the effects of epinephrine (adrenaline)and norepinephrine in the body.
The primary locations of Beta I, II, and III receptors.
Effects of epinephrine & norepinephrine’s stimulation of beta receptors on the heart.
Beta blockers effects on the heart.
When we should consider the use of beta blockers in the Acute Coronary Syndrome (ACS)and Tachycardia algorithms.
Contraindications to the use of beta blocker medications.
More detailed information about beta blocker’s mechanism of action and specific instances for use can be found on the Pod Resource page at PassACLS.com.
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This episode we are reviewing the use of advanced airways in the adult cardiac arrest algorithm.
When we should consider insertion of an advanced airway for patients in a shockable vs non-shockable rhythm.
In addition to an endotracheal tube (ETT), other ACLS advanced airways include the Laryngeal Mask Airway (LMA) and the Laryngeal Tube airway.
The advantages of using an advanced airway over basic airway maneuvers.
Use of end tidal CO2 waveform capnography to confirm placement and assess the adequacy of CPR.
Identification and management of a misplaced ET tube.
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Our primary focus immediately following return of spontaneous circulation (ROSC) is aimed at ensuring adequate perfusion of the patient’s vital organs and decreasing cerebral damage.
Post-arrest goals for O2 saturation, ETCO2, and BP/MAP.
Indications for use of an antiarrhythmic after ROSC.
Determining which antiarrhythmic to use post cardiac arrest.
Administration of Amiodarone or Lidocaine to control ventricular ectopy after ROSC.
The use of Amiodarone post arrest if no antiarrhythmics were administered prior to obtaining ROSC.
Links to other medical podcasts that cover antiarrhythmics and other ACLS-related topics are on the Pod Resource page at PassACLS.com.
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Hydrogen ions is on one of the Hs in ACLS's H&T reversible causes of cardiac arrest.
When considering hydrogen ions as a cause, what we’re looking at is the patient’s pH, or acid/base balance, and conditions that affect it.
The body's normal pH.
Using patient history, ABGs, & labs to determine acidosis or alkalosis.
Common conditions/causes that may lead us to suspect acidosis.
Common conditions/causes that may lead us to suspect alkalosis.
Correcting acidosis by changing the rate of ventilations.
The indications, dose, and considerations for use of Sodium Bicarbonate.
Treatment of alkalosis depends on the type (metabolic or respiratory) and is aimed at correcting the underlying cause.
Other podcasts that cover acid/base balance and conditions that cause acidosis or alkalosis can be found on the Pod Resource Page at PassACLS.com.
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For patients exhibiting symptoms consistent with myocardial ischemia, Aspirin is the first medications we should consider along with morphine, oxygen, and nitroglycerine; if indicated & safe.
Aspirin's mechanism of action & benefits for Acute Coronary Syndrome (ACS) patients.
Contraindications and considerations for aspirin’s use.
The dose and route of administration of aspirin for ACS patients.
The use of aspirin in the ACLS Stroke algorithm.
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To pass ACLS, you will need to be able to identify common rhythms on a monitor during your mega code and ECG strips on your written exam.
If you don't normally monitor patients as part of your job, I suggest two things:
- Find a system for ECG interpretation that works well for you; and
- Practice reading ECGs every day for a few weeks before your class.
Review of normal ECG morphology of P wave, QRS complex, and T wave in lead II.
Characteristics of first degree heart block.
Characteristics of third degree (complete) AV block.
Treatment of unstable patients in third degree block following the ACLS Bradycardia algorithm.
Special considerations for use of Atropine when patients are in a third degree heart block.
The use of TCP, Dopamine, & Epinephrine drip for unstable bradycardic patients refractory to Atropine.
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In the Adult Cardiac Arrest algorithm, we should administer an antiarrhythmic medication to patients in V-Fib or pulseless ventricular tachycardia approximately two minutes after the first dose of epinephrine.
The two first-line ACLS antiarrhythmics that are generally used are Amiodarone and Lidocaine.
Review of Lidocaine dosing and administration to patients in persistent V-Fib or pulseless V-Tach.
Review of Amiodarone dosing and administration to patients in persistent V-Fib or pulseless V-Tach.
Use of antiarrhythmic infusions post-cardiac arrest to suppress ventricular ectopy.
Amiodarone use & dosing for stable patients in V-Tach with a pulse.
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The tongue is the most common airway obstruction in an unconscious patient.
For patients with a decreased level of consciousness that can't control their airway, yet have an intact gag reflex, the nasopharyngeal airway (NPA) should be used as an alternative to the oropharyngeal airway (OPA).
Examples of when a NPA should be considered.
Contraindications and considerations for nasal airway insertion.
Measuring a nasal airway for appropriate length and diameter.
Insertion of a nasopharyngeal airway.
Patients with a NPA in place can receive supplemental O2, be ventilated with a BVM, have ETCO2 monitored, and have their upper airway suctioned as needed.
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When blood, or other fluids, accumulate in the sac around the heart it’s called a cardiac tamponade or pericardial tamponade.
The effects of tamponade on the electrical system and chambers of the heart.
Cardiac tamponade can be acute or chronic and caused by traumatic, iatrogenic, or pathological etiologies.
Common traumatic events, medical procedures, and diseases that can result in a pericardial tamponade.
Signs & symptoms of cardiac tamponade.
Treatment of cardiac tamponade with pericardiocentesis.
For additional information on cardiac tamponade, check out the Pod Resources page at PassACLS.com.
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Two things have changed in recent years to aid students that don't use ACLS in their daily practice.
-
The role of the team leader; and
-
The ability to use your quick reference cards.
The team leader is responsible for assigning tasks and overall direction of the team but can & should ask team members for help.
Using closed-loop communication to ensure the clarity of orders and speaking up if there’s any doubt about an order or action.
Use of your course’s approved text book and quick reference cards during the megacode and written exam.
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Two factors to cardiac arrest survivability that have been clearly shown to make the biggest difference is continuous, high-quality CPR and early defibrillation.
The most common dysrhythmia present during the first few minutes of cardiac arrest is ventricular fibrillation.
The chance of successful defibrillation decreases every minute that passes.
How our chance of successfully defibrillating a patient into a perfusing rhythm significantly changes when good CPR is delivered vs when it isn't.
Why bystander CPR is important for out-of-hospital cardiac arrest (OHCA) outcomes.
The role of the CPR coach.
Five tips to aid us in limiting CPR interruptions to less than 10 seconds so we can maintain a chest compression fraction (CCF) of at least 80%.
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Quantitative waveform capnography is used in ACLS as a way to confirm good CPR and placement of an endotracheal tube; identify return of spontaneous circulation; and during post-cardiac arrest care.
We can use waveform capnography with, and without, an advanced airway in place.
Monitoring end tidal CO2 during rescue breathing.
Use of capnography to objectively measure good CPR.
Capnography is a preferred method of confirming endotracheal tube (ETT) placement over x-ray during a code.
During CPR, a sudden increase in ETCO2 may indicate ROSC.
Quantitative waveform capnography use in the post-cardiac arrest algorithm.
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Patients with a narrow complex tachycardia with a rate over 150 BPM are in SVT.
Unstable patients in SVT, or V-Tach with a pulse, should be cardioverted with a synchronized shock.
Assessment & treatment of stable tachycardic patients.
Commonly used vagal techniques.
A less common technique to stimulate the vagus nerve is the dive reflex.
Indications and use of Adenosine for stable patients in SVT refractory to vagal maneuvers.
Possible treatments for patients found to be in A-Fib or A-Flutter with RVR after administration of Adenosine.
Carotid sinus massage.
Additional medical podcasts that have episodes on tachycardia can be found on the pod resources page at passacls.com.
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Good luck with your ACLS class!
Remembering all the different energy setting needed for synchronized cardioversion and defibrillation used to be confusing for a lot of people.
Defibrillators can be broken down into three basic categories:
-
Automated External Defibrillator (AED);
-
Biphasic defibrillators; and
-
Monophasic defibrillators.
Use of an AED to rapidly deliver a shock.
Advantages & use of Biphasic defibrillators.
For monophasic defibrillators, use 360J to defibrillate V-Fib or pulseless V-Tach.
AEDs must not be used on patients with a pulse.
Cardioversion of patients in unstable SVT or V-Tach with a pulse using biphasic vs monophasic monitor/defibrillators.
Team safety when performing synchronized cardioversion.
Energy needed to cardiovert unstable patients with a narrow vs wide complex tachycardia.
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Patients with a heart rate less than 60 are bradycardic. Some people can have a resting heart rate in the 40s without any compromise. For others, a heart rate of 50 or less could signify the need for immediate intervention and warrants additional assessment.
Signs & symptoms that indicate a bradycardic patient is unstable.
Monitoring oxygen saturation with pulse oximetry and indications for administration of oxygen.
Calcium channel blockers and beta blocker medication as treatable causes of bradycardia.
The indications and dosage of Atropine.
Precautions for Atropine use in patients with second or third degree AV blocks.
The use of transcutaneous pacing (TCP) for unstable bradycardic patients refractory to Atropine.
The use and dosing of Dopamine and Epinephrine drips.
For additional information about causes and treatment of bradycardia, check out the pod resources page at PassACLS.com.
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The goal of CPR is to keep the brain and vital organs perfused until return of spontaneous circulation (ROSC) is achieved.
Post-arrest care and recovery are the final two links in the chain of survival.
Identification of ROSC during CPR.
Initial patient management goals after identifying ROSC.
The patient’s GCS/LOC should be evaluated to determine if targeted temperature management (TTM) is indicated.
Patients that cannot obey simple commands should receive TTM for at least 24 hours.
Recently published studies on TTM and ACLS’s current standard.
Monitoring the patient’s core temperature during TTM.
Patients can undergo EEG, CT, MRI, & PCI while receiving TTM.
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The chain of survival for ACLS is the same as was learned in your BLS class.
The beginning steps of the Cardiac Emergency and Stroke chain of survival.
ACLS's timed goals for first medical contact to PCI for STEMI and door-to-needle for ischemic stroke.
Characteristics of areas that have significantly better stroke and out-of-hospital cardiac arrest outcomes.
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Heart muscle contraction and repolarization is dependent on Sodium, Calcium, Magnesium, and Potassium ions crossing cellular membranes.
When a patient’s potassium levels get too low or too high, hypokalemia or hyperkalemia results respectively.
Two things that may lead us to suspect hypo or hyperkalemia.
Medical conditions & medications that can cause potassium imbalance.
ECG changes seen in hypo and hyperkalemia.
Critical lab values that would indicate a need for treatment.
Emergent, ACLS interventions for hypokalemia and hyperkalemia.
Additional information on causes of hypo and hyperkalemia can be found on Ninja Nerd podcast. Check out the pod resources page at passacls.com.
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When treating patients having an MI or stroke, more minutes equals more dead cells. Because the majority of strokes are the ischemic type, the treatment for stroke is similar to an MI – to reestablish perfusion to the ischemic tissues.
Review the first four steps in the Stroke Chain of Survival.
Time criteria for the administration of tPA or EVT of LVO strokes.
Stroke benchmarks for door to:
- assessment;
- completing a non-contrast CT; and
- administration of tPA (door-to-needle).
EMS interaction with stroke teams and destination protocols to reduce time to definitive care.
The difference for timed goals for the identification & treatment of AMI vs Stroke.
Additional information about timed goals for stroke and how EMS affects outcomes, can be found on the PassACLS.com pod resources page.
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Adenosine is the first IV medication given to stable patients with sustained supraventricular tachycardia (SVT) refractory to vagal maneuvers.
Symptoms indicating a stable vs unstable patient.
Common causes of tachycardia.
Cardiac effects of Adenosine.
Indications for use in the ACLS Tachycardia algorithm.
Considerations and contraindications.
Adenosine as a diagnostic for patients in A-Fib or A-Flutter with RVR.
Dosing and administration.
Other podcasts that cover common ACLS antiarrhythmics in more detail and another covering Brugata Criteria used to differentiate V-Tach from SVT with an aberrancy can be found on the Pod Resources page at passacls.com.
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To pass the written ACLS exam and mega code, students need to be able to identify basic ECG dysrhythmias, including the two types of second-degree heart block.
One method of ECG rhythm identification is to ask a series of questions such as:
- What's the rate (<60, 60-100, 101-149, or >150);
- Is the rhythm regular or irregular;
- What's the shape and frequency of P waves and QRS complexes; and
- What's the P-R interval and is it constant?
ECG characteristics of a second-degree Mobitz type I (Wenckebach).
Identification of unstable bradycardia and its treatment with Atropine.
ECG characteristics of a second-degree Mobitz type II.
Possible effect of using Atropine on patients with a second-degree type II AV block.
Treatment of unstable bradycardic patients refractory to Atropine using TCP, Dopamine, or Epinephrine drip.
Starting dose and titration of Dopamine and Epinephrine drips.
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The
Curious Clinicians: History of Doctor Wenckebach & Mobitz
When treating patients with Acute Coronary Syndrome (ACS), MONA is an acronym sometimes used to help us remember the initial interventions.
The O in MONA is Oxygen.
When we should administer oxygen to ACS patients.
When O2 administration is unnecessary based on an accurate pulse ox.
Monitoring patient's oxygen saturation (SaO2) using a pulse oximeter.
Review two common ACLS pre-arrest mega code scenarios.
Oxygen administration during CPR and post cardiac arrest.
You can find additional medical podcasts that cover ACLS-related topics, on the Pod Resources page at PassACLS.com.
Check out ConveyMed.io for more online and streaming medical education opportunities.
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In the Adult Cardiac Arrest algorithm, we should administer an antiarrhythmic medication to patients in V-Fib or pulseless ventricular tachycardia approximately two minutes after the first dose of epinephrine.
The two first-line ACLS antiarrhythmics that are generally used are Amiodarone and Lidocaine.
Review of Lidocaine dosing and administration to patients in persistent V-Fib or pulseless V-Tach.
Review of Amiodarone dosing and administration to patients in persistent V-Fib or pulseless V-Tach.
Use of antiarrhythmic infusions post-cardiac arrest to suppress ventricular ectopy.
Amiodarone use & dosing for stable patients in V-Tach with a pulse.
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Good luck with your ACLS class!
The tongue is the most common airway obstruction in an unconscious patient.
For patients with a decreased level of consciousness that can't control their airway, yet have an intact gag reflex, the nasopharyngeal airway (NPA) should be used as an alternative to the oropharyngeal airway (OPA).
Examples of when a NPA should be considered.
Contraindications and considerations for nasal airway insertion.
Measuring a nasal airway for appropriate length and diameter.
Insertion of a nasopharyngeal airway.
Patients with a NPA in place can receive supplemental O2, be ventilated with a BVM, have ETCO2 monitored, and have their upper airway suctioned as needed.
Connect with me:
Website: https://passacls.com
@PassACLS on Twitter
@Pass-ACLS-Podcast on LinkedIn
Give back & support the show:
via PayPal
Good luck with your ACLS class!
When blood, or other fluids, accumulate in the sac around the heart it’s called a cardiac tamponade or pericardial tamponade.
Effects of tamponade on the electrical system and chambers of the heart.
Cardiac tamponade can be acute or chronic and caused by traumatic, iatrogenic, or pathological etiologies.
Common traumatic events, medical procedures, and diseases that can result in a pericardial tamponade.
Signs & symptoms of cardiac tamponade.
PEA is common because the electrical system of the heart is fine.
Treatment of cardiac tamponade with pericardiocentesis.
For additional information on cardiac tamponade, check out the Pod Resources page at PassACLS.com.
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Give back & support the show:
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Good luck with your ACLS class!
Two things have changed in recent years to aid students that don't use ACLS in their daily practice.
1. The role of the team leader; and
2. The ability to use your quick reference cards.
The team leader is responsible for assigning tasks and overall direction of the team but should ask team members for help to confirm the ECG, suggest medications, identify possible reversible causes of cardiac arrest, and to speak up if they identify something that is unsafe.
Use of your course’s approved text book and quick reference cards during the megacode and written exam.
Connect with me:
Website: https://passacls.com
@PassACLS on Twitter
@Pass-ACLS-Podcast on LinkedIn
Give back & support the show:
via PayPal
Good luck with your ACLS class!
Two factors to cardiac arrest survivability that have been clearly shown to make the biggest difference is continuous high quality CPR and early defibrillation.
The most common dysrhythmia present during the first few minutes of cardiac arrest is ventricular fibrillation.
The chance of successful defibrillation decreases every minute that passes.
How our chance of successfully defibrillating a patient into a perfusing rhythm significantly changes when good CPR is delivered vs when it isn't.
Examples of in-hospital and out-of-hospital cardiac arrest (OHCA) outcomes when CPR is performed until defibrillation vs defibrillation without CPR.
The role of the CPR coach.
Five tips to aid us in limiting CPR interruptions to less than 10 seconds so we can maintain a chest compression fraction (CCF) of at least 80%.
Connect with me:
Website: https://passacls.com
@PassACLS on Twitter
@Pass-ACLS-Podcast on LinkedIn
Give back & support the show:
via PayPal
Good luck with your ACLS class!
Quantitative waveform capnography is used in ACLS as a way to confirm good CPR and placement of an endotracheal tube; identify return of spontaneous circulation; and during post-cardiac arrest care.
We can use waveform capnography with, and without, an advanced airway in place.
Monitoring end tidal CO2 during rescue breathing.
Use of capnography to objectively measure good CPR.
Capnography is a preferred method of confirming endotracheal tube (ETT) placement over x-ray during a code.
During CPR, a sudden increase in ETCO2 may indicate ROSC.
Quantitative waveform capnography is used post-cardiac arrest to aid us in maintaining an ETCO2 of 35-45 mm Hg.
Connect with me:
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Give back & support the show:
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Good luck with your ACLS class!
Patients with a narrow complex tachycardia with a rate over 150 BPM are in SVT.
Unstable patients in SVT, or V-Tach with a pulse, should be cardioverted with a synchronized shock.
Assessment & treatment of stable tachycardic patients.
Commonly used vagal techniques.
A less common technique to stimulate the vagus nerve is the dive reflex.
Indications and use of Adenosine for stable patients in SVT refractory to vagal maneuvers.
Possible treatments for patients found to be in A-Fib or A-Flutter with RVR after administration of Adenosine.
Carotid sinus massage.
Additional medical podcasts that have episodes on tachycardia can be found on the pod resources page at passacls.com.
Connect with me:
Website: https://passacls.com
@PassACLS on Twitter
@Pass-ACLS-Podcast on LinkedIn
Give back & support the show:
via PayPal
Good luck with your ACLS class!
Remembering all the different energy setting needed for synchronized cardioversion and defibrillation used to be confusing for a lot of people.
Defibrillators can be broken down into three basic categories:
-
Automated External Defibrillator (AED);
-
Biphasic defibrillators; and
-
Monophasic defibrillators.
Because AEDs are designed to be used by first responders, and lay people with only minimal medical training, the controls are kept simple and are pre-programmed into the machine.
Use of an AED to rapidly deliver a shock.
Biphasic defibrillators automatically measure the impedance between the defib pads and will adjust the energy to deliver the shock needed based on the patient.
Biphasic defibrillator use and energy setting.
For monophasic defibrillators, use 360J to defibrillate V-Fib or pulseless V-Tach.
AEDs must not be used on patients with a pulse.
Cardioversion of patients in unstable SVT or V-Tach with a pulse using biphasic vs monophasic monitor/defibrillators.
Team safety when performing synchronized cardioversion.
Energy needed to cardiovert unstable patients with a narrow vs wide complex tachycardia.
Connect with me:
Website: https://passacls.com
@PassACLS on Twitter
@Pass-ACLS-Podcast on LinkedIn
Give back & support the show:
via PayPal
Good luck with your ACLS class!
Patients with a heart rate less than 60 are bradycardic. Some people can have a resting heart rate in the 40s without any compromise. For others, a heart rate of 50 or less could signify the need for immediate intervention and warrants additional assessment.
Signs & symptoms that indicate a bradycardic patient is unstable.
Monitoring oxygen saturation with pulse oximetry and indications for administration of oxygen.
Calcium channel blockers and beta blocker medication as treatable causes of bradycardia.
The indications and dosage of Atropine.
Precautions for Atropine use in patients with second or third degree AV blocks.
The use of transcutaneous pacing (TCP) for unstable bradycardic patients refractory to Atropine.
The use and dosing of Dopamine and Epinephrine drips.
For additional information about causes and treatment of bradycardia, check out the pod resources page at PassACLS.com.
Connect with me:
Website: https://passacls.com
@PassACLS on Twitter
@Pass-ACLS-Podcast on LinkedIn
Give back & support the show:
via PayPal
Good luck with your ACLS class!
The goal of CPR is to keep the brain and vital organs perfused until return of spontaneous circulation (ROSC) is achieved.
Post-arrest care and recovery are the final two links in the chain of survival.
Identification of ROSC during CPR.
Initial patient management goals after identifying ROSC.
The patient’s GCS/LOC should be evaluated to determine if targeted temperature management (TTM) is indicated.
Patients that cannot obey simple commands should receive TTM for at least 24 hours.
Recently published studies on TTM and ACLS’s current standard.
Monitoring the patient’s core temperature during TTM.
Patients can undergo EEG, CT, MRI, & PCI while receiving TTM.
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The chain of survival for ACLS is the same as was learned in your BLS class.
The beginning steps of the Cardiac Emergency and Stroke chain of survival are the same
-
Recognizing the symptoms of a cardiac emergency or stroke;
-
Activating an emergency response by calling 9-1-1, or a specialized code team if in the healthcare setting;
-
Rapid assessment including 12 lead ECG for cardiac patients or FAST assessment for suspected stroke emergencies;
-
Provide ALS care and transport to the most appropriate facility; for
-
Early reperfusion.
ACLS's timed goals for first medical contact to PCI for STEMI and door-to-needle for ischemic stroke.
Areas with strong EMS relationships, well-defined transport protocols, and specialized teams that care for the patient in the hospital have significantly better patient outcomes.
The cardiac arrest chain of survival adds: high quality CPR, early defibrillation, and advanced resuscitation as the next critical links followed by post arrest care and recovery.
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Heart muscle contraction and repolarization is dependent on Sodium, Calcium, Magnesium, and Potassium ions crossing cellular membranes.
When a patient’s potassium levels get too low or too high, hypokalemia or hyperkalemia results respectively.
Two things that may lead us to suspect hypo or hyperkalemia.
Medical conditions & medications that can cause potassium imbalance.
ECG changes seen in hypo and hyperkalemia.
Critical lab values that would indicate a need for treatment.
Emergent, ACLS interventions for hypokalemia and hyperkalemia.
Additional information on causes of hypo and hyperkalemia can be found on Ninja Nerd podcast. Check out the pod resources page at passacls.com.
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When treating patients having an MI or stroke, more minutes equals more dead cells. Because the majority of strokes are the ischemic type, the treatment for stroke is similar to an MI – to reestablish perfusion to the ischemic tissues.
Review the first four steps in the Stroke Chain of Survival.
Time criteria for the administration of tPA or EVT of LVO strokes.
Stroke benchmarks for door to:
- assessment;
- completing a non-contrast CT; and
- administration of tPA (door-to-needle).
EMS interaction with stroke teams and destination protocols to reduce time to definitive care.
The difference for timed goals for the identification & treatment of AMI vs Stroke.
Additional information about timed goals for stroke and how EMS affects outcomes, can be found on the PassACLS.com pod resources page.
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Adenosine is the first IV medication given to stable patients with sustained supraventricular tachycardia (SVT) refractory to vagal maneuvers.
Common causes of tachycardia.
Symptoms indicating a stable vs unstable patient.
Cardiac effects of Adenosine.
Indications for use in the ACLS Tachycardia algorithm.
Considerations and contraindications.
Adenosine as a diagnostic for patients in A-Fib or A-Flutter with RVR.
Dosing and administration.
Other podcasts that cover common ACLS antiarrhythmics in more detail and another covering Brugata Criteria used to differentiate V-Tach from SVT with an aberrancy can be found on the Pod Resources page at passacls.com.
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To pass the written ACLS exam and mega code, students need to be able to identify basic ECG dysrhythmias, including the two types of second-degree heart block.
One method of ECG rhythm identification is to ask a series of questions such as:
- What's the rate (<60, 60-100, 101-149, or >150);
- Is the rhythm regular or irregular;
- What's the shape and frequency of P waves and QRS complexes; and
- What's the P-R interval and is it constant?
ECG characteristics of a second-degree Mobitz type I (Wenckebach).
Identification of unstable bradycardia and its treatment with Atropine.
ECG characteristics of a second-degree Mobitz type II.
Possible effect of using Atropine on patients with a second-degree type II AV block.
Treatment of unstable bradycardic patients refractory to Atropine using TCP, Dopamine, or Epinephrine drip.
Starting dose and titration of Dopamine and Epinephrine drips.
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The Curious Clinicians: History of Doctor Wenckebach & Mobitz
When treating patients with Acute Coronary Syndrome (ACS), MONA is an acronym sometimes used to help us remember the initial interventions.
The O in MONA is Oxygen.
When we should administer oxygen to ACS patients.
When O2 administration is unnecessary based on an accurate pulse ox.
Monitoring patient's oxygen saturation (SaO2) using a pulse oximeter.
Review two common ACLS pre-arrest mega code scenarios.
Oxygen administration during CPR and post cardiac arrest.
You can find additional medical podcasts that cover ACLS-related topics, on the Pod Resources page at PassACLS.com
Check out ConveyMed.io for more online and streaming medical education opportunities.
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Along with early defibrillation, high quality CPR with minimal interruptions is one of the two factors that has been shown to improve cardiac arrest outcomes.
How do we know if high quality, effective CPR is being performed?
Objective measures of high-quality CPR include:
- Compression rate of 100-120 per minute;
- Compression depth of at least 5 cm;
- Allowing for full chest recoil;
- Maintaining an ETCO2 of at least 10 mm Hg; and
- Keeping interruptions to less than 10 seconds to obtain a chest compression fraction (CCF) of 80%.
The role of the CPR coach position on the code team.
The advantages and use of real-time feedback devices to monitor the rate, depth, and chest recoil of CPR compressions.
The use of end tidal waveform capnography.
A no-tech way to monitor effective CPR if no compression feedback device or ETCO2 capnography is available.
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The 2020 ACLS guidelines updated the dose for administration of Atropine and Dopamine for the treatment of unstable bradycardia.
The signs & symptoms of unstable bradycardia.
Atropine's new dose and maximum.
The use of atropine when a patient is in a second degree type II or third degree heart block.
ECG changes that indicate subsequent doses of atropine are likely to be ineffective.
The 2020 update to the starting dose of Dopamine.
The use of Dopamine for bradycardia as an interim until TCP vs hypotension.
The use of Atropine and Dopamine in patients with myocardial ischemia.
Podcasts with additional (advanced-provider level) information about bradycardia, Atropine, & Dopamine can be found on the PassACLS.com Pod Resources page.
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The tongue is the most common airway obstruction in an unconscious patient.
Insertion an oropharyngeal airway helps keep the patient’s tongue from falling to the back of the pharynx and causing an airway obstruction.
The oropharyngeal airway is sometimes called an OPA or simply an oral airway.
Indications for using an oral airway.
Contraindication for an oral airway and an alternative that can be used instead.
Measuring an OPA and possible complications from inserting one that's too small or too large.
Two techniques to properly insert an OPA and avoid complications.
The use of an oral airway during CPR.
The use of an OPA as a bite block after a patient has an advanced airway placed.
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Hypoxia is a state of low oxygen levels in the blood.
Determining hypoxia using a pulse oximeter or arterial blood gasses (ABGs).
A goal of ACLS is to recognize signs of hypoxia and provide timely treatment to prevent an arrest.
Examples of some things that might lead us to think of hypoxia as a cause of cardiac arrest.
Why we should not rely on pulse ox to give accurate readings during CPR.
Delivering ventilations with near 100% oxygen concentration using a BVM attached to supplemental O2 and a reservoir.
Using end tidal waveform capnography to assess the quality of CPR.
Changes to ventilation rates, tidal volume, and O2 concentration affects a patient's oxygen, carbon dioxide, and pH.
The danger of excessive ventilation of a patient in cardiac arrest.
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ECG characteristics of supraventricular tachycardia (SVT) vs. sinus tachycardia.
Signs & symptoms that indicate a patient is unstable.
Delivery of a synchronized shock for the treatment of unstable SVT using a biphasic vs monophasic defibrillator.
Consideration for team safety while performing synchronized cardioversion.
Actions to take immediately if an unstable patient we’ve cardioverted goes into a pulseless rhythm.
Management of stable patients in SVT.
For more on narrow complex tachycardias, check out the pod resource page at passacls.com.
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When working to resuscitate a patient in sudden cardiac arrest, Epinephrine is the first IV medication we administer.
When we give the first dose of epinephrine depends on whether the patient is in a shockable or non-shockable rhythm.
When to give the first dose of epinephrine and its frequency for patients in asystole or PEA following the right side of the Adult Cardiac Arrest algorithm.
When to give the first dose of epi and its frequency for patients in V-Fib or pulseless V-Tach following the left side of the Adult Cardiac Arrest algorithm.
Example chronology of events for a scenario where a patient is found unresponsive with only gasping/agonal breathing.
Administration of epi via the IO or endotracheal route in the absence of an IV.
The maximum cumulative dose of epinephrine that can be administered to patients in cardiac arrest.
When do we stop administering epinephrine.
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If a person suddenly develops symptoms such as weakness, slurred or garbled speech, loss of balance, or a massive & severe headache; it’s possible they could be having a stroke.
The Cincinnati Prehospital Stroke Scale uses the acronym FAST to assess Facial droop, Arm Drift; Speech, and Time.
There are several conditions that can mimic a stroke.
Identification & Treatment of hypoglycemia or hyperglycemia.
Identification & Treatment of hypoxia using a pulse oximeter.
Some seizures, electrolyte imbalance, sepsis, brain tumors, and Bell’s Palsy can also mimic a stroke.
Prehospital providers should transport suspected stroke patients to a stroke center following their local protocols.
Hospital providers should active their stroke team to ensure rapid assessment and treatment.
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Most ACLS medications are given IV push. But, what happens if we can't get an IV?
When IV access isn't available, we should consider administering our IV medications via intraosseous (IO)or endotracheal tube (ETT) route.
Why IO is better for than ETT as an alternative route.
The locations we should place an IO when running a code and a location we should avoid.
The ACLS medications that can be given intraosseous.
Where you can find more information about intraosseous access during resuscitation efforts.
In the absence of an IV or IO, some medications may be given down the endotracheal tube.
The disadvantages of medication administration via ETT.
Review of the medications that can be given down the tube and how they should be given.
Medications should not be given down the tube when anything other than an endotracheal tube is used as an advanced airway.
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The chain of survival for a cardiac emergency and stroke start the same:
-
preparedness & recognition of an emergency;
-
activation of EMS;
-
delivery of Advanced Life Support; and
-
transporting to the most appropriate facility.
Depending on where you live, Emergency Medical Services (EMS) may provide prehospital Advanced Life Support (ALS).
ALS ambulances are staffed with paramedics who have training in ACLS skills. Paramedics can perform an assessment, obtain a medical history, and provide life-saving care within minutes of recognition.
Why EMS "Destination Protocols" for suspected stroke and STEMI make a difference.
ACLS’s timed benchmarks for:
- point of first medical contact to PCI for ST elevation MI;
- door to tPA for ischemic stroke; and
- onset of symptoms to EVT for LVO strokes.
EMS may bypass a close hospital to transport a STEMI or suspected stroke patient to a hospital capable of 24/7 PCI or a certified stroke center; because time is heart muscle or brain cells.
Check out the Pod Resource page at passacls.com for links to the "EMS On Air" podcast for links to episodes that look at EMS's role in stroke outcomes in the rural vs urban area.
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Performing good CPR and delivering a shock as soon as possible to a patient in Ventricular Fibrillation or pulseless V-Tach are the two most critical interventions that have been shown to increase survival from sudden cardiac arrest.
Studies have demonstrated significantly better out-of-hospital cardiac arrest survival outcomes in communities with robust public CPR training and public access/first responder AEDs.
The general use of AED including: indications for use; attaching the AED pads; following verbal prompts; and safely administering a shock.
Following the Adult Cardiac Arrest algorithm while using an AED.
Contraindications to AED use.
General safety considerations to remember.
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For apneic patients without a carotid pulse or pulseless patients with only gasping/agonal respirations, we will follow the Adult Cardiac Arrest algorithm.
For pulseless patients that the AED doesn't advise a shock, the patient's ECG shows asystole, or a non-perfusing organized rhythm (PEA), we will follow the right side of the algorithm.
Initial steps are aimed at delivery of high-quality CPR to keep the brain and vital organs alive.
Epinephrine administration.
Placement of an advanced airway.
Considering possible reversible H & T causes of cardiac arrest including three common causes of PEA and their emergent interventions.
When we should discontinue resuscitation efforts and call the code.
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Providing good, high quality, CPR with minimal interruptions and early defibrillation are two keys to improved cardiac arrest outcomes.
A training tool used in many CPR and ACLS classes is to use a song (or a song list) with a tempo of 100 to 120 beats per minute to help the person doing chest compressions maintain an adequate rate.
Characteristics of good songs that will help us.
Advantages & disadvantages of using a song during CPR.
Selected songs from various genres and time periods from AHA's "Don’t Drop The Beat" playlist on Spotify.
https://open.spotify.com/playlist/2mU2FNAhSOtQwW0hBgQMaK
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A patient’s medical history will help us identify things that may be causing (or contributing) to their current condition as well as guide our decisions so we provide the safest evidence-based care possible.
Examples of information obtained in a medical history that will impact the treatment we provide.
There are several mnemonics and memory aids that people use to guide their history taking.
Review the SAMPLE-PQRST medical history format.
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Although magnesium can be used in the treatment of other medical conditions such as eclampsia, asthma, & digitalis toxicity; for ACLS, magnesium is primarily used to treat Torsades de Pointes.
Identification of Torsades on the ECG.
Administration of a magnesium infusion for stable patients vs slow IV push for patients in cardiac arrest.
Procainamide use for stable patients with a monomorphic wide-complex tachycardia.
Procainamide dosing and when to stop the infusion.
Tip for determining whether magnesium or Procainamide should be used when treating stable patients with V-Tach.
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When a patient loses excessive amounts of fluids, we say that they are in a state of hypovolemia.
The most obvious cause of hypovolemia is from bleeding.
Bleeding can be internal or external and caused by trauma, pathology, or iatrogenic.
Classic signs & symptoms of hypovolemic shock.
Volume replacement with crystalloids vs blood.
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MONA is the acronym sometimes used to help us remember the interventions to consider for patients with Acute Coronary Syndrome or ACS.
Morphine's use in the Acute Coronary Syndrome (ACS) algorithm.
Why Morphine is helpful for patients with ACS.
Contraindications and considerations for the safe administration of Morphine.
Morphine as an alternative to nitro for patients with chest pain that take PDE inhibitors.
Common dosing & administration of Morphine.
Monitoring of the patient's level of consciousness, pain, blood pressure, and respirations after administration.
Possible side effects of Morphine administration.
Narcan as an antidote to Morphine if needed.
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Even good CPR is far less efficient at circulating blood than a functioning heart.
The indicators of high-quality CPR that were identified at the 2012 AHA CPR Quality Summit in order of importance include:
- Chest compression fraction (CCF);
- Chest compression rate;
- Chest compression depth;
- Allowing for full recoil; and
- Adequate ventilations.
Using real-time feedback devices and ETCO2 to assess CPR quality.
Tips to limit pauses in CPR compressions to 10 seconds or less include:
-
Pre-charge the defibrillator for 15 seconds before completion of a 2 minute cycle;
-
Continuing chest compressions until the defibrillator is fully charged;
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Continuing chest compressions during insertion of an advanced airway; and
-
Performing other activities simultaneously during scheduled pauses.
Limiting interruptions to chest compressions to less than 10 seconds so we can maintain a CCF of 80% requires teamwork and communication.
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Epinephrine and Dopamine are adrenergic agonist used in several ACLS algorithms.
The use of epinephrine for severe anaphylaxis or unstable bradycardia.
Review epinephrine’s effects on blood vessels and bronchioles.
Why epinephrine is helpful for patients with anaphylaxis.
Using an epi drip for unstable bradycardia.
Epinephrine administration during cardiac arrest.
Starting and epinephrine or Dopamine drip for patients that have ROSC.
Review the effects of Dopamine based on mcg/kg/min dosing.
Monitoring the patient and titrating epi or Dopamine drips to prevent harm.
For more information on ACLS medications, check out the pod resource page at passacls.com.
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Providing rescue breathing to apneic patients with a palpable pulse.
Normal end tidal CO2 for patients with a pulse.
Identification of cardiac arrest and our immediate actions.
Providing artificial ventilations during CPR without an advanced airway vs with an advanced airway in place.
Using quantitative waveform capnography to confirm placement of an advanced airway, assess the quality of CPR, and identify ROSC.
The effects of hyperventilating patients in cardiac arrest.
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Hypothermic patients aren't dead until they are warm and dead.
When a patient’s core body temperature drops below 96.8 F (36 C), they are hypothermic. As the body’s temperature drops below 36 C, hypothermia may further be classified as moderate or severe:
- Moderate if the patient’s body core temp is between 30-34 C; and
- Severe if it's below 30 C.
Modifying the ACLS Adult Cardiac Arrest algorithm for patients with severe hypothermia.
Following the ACLS algorithm for patients with a body core temperature above 30 C.
Methods for rewarming patients with moderate vs severe hypothermia.
Continuation of CPR and ACLS efforts until the patient’s body core temp is above 36 C.
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Calcium is one of the ions that move across the cellular membrane during cardiac contraction and relaxation.
The primary use of calcium channel blockers in ACLS is for the treatment of stable, narrow complex tachycardias refractory to Adenosine and to lower the blood pressure of ischemic stroke patients with severe hypertension.
Use of calcium channel blockers for SVT refractory to Adenosine and A-Fib or A-Flutter with RVR.
Contraindications of calcium channel blockers.
Nicardipine use during the treatment of ischemic strokes.
For more information on ACLS medications, tachycardia, or stroke check out the pod resource page at passacls.com.
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The goal of CPR is to keep the brain and vital organs perfused until return of spontaneous circulation (ROSC) is achieved.
Post-arrest care and recovery are the final two links in the chain of survival.
Identification of ROSC during CPR.
Initial patient management goals after identifying ROSC.
The patient’s GCS/LOC should be evaluated to determine if targeted temperature management (TTM) is indicated.
Patients that cannot obey simple commands should receive TTM for at least 24 hours.
Monitoring the patient’s core temperature during TTM.
Why we should cool unresponsive post-arrest patients.
Patients can undergo EEG, CT, MRI, & PCI while receiving TTM.
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Nitroglycerine is vasodilator that affects peripheral blood vessels and coronary arteries.
Because of its widespread dilation effects on blood vessels, nitro can quickly lower a patient’s blood pressure, sometimes to the point of making a patient hypotensive.
Assessment of vital signs prior to administering nitro is necessary to ensure patient safety.
Indications for use of nitroglycerine.
Nitroglycerine's contraindications & considerations for use.
Effects of nitro on patients taking PDE inhibitors.
Administration of nitroglycerine to patients with ischemic chest pain.
Considerations for patients that took their home nitroglycerine.
Monitoring patient's pain and vital signs after nitro administration.
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In atrial fibrillation (A-Fib) and atrial flutter (A-Flutter) the electrical impulse for cardiac contraction is in the atria but isn't the normal pacemaker of the heart, the SA node.
The ECG characteristics of A-Fib and A-Flutter.
Recognition and treatment of unstable patients in A-Fib/Flutter with rapid ventricular response (RVR).
Suggested energy settings for synchronized cardioversion of stable patients with a narrow complex tachycardia.
Team safety when cardioverting an unstable patient in A-FIB.
Adenosine’s role for stable SVT patients with atrial rhythms.
Treatment of stable patients in A-Fib/Flutter with RVR.
For other medical podcasts that cover narrow complex tachycardias, visit the pod resource page at passacls.com.
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As an ACLS provider you do not need to be familiar with all of the different signs of various types of poisoning. You should be able to obtain a history and know to order toxicology.
The majority of toxins don’t have a specific antidote. There are a few toxins for which we have emergency interventions and ACLS providers should be familiar with.
Reviewing the patient's medical history for indicators that may lead us to suspect a tablet/toxin cause of cardiac arrest.
Administration of Narcan for suspected narcotics overdose following the Opioid Associated Emergency algorithm.
Other common ACLS Tablet Toxin scenarios with possible treatments.
Medications commonly used to treat specific toxins that are regularly stocked on crash carts or carried in EMS med bags.
ACLS providers that suspect a specific toxin should consult with their Pharmacy or call Poison Control for treatment directions.
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The ACLS algorithms are designed to make it easier to remember the key interventions we should deliver, and the order in which they should be delivered, to provide the best evidence-based care possible.
Generally speaking, if there’s a change in a patient’s condition, we should ensure we’re using the correct algorithm.
Three key points to remember when using ACLS algorithms:
-
If a patient’s condition changes, we should do an assessment and use the algorithm that matches the patient’s current state.
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If an action was already done, we don’t need to repeat it.
-
We only do actions that are clinically appropriate and within our scope of practice.
Walk through of an example mega code scenario with explanations of when and why we change to a different ACLS algorithm.
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Beta blocking medications attach to Beta receptors to inhibit or “block” the effects of epinephrine (adrenaline)and norepinephrine in the body.
The primary locations of Beta I, II, and III receptors.
Effects of epinephrine & norepinephrine’s stimulation of beta receptors on the heart.
Beta blockers effects on the heart.
When we should consider the use of beta blockers in the Acute Coronary Syndrome (ACS)and Tachycardia algorithms.
Contraindications to the use of beta blocker medications.
More detailed information about beta blocker’s mechanism of action and specific instances for use can be found on the Pod Resource page at PassACLS.com.
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This episode we are reviewing the use of advanced airways in the adult cardiac arrest algorithm.
When we should consider insertion of an advanced airway for patients in a shockable vs non-shockable rhythm.
In addition to an endotracheal tube (ETT), other ACLS advanced airways include the Laryngeal Mask Airway (LMA) and the Laryngeal Tube airway.
The advantages of using an advanced airway over basic airway maneuvers.
Use of end tidal CO2 waveform capnography to confirm placement and assess the adequacy of CPR.
Identification and management of a misplaced ET tube.
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Our primary focus immediately following return of spontaneous circulation (ROSC) is aimed at ensuring adequate perfusion of the patient’s vital organs and decreasing cerebral damage.
After we have assessed and addressed O2 saturation, ETCO2, and BP, we may consider the use of an antiarrhythmic infusion if the patient has ventricular ectopy on the ECG.
Indications for use of an antiarrhythmic after ROSC.
Determining which antiarrhythmic to use post cardiac arrest.
Administration of Amiodarone or Lidocaine to control ventricular ectopy after ROSC.
The use of Amiodarone post arrest if no antiarrhythmics were administered prior to obtaining ROSC.
Links to other medical podcasts that cover antiarrhythmics and other ACLS-related topics are on the Pod Resource page at PassACLS.com.
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Hydrogen ions is on one of the Hs in ACLS's H&T reversible causes of cardiac arrest. When considering hydrogen ions as a cause, what we’re looking at is the patient’s pH, or acid/base balance, and conditions that affect it.
The body's normal pH.
Using patient history, ABGs, & labs to determine acidosis or alkalosis.
Common conditions/causes that may lead us to suspect acidosis.
Common conditions/causes that may lead us to suspect alkalosis.
Correcting acidosis by changing the rate of ventilations.
The indications, dose, and considerations for use of Sodium Bicarbonate.
Treatment of alkalosis depends on the type (metabolic or respiratory) and is aimed at correcting the underlying cause.
Other podcasts that cover acid/base balance and conditions that cause acidosis or alkalosis can be found on the Pod Resource Page at PassACLS.com.
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Being the team leader during a cardiac arrest is challenging. Using an algorithm helps by standardizing & prioritizing our interventions using an If/Then methodology.
Review of BLS steps for determining if rescue breathing or CPR is needed and use of an AED for patients in cardiac arrest.
If the patient is in a non-shockable rhythm on the ECG such as PEA or asystole, we will go down the right side of the Adult Cardiac Arrest Algorithm.
If the patient is in a shockable rhythm on the ECG such as V-Fib or V-Tach, we will go down the left side of the Adult Cardiac Arrest Algorithm.
An example of a code's flow for shockable rhythms when an antiarrhythmic such as Amiodarone or Lidocaine is administered.
We will follow the algorithm until the patient has ROSC or we call the code.
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For patients exhibiting symptoms consistent with myocardial ischemia, Aspirin is the first medications we should consider along with morphine, oxygen, and nitroglycerine; if indicated & safe.
Aspirin's mechanism of action & benefits for Acute Coronary Syndrome (ACS) patients.
Contraindications and considerations for aspirin’s use.
The dose and route of administration of aspirin for ACS patients.
The use of aspirin in the ACLS Stroke algorithm.
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To pass ACLS, you will need to be able to identify common rhythms on a monitor during your mega code and ECG strips on your written exam.
If you don't normally monitor patients as part of your job, I suggest two things:
-
Find a system for ECG interpretation that works well for you; and
-
Practice reading ECGs every day for a few weeks before your class.
Review of normal ECG morphology of P wave, QRS complex, and T wave in lead II.
Characteristics of first degree heart block.
Characteristics of third degree (complete) AV block.
Treatment of unstable patients in third degree block following the ACLS Bradycardia algorithm.
Special considerations for use of Atropine when patients are in a third degree heart block.
The use of TCP, Dopamine, & Epinephrine drip for unstable bradycardic patients refractory to Atropine.
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In the Adult Cardiac Arrest algorithm, we should administer an antiarrhythmic medication to patients in V-Fib or pulseless ventricular tachycardia approximately two minutes after the first dose of epinephrine.
The two first-line ACLS antiarrhythmics that are generally used are Amiodarone and Lidocaine.
Review of Lidocaine dosing and administration to patients in persistent V-Fib or pulseless V-Tach.
Review of Amiodarone dosing and administration to patients in persistent V-Fib or pulseless V-Tach.
Use of antiarrhythmic infusions post-cardiac arrest to suppress ventricular ectopy.
Amiodarone use & dosing for stable patients in V-Tach with a pulse.
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The tongue is the most common airway obstruction in an unconscious patient.
For patients with a decreased level of consciousness that can't control their airway, yet have an intact gag reflex, the nasopharyngeal airway (NPA) should be used as an alternative to the oropharyngeal airway (OPA).
Examples of when a NPA should be considered.
Contraindications and considerations for nasal airway insertion.
Measuring a nasal airway for appropriate length and diameter.
Insertion of a nasopharyngeal airway.
Patients with a NPA in place can receive supplemental O2, be ventilated with a BVM, have ETCO2 monitored, and have their upper airway suctioned as needed.
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When blood, or other fluids, accumulate in the sac around the heart it’s called a cardiac tamponade or pericardial tamponade.
Effects of tamponade on the electrical system and chambers of the heart.
Cardiac tamponade can be acute or chronic and caused by traumatic, iatrogenic, or pathological etiologies.
Common traumatic events, medical procedures, and diseases that can result in a pericardial tamponade.
Signs & symptoms of cardiac tamponade.
PEA is common because the electrical system of the heart is fine.
Treatment of cardiac tamponade with pericardiocentesis.
For additional information on cardiac tamponade, check out the Pod Resources page at PassACLS.com.
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Two things have changed in recent years to aid students that don't use ACLS in their daily practice.
1. The role of the team leader; and
2. The ability to use your quick reference cards.
The team leader is responsible for assigning tasks and overall direction of the team but should ask team members for help to confirm the ECG, suggest medications, identify possible reversible causes of cardiac arrest, and to speak up if they identify something that is unsafe.
Use of your course’s approved text book and quick reference cards during the megacode and written exam.
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Two factors to cardiac arrest survivability that have been clearly shown to make the biggest difference are continuous high quality CPR and early defibrillation.
The most common dysrhythmia present during the first few minutes of cardiac arrest is ventricular fibrillation.
The chance of successful defibrillation decreases every minute that passes.
How our chance of successfully defibrillating a patient into a perfusing rhythm significantly changes when good CPR is delivered vs when it isn't.
Examples of in-hospital and out-of-hospital cardiac arrest (OHCA) outcomes when CPR is performed until defibrillation vs defibrillation without CPR.
The role of the CPR coach.
Five tips to aid us in limiting CPR interruptions to less than 10 seconds so we can maintain a chest compression fraction (CCF) of at least 80%.
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Quantitative waveform capnography is used in ACLS as a way to confirm good CPR and placement of an endotracheal tube; identify return of spontaneous circulation; and during post-cardiac arrest care.
We can use waveform capnography with, and without, an advanced airway in place.
Monitoring end tidal CO2 during rescue breathing.
Use of capnography to objectively measure good CPR.
Capnography is a preferred method of confirming endotracheal tube (ETT) placement over x-ray during a code.
During CPR, a sudden increase in ETCO2 may indicate ROSC.
Quantitative waveform capnography is used post-cardiac arrest to aid us in maintaining an ETCO2 of 35-45 mm Hg.
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Patients with a narrow complex tachycardia with a rate over 150 BPM are in SVT.
Unstable patients in SVT, or V-Tach with a pulse, should be cardioverted with a synchronized shock.
Assessment & treatment of stable tachycardic patients.
Commonly used vagal techniques.
A less common technique to stimulate the vagus nerve is the dive reflex.
Indications and use of Adenosine for stable patients in SVT refractory to vagal maneuvers.
Possible treatments for patients found to be in A-Fib or A-Flutter with RVR after administration of Adenosine.
Carotid sinus massage.
Additional medical podcasts that have episodes on tachycardia can be found on the pod resources page at passacls.com.
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Remembering all the different energy setting needed for synchronized cardioversion and defibrillation used to be confusing for a lot of people.
Defibrillators can be broken down into three basic categories:
-
Automated External Defibrillator (AED);
-
Biphasic defibrillators; and
-
Monophasic defibrillators.
Because AEDs are designed to be used by first responders, and lay people with only minimal medical training, the controls are kept simple and are pre-programmed into the machine.
Use of an AED to rapidly deliver a shock.
Biphasic defibrillators automatically measure the impedance between the defib pads and will adjust the energy to deliver the shock needed based on the patient.
Biphasic defibrillator use and energy setting.
For monophasic defibrillators, use 360J to defibrillate V-Fib or pulseless V-Tach.
AEDs must not be used on patients with a pulse.
Cardioversion of patients in unstable SVT or V-Tach with a pulse using biphasic vs monophasic monitor/defibrillators.
Team safety when performing synchronized cardioversion.
Energy needed to cardiovert unstable patients with a narrow vs wide complex tachycardia.
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Patients with a heart rate less than 60 are bradycardic. Some people can have a resting heart rate in the 40s without any compromise. For others, a heart rate of 50 or less could signify the need for immediate intervention and warrants additional assessment.
Signs & symptoms that indicate a bradycardic patient is unstable.
Monitoring oxygen saturation with pulse oximetry and indications for administration of oxygen.
Calcium channel blockers and beta blocker medication as treatable causes of bradycardia.
The indications and dosage of Atropine.
Precautions for Atropine use in patients with second or third degree AV blocks.
The use of transcutaneous pacing (TCP) for unstable bradycardic patients refractory to Atropine.
The use and dosing of Dopamine and Epinephrine drips.
For additional information about causes and treatment of bradycardia, check out the pod resources page at PassACLS.com.
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The goal of CPR is to keep the brain and vital organs perfused until return of spontaneous circulation (ROSC) is achieved.
Post-arrest care and recovery are the final two links in the chain of survival.
Identification of ROSC during CPR.
Initial patient management goals after identifying ROSC.
The patient’s GCS/LOC should be evaluated to determine if targeted temperature management (TTM) is indicated.
Patients that cannot obey simple commands should receive TTM for at least 24 hours.
Recently published studies on TTM and ACLS’s current standard.
Monitoring the patient’s core temperature during TTM.
Patients can undergo EEG, CT, MRI, & PCI while receiving TTM.
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The chain of survival for ACLS is the same as was learned in your BLS class.
The beginning steps of the Cardiac Emergency and Stroke chain of survival are the same.
-
Recognizing the symptoms of a cardiac emergency or stroke;
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Activating an emergency response by calling 9-1-1, or a specialized code team if in the healthcare setting;
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Rapid assessment including 12 lead ECG for cardiac patients or FAST assessment for suspected stroke emergencies;
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Provide ALS care and transport to the most appropriate facility; for
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Early reperfusion.
ACLS's timed goals for first medical contact to PCI for STEMI and door-to-needle for ischemic stroke.
Areas with strong EMS relationships, well-defined transport protocols, and specialized teams that care for the patient in the hospital have significantly better patient outcomes.
The cardiac arrest chain of survival adds: high quality CPR, early defibrillation, and advanced resuscitation as the next critical links followed by post arrest care and recovery.
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Heart muscle contraction and repolarization is dependent on Sodium, Calcium, Magnesium, and Potassium ions crossing cellular membranes.
When a patient’s potassium levels get too low or too high, hypokalemia or hyperkalemia results respectively.
Two things that may lead us to suspect hypo or hyperkalemia.
Medical conditions & medications that can cause potassium imbalance.
ECG changes seen in hypo and hyperkalemia.
Critical lab values that would indicate a need for treatment.
Emergent, ACLS interventions for hypokalemia and hyperkalemia.
Additional information on causes of hypo and hyperkalemia can be found on Ninja Nerd
podcast. Check out the pod resources page at passacls.com.
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When treating patients having an MI or stroke, more minutes equals more dead cells.
Because the majority of strokes are the ischemic type, the treatment for stroke is similar to an MI – to reestablish perfusion to the ischemic tissues.
Review the first four steps in the Stroke Chain of Survival.
Time criteria for the administration of tPA or EVT of LVO strokes.
Stroke benchmarks for door to:
- assessment;
- completing a non-contrast CT; and
- administration of tPA (door-to-needle).
EMS interaction with stroke teams and destination protocols to reduce time to definitive care.
The difference for timed goals for the identification & treatment of AMI vs Stroke.
Additional information about timed goals for stroke and how EMS affects outcomes, can be found on the PassACLS.com pod resources page.
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Adenosine is the first IV medication given to stable patients with sustained supraventricular tachycardia (SVT) refractory to vagal maneuvers.
Common causes of tachycardia.
Symptoms indicating a stable vs unstable patient.
Cardiac effects of Adenosine.
Indications for use in the ACLS Tachycardia algorithm.
Considerations and contraindications.
Adenosine as a diagnostic for patients in A-Fib or A-Flutter with RVR.
Dosing and administration.
Other podcasts that cover common ACLS antiarrhythmics in more detail and another covering Brugata Criteria used to differentiate V-Tach from SVT with an aberrancy can be found on the Pod Resources page at passacls.com.
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To pass the written ACLS exam and mega code, students need to be able to identify basic ECG dysrhythmias, including the two types of second-degree heart block.
One method of ECG rhythm identification is to ask a series of questions such as:
- What's the rate (<60, 60-100, 101-149, or >150);
- Is the rhythm regular or irregular;
- What's the shape and frequency of P waves & QRS complexes; and
- What's the P-R interval and is it constant?
ECG characteristics of a second-degree Mobitz type I (Wenckebach).
Identification of unstable bradycardia and its treatment with Atropine.
ECG characteristics of a second-degree Mobitz type II.
Possible effect of using Atropine on patients with a second-degree type II AV block.
Treatment of unstable bradycardic patients refractory to Atropine using TCP, Dopamine, or Epinephrine drip.
Starting dose and titration of Dopamine and Epinephrine drips.
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The Curious Clinicians: History of Doctor Wenckebach & Mobitz
When treating patients with Acute Coronary Syndrome (ACS), MONA is an acronym sometimes used to help us remember the initial interventions.
The O in MONA is Oxygen.
When we should administer oxygen to ACS patients.
When O2 administration is unnecessary based on an accurate pulse ox.
Monitoring patient's oxygen saturation (SaO2) using a pulse oximeter.
Review two common ACLS pre-arrest mega code scenarios.
Oxygen administration during CPR and post cardiac arrest.
You can find additional medical podcasts that cover ACLS-related topics, on the Pod Resources page at PassACLS.com
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Along with early defibrillation, high quality CPR with minimal interruptions is one of the two factors that has been shown to improve cardiac arrest outcomes.
How do we know if high quality, effective CPR is being performed?
Objective measures of high-quality CPR include:
- Compression rate of 100-120 per minute;
- Compression depth of at least 5 cm;
- Allowing for full chest recoil;
- Maintaining an ETCO2 of at least 10 mm Hg; and
- Keeping interruptions to less than 10 seconds to obtain a chest compression fraction (CCF) of 80%.
The role of the CPR coach position on the code team.
The advantages and use of real-time feedback devices to monitor the rate, depth, and chest recoil of CPR compressions.
The use of end tidal waveform capnography.
A no-tech way to monitor effective CPR if no compression feedback device or ETCO2 capnography is available.
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The 2020 ACLS guidelines updated the dose for administration of Atropine and Dopamine for the treatment of unstable bradycardia.
The signs & symptoms of unstable bradycardia.
Atropine's new dose and maximum.
The use of atropine when a patient is in a second degree type II or third degree heart block.
ECG changes that indicate subsequent doses of atropine are likely to be ineffective.
The 2020 update to the starting dose of Dopamine.
The use of Dopamine for bradycardia as an interim until TCP vs hypotension.
The use of Atropine and Dopamine in patients with myocardial ischemia.
Podcasts with additional (advanced-provider level) information about bradycardia, Atropine, & Dopamine can be found on the PassACLS.com Pod Resources page.
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The tongue is the most common airway obstruction in an unconscious patient.
Insertion an oropharyngeal airway helps keep the patient’s tongue from falling to the back of the pharynx and causing an airway obstruction.
The oropharyngeal airway is sometimes called an OPA or simply an oral airway.
Indications for using an oral airway.
Contraindication for an oral airway and an alternative that can be used instead.
Measuring an OPA and possible complications from inserting one that's too small or too large.
Two techniques to properly insert an OPA and avoid complications.
The use of an oral airway during CPR.
The use of an OPA as a bite block after a patient has an advanced airway placed.
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Hypoxia is a state of low oxygen levels in the blood.
Determining hypoxia using a pulse oximeter or arterial blood gasses (ABGs).
A goal of ACLS is to recognize signs of hypoxia and provide timely treatment to prevent an arrest.
Examples of some things that might lead us to think of hypoxia as a cause of cardiac arrest.
Why we should not rely on pulse ox to give accurate readings during CPR.
Delivering ventilations with near 100% oxygen concentration using a BVM attached to supplemental O2 and a reservoir.
Using end tidal waveform capnography to assess the quality of CPR.
Changes to ventilation rates, tidal volume, and O2 concentration affects a patient's oxygen, carbon dioxide, and pH.
The danger of excessive ventilation of a patient in cardiac arrest.
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ECG characteristics of supraventricular tachycardia (SVT) vs. sinus tachycardia.
Signs & symptoms that indicate a patient is unstable.
Delivery of a synchronized shock for the treatment of unstable SVT using a biphasic vs monophasic defibrillator.
Consideration for team safety while performing synchronized cardioversion.
Actions to take immediately if an unstable patient we’ve cardioverted goes into a pulseless rhythm.
Management of stable patients in SVT.
For more on narrow complex tachycardias, check out the pod resource page at passacls.com.
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When working to resuscitate a patient in sudden cardiac arrest, Epinephrine is the first IV medication we administer.
When we give the first dose of epinephrine depends on whether the patient is in a shockable or non-shockable rhythm.
When to give the first dose of epinephrine and its frequency for patients in asystole or PEA following the right side of the Adult Cardiac Arrest algorithm.
When to give the first dose of epi and its frequency for patients in V-Fib or pulseless V-Tach following the left side of the Adult Cardiac Arrest algorithm.
Example chronology of events for a scenario where a patient is found unresponsive with only gasping/agonal breathing.
Administration of epi via the IO or endotracheal route in the absence of an IV.
The maximum cumulative dose of epinephrine that can be administered to patients in cardiac arrest.
When do we stop administering epinephrine.
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If a person suddenly develops symptoms such as weakness, slurred or garbled speech, loss of balance, or a massive & severe headache; it’s possible they could be having a stroke.
The Cincinnati Prehospital Stroke Scale uses the acronym FAST to assess Facial droop – Arm Drift - Speech – and Time.
There are several conditions that can mimic a stroke.
Identification & Treatment of hypoglycemia or hyperglycemia.
Identification & Treatment of hypoxia using a pulse oximeter.
Some seizures, electrolyte imbalance, sepsis, brain tumors, and Bell’s Palsy can also mimic a stroke.
Prehospital providers should transport suspected stroke patients to a stroke center following their local protocols.
Hospital providers should active their stroke team to ensure rapid assessment and treatment.
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Most ACLS medications are given IV push. But, what happens if we can't get an IV?
When IV access isn't available, we should consider administering our IV medications via intraosseous (IO)or endotracheal tube (ETT) route.
The locations we should place an IO when running a code and a location we should avoid.
The ACLS medications that can be given intraosseous.
Where you can find more information about intraosseous access during resuscitation efforts.
In the absence of an IV or IO, some medications may be given down the endotracheal tube.
Why IO is better for than ETT as an alternative route.
The disadvantages of medication administration via ETT.
Review of the medications that can be given down the tube and how they should be given.
Medications should not be given down the tube when anything other than an endotracheal tube is used as an advanced airway.
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The chain of survival for a cardiac emergency and stroke start the same:
- preparedness & recognition of an emergency;
- activation of EMS;
- delivery of Advanced Life Support; and
- transporting to the most appropriate facility.
Depending on where you live, Emergency Medical Services (EMS) may provide prehospital Advanced Life Support (ALS).
ALS ambulances are staffed with paramedics who have training in ACLS skills.
Paramedics can perform an assessment, obtain a medical history, and provide life-saving care within minutes of recognition.
Why EMS "Destination Protocols" for suspected stroke and STEMI make a difference.
ACLS’s timed benchmarks for:
- point of first medical contact to PCI for ST elevation MI;
- door to tPA for ischemic stroke; and
- onset of symptoms to EVT for LVO strokes.
EMS may bypass a close hospital to transport a STEMI or suspected stroke patient to a hospital capable of 24/7 PCI or a certified stroke center; because time is heart muscle or brain cells.
Check out the Pod Resource page at passacls.com for links to the "EMS On Air" podcast for links to episodes that look at EMS's role in stroke outcomes in the rural vs urban area.
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Performing good CPR and delivering a shock as soon as possible to a patient in Ventricular Fibrillation or pulseless V-Tach are the two most critical interventions that have been shown to increase survival from sudden cardiac arrest.
Studies have demonstrated significantly better out-of-hospital cardiac arrest survival outcomes in communities with robust public CPR training and public access/first responder AEDs.
The general use of AED including: indications for use; attaching the AED pads; following verbal prompts; and safely administering a shock.
Following the Adult Cardiac Arrest algorithm while using an AED.
Contraindications to AED use.
General safety considerations to remember.
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For apneic patients without a carotid pulse or patients with only gasping/agonal respirations, we will follow the Adult Cardiac Arrest algorithm.
For pulseless patients that the AED doesn't advise a shock, or if the patient's ECG shows asystole or or a non-perfusing organized rhythm (PEA), we will follow the right side of the algorithm.
Initial steps are aimed at delivery of high-quality CPR to keep the brain and vital organs alive.
Epinephrine administration.
Placement of an advanced airway.
Considering possible reversible H & T causes of cardiac arrest including three common causes of PEA and their emergent interventions.
When we should discontinue resuscitation efforts and call the code.
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Providing good, high quality, CPR with minimal interruptions and early defibrillation are two keys to improved cardiac arrest outcomes.
A training tool used in many CPR and ACLS classes is to use a song (or a song list) with a tempo of 100 to 120 beats per minute to help the person doing chest compressions maintain an adequate rate.
Characteristics of good songs that will help us.
Advantages & disadvantages of using a song during CPR.
Selected songs from various genres and time periods from AHA's "Don’t Drop The Beat" playlist on Spotify.
https://open.spotify.com/playlist/2mU2FNAhSOtQwW0hBgQMaK
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Providing good, high quality, CPR with minimal interruptions and early defibrillation are two keys to improved cardiac arrest outcomes.
A training tool used in many CPR and ACLS classes is to use a song (or a song list) with a tempo of 100 to 120 beats per minute to help the person doing chest compressions maintain an adequate rate.
Characteristics of good songs that will help us.
Advantages & disadvantages of using a song during CPR.
Selected songs from various genres and time periods from AHA's "Don’t Drop The Beat" playlist on Spotify.
https://open.spotify.com/playlist/2mU2FNAhSOtQwW0hBgQMaK
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A patient’s medical history will help us identify things that may be causing (or contributing) to their current condition as well as guide our decisions so we provide the safest evidence-based care possible.
Examples of information obtained in a medical history that will impact the treatment we provide.
There are several mnemonics and memory aids that people use to guide their history taking.
Review the SAMPLE-PQRST medical history format.
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Although magnesium can be used in the treatment of other medical conditions such as eclampsia, asthma, & digitalis toxicity; for ACLS, magnesium is primarily used to treat Torsades de Pointes.
Identification of torsades on the ECG.
Administration of a magnesium infusion for stable patients vs slow IV push for patients in cardiac arrest.
Procainamide use for stable patients with a monomorphic wide-complex tachycardia.
Procainamide dosing and when to stop the infusion.
Tip for determining whether magnesium or Procainamide should be used when treating stable patients with V-Tach.
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When a patient loses excessive amounts of fluids, we say that they are in a state of hypovolemia.
The most obvious cause of hypovolemia is from bleeding.
Bleeding can be internal or external and caused by trauma, pathology, or iatrogenic.
Classic signs & symptoms of hypovolemic shock.
Volume replacement with crystalloids vs blood.
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MONA is the acronym sometimes used to help us remember the interventions to consider for patients with Acute Coronary Syndrome or ACS.
Morphine's use in the Acute Coronary Syndrome (ACS) algorithm.
Why Morphine is helpful for patients with ACS.
Contraindications and considerations for the safe administration of Morphine.
Morphine as an alternative to nitro for patients with chest pain that take PDE inhibitors.
Common dosing & administration of Morphine.
Monitoring of the patient's level of consciousness, pain, blood pressure, and respirations after administration.
Possible side effects of Morphine administration.
Narcan as an antidote to Morphine if needed.
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Even good CPR is far less efficient at circulating blood than a functioning heart.
The indicators of high-quality CPR that were identified at the 2012 AHA CPR Quality Summit in order of importance include:
- Chest compression fraction (CCF);
- Chest compression rate;
- Chest compression depth;
- Allowing for full recoil; and
- Adequate ventilations.
Using real-time feedback devices and ETCO2 to assess CPR quality.
Tips to limit pauses in CPR compressions to 10 seconds or less include:
-
Pre-charge the defibrillator for 15 seconds before completion of a 2 minute cycle;
-
Continuing chest compressions until the defibrillator is fully charged;
-
Continuing chest compressions during insertion of an advanced airway; and
-
Performing other activities simultaneously during scheduled pauses.
Limiting interruptions to chest compressions to less than 10 seconds so we can maintain a CCF of 80% requires teamwork and communication.
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Epinephrine and Dopamine are adrenergic agonist used in several ACLS algorithms.
The use of epinephrine for severe anaphylaxis or unstable bradycardia.
Review epinephrine’s effects on blood vessels and bronchioles.
Why epinephrine is helpful for patients with anaphylaxis.
Using an epi drip for unstable bradycardia.
Epinephrine administration during cardiac arrest.
Starting and epinephrine or Dopamine drip for patients that have ROSC.
Review the effects of Dopamine based on mcg/kg/min dosing.
Monitoring the patient and titrating epi or Dopamine drips to prevent harm.
For more information on ACLS medications, check out the pod resource page at passacls.com.
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Providing rescue breathing to apneic patients with a palpable pulse.
Normal end tidal CO2 for patients with a pulse.
Identification of cardiac arrest and our immediate actions.
Providing artificial ventilations during CPR without an advanced airway vs with an advanced airway in place.
Using quantitative waveform capnography to confirm placement of an advanced airway, assess the quality of CPR, and identify ROSC.
The effects of hyperventilating patients in cardiac arrest.
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Hypothermic patients aren't dead until they are warm and dead.
When a patient’s core body temperature drops below 96.8 F (36 C), they are hypothermic. As the body’s temperature drops below 36 C, hypothermia may further be classified as moderate or severe:
- Moderate if the patient’s body core temp is between 30-34 C; and
- Severe if it's below 30 C.
Modifying the ACLS Adult Cardiac Arrest algorithm for patients with severe hypothermia.
Following the ACLS algorithm for patients with a body core temperature above 30 C.
Methods for rewarming patients with moderate vs severe hypothermia.
Continuation of CPR and ACLS efforts until the patient’s body core temp is above 36 C.
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Calcium is one of the ions that move across the cellular membrane during cardiac contraction and relaxation.
The primary use of calcium channel blockers in ACLS is for the treatment of stable, narrow complex tachycardias refractory to Adenosine and to lower the blood pressure of ischemic stroke patients with severe hypertension.
Use of calcium channel blockers for SVT refractory to Adenosine and A-Fib or A-Flutter with RVR.
Contraindications of calcium channel blockers.
Nicardipine use during the treatment of ischemic strokes.
For more information on ACLS medications, tachycardia, or stroke check out the pod resource page at passacls.com.
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The goal of CPR is to keep the brain and vital organs perfused until return of spontaneous circulation (ROSC) is achieved.
Post-arrest care and recovery are the final two links in the chain of survival.
Identification of ROSC during CPR.
Initial patient management goals after identifying ROSC.
The patient’s GCS/LOC should be evaluated to determine if targeted temperature management (TTM) is indicated.
Patients that cannot obey simple commands should receive TTM for at least 24 hours.
Monitoring the patient’s core temperature during TTM.
Why we should cool unresponsive post-arrest patients.
Patients can undergo EEG, CT, MRI, & PCI while receiving TTM.
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Nitroglycerine is vasodilator that affects peripheral blood vessels and coronary arteries.
Because of its widespread dilation effects on blood vessels, nitro can quickly lower a patient’s blood pressure, sometimes to the point of making a patient hypotensive.
Assessment of vital signs prior to administering nitro is necessary to ensure patient safety.
Indications for use of nitroglycerine.
Nitroglycerine's contraindications & considerations for use.
Effects of nitro on patients taking PDE inhibitors.
Administration of nitroglycerine to patients with ischemic chest pain.
Considerations for patients that took their home nitroglycerine.
Monitoring patient's pain and vital signs after nitro administration.
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In atrial fibrillation (A-Fib) and atrial flutter (A-Flutter) the electrical impulse for cardiac contraction is in the atria but isn't the normal pacemaker of the heart, the SA node.
The ECG characteristics of A-Fib and A-Flutter.
Recognition and treatment of unstable patients in A-Fib/Flutter with rapid ventricular response (RVR).
Suggested energy settings for synchronized cardioversion of stable patients with a narrow complex tachycardia.
Team safety when cardioverting an unstable patient in A-FIB.
Adenosine’s role for stable SVT patients with atrial rhythms.
Treatment of stable patients in A-Fib/Flutter with RVR.
For other medical podcasts that cover narrow complex tachycardias, visit the pod resource page at passacls.com.
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If you're attending Save MI Heart, be sure to say hello!
As an ACLS provider you do not need to be familiar with all of the different signs of various types of poisoning. You should be able to obtain a history and know to order toxicology.
The majority of toxins don’t have a specific antidote. There are a few toxins for which we have emergency interventions and ACLS providers should be familiar with.
Reviewing the patient's medical history for indicators that may lead us to suspect a tablet/toxin cause of cardiac arrest.
Administration of Narcan for suspected narcotics overdose following the Opioid Associated Emergency algorithm.
Other common ACLS Tablet Toxin scenarios with possible treatments.
Medications commonly used to treat specific toxins that are regularly stocked on crash carts or carried in EMS med bags.
ACLS providers that suspect a specific toxin should consult with their Pharmacy or call Poison Control for treatment directions.
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The ACLS algorithms are designed to make it easier to remember the key interventions we should deliver, and the order in which they should be delivered, to provide the best evidence-based care possible.
Generally speaking, if there’s a change in a patient’s condition, we should ensure we’re using the correct algorithm.
Three key points to remember when using ACLS algorithms:
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If a patient’s condition changes, we should do an assessment and use the algorithm that matches the patient’s current state.
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If an action was already done, we don’t need to repeat it.
-
We only do actions that are clinically appropriate and within our scope of practice.
Walk through of an example mega code scenario with explanations of when and why we change to a different ACLS algorithm.
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Beta blocking medications attach to Beta receptors to inhibit or “block” the effects of epinephrine (adrenaline) and norepinephrine in the body.
The primary locations of Beta I, II, and III receptors.
Effects of epinephrine & norepinephrine's stimulation of beta receptors on the heart.
Beta blockers effects on the heart.
When we should consider the use of beta blockers in the Acute Coronary Syndrome (ACS)and Tachycardia algorithms.
Contraindications to the use of beta blocker medications.
More detailed information about beta blocker’s mechanism of action and specific instances for use can be found on the Pod Resource page at PassACLS.com.
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This episode we are reviewing the use of advanced airways in the adult cardiac arrest algorithm.
When we should consider insertion of an advanced airway for patients in a shockable vs non-shockable rhythm.
In addition to an endotracheal tube (ETT), other ACLS advanced airways include the Laryngeal Mask Airway (LMA) and the Laryngeal Tube airway.
The advantages of using an advanced airway over basic airway maneuvers.
Use of end tidal CO2 waveform capnography to confirm placement and assess the adequacy of CPR.
Identification and management of a misplaced ET tube.
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Our primary focus immediately following return of spontaneous circulation (ROSC) is aimed at ensuring adequate perfusion of the patient’s vital organs and decreasing cerebral damage.
After we have assessed and addressed O2 saturation, ETCO2, and BP, we may consider the use of an antiarrhythmic infusion if the patient has ventricular ectopy on the ECG.
Indications for use of an antiarrhythmic after ROSC.
Determining which antiarrhythmic to use post cardiac arrest.
Administration of Amiodarone or Lidocaine to control ventricular ectopy after ROSC.
The use of Amiodarone post arrest if no antiarrhythmics were administered prior to obtaining ROSC.
Links to other medical podcasts that cover antiarrhythmics and other ACLS-related topics are on the Pod Resource page at PassACLS.com.
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Hydrogen ions is on one of the Hs in ACLS's H&T reversible causes of cardiac arrest.
When considering hydrogen ions as a cause, what we’re looking at is the patient’s pH, or acid/base balance, and conditions that affect it.
The body's normal pH.
Using patient history, ABGs, & labs to determine acidosis or alkalosis.
Common conditions/causes that may lead us to suspect acidosis.
Common conditions/causes that may lead us to suspect alkalosis.
Correcting acidosis by changing the rate of ventilations.
The indications, dose, and considerations for use of Sodium Bicarbonate.
Treatment of alkalosis depends on the type (metabolic or respiratory) and is aimed at correcting the underlying cause.
Other podcasts that cover acid/base balance and conditions that cause acidosis or alkalosis can be found on the Pod Resource Page at PassACLS.com.
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Being the team leader during a cardiac arrest is challenging. Using an algorithm helps by standardizing & prioritizing our interventions using an If/Then methodology.
Review of BLS steps for determining if rescue breathing or CPR is needed and use of an AED for patients in cardiac arrest.
If the patient is in a non-shockable rhythm on the ECG such as PEA or asystole, we will go down the right side of the Adult Cardiac Arrest Algorithm.
If the patient is in a shockable rhythm on the ECG such as V-Fib or V-Tach, we will go down the left side of the Adult Cardiac Arrest Algorithm.
An example of a code's flow for shockable rhythms when an antiarrhythmic such as Amiodarone or Lidocaine is administered.
We will follow the algorithm until the patient has ROSC or we call the code.
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For patients exhibiting symptoms consistent with myocardial ischemia, Aspirin is the first medications we should consider along with morphine, oxygen, and nitroglycerine; if indicated & safe.
Aspirin's mechanism of action & benefits for Acute Coronary Syndrome (ACS) patients.
Contraindications and considerations for aspirin’s use.
The dose and route of administration of aspirin for ACS patients.
The use of aspirin in the ACLS Stroke algorithm.
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To pass ACLS, you will need to be able to identify common rhythms on a monitor during your mega code and ECG strips on your written exam.
If you don't normally monitor patients as part of your job, I suggest two things:
- Find a system for ECG interpretation that works well for you; and
- Practice reading ECGs every day for a few weeks before your class.
Review of normal ECG morphology of P wave, QRS complex, and T wave in lead II.
Characteristics of first degree heart block.
Characteristics of third degree (complete) AV block.
Treatment of unstable patients in third degree block following the ACLS Bradycardia
algorithm.
Special considerations for use of Atropine when patients are in a third degree heart block.
The use of TCP, Dopamine, & Epinephrine drip for unstable bradycardic patients refractory to Atropine.
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In the Adult Cardiac Arrest algorithm, we should administer an antiarrhythmic medication to patients in V-Fib or pulseless ventricular tachycardia approximately two minutes after the first dose of epinephrine.
The two first-line ACLS antiarrhythmics that are generally used are Amiodarone and Lidocaine.
Review of Lidocaine dosing and administration to patients in persistent V-Fib or pulseless V-Tach.
Review of Amiodarone dosing and administration to patients in persistent V-Fib or pulseless V-Tach.
Use of antiarrhythmic infusions post-cardiac arrest to suppress ventricular ectopy.
Amiodarone use & dosing for stable patients in V-Tach with a pulse.
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The tongue is the most common airway obstruction in an unconscious patient.
For patients with a decreased level of consciousness that can't control their airway, yet have an intact gag reflex, the nasopharyngeal airway (NPA) should be used as an alternative to the oropharyngeal airway (OPA).
Examples of when a NPA should be considered.
Contraindications and considerations for nasal airway insertion.
Measuring a nasal airway for appropriate length and diameter.
Insertion of a nasopharyngeal airway.
Patients with a NPA in place can receive supplemental O2, be ventilated with a BVM, have ETCO2 monitored, and have their upper airway suctioned as needed.
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When blood, or other fluids, accumulate in the sac around the heart it’s called a cardiac tamponade or pericardial tamponade.
Effects of tamponade on the electrical system and chambers of the heart.
Cardiac tamponade can be acute or chronic and caused by traumatic, iatrogenic, or pathological etiologies.
Common traumatic events, medical procedures, and diseases that can result in a pericardial tamponade.
Signs & symptoms of cardiac tamponade.
PEA is common because the electrical system of the heart is fine.
Treatment of cardiac tamponade with pericardiocentesis.
For additional information on cardiac tamponade, check out the Pod Resources page at PassACLS.com.
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Two things have changed in recent years to aid students that don't use ACLS in their daily practice.
1. The role of the team leader; and
2. The ability to use your quick reference cards.
The team leader is responsible for assigning tasks and overall direction of the team but should ask team members for help to confirm the ECG, suggest medications, identify possible reversible causes of cardiac arrest, and to speak up if they identify something that is unsafe.
Use of your course’s approved text book and quick reference cards during the megacode and written exam.
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Two factors to cardiac arrest survivability that have been clearly shown to make the biggest difference is continuous high quality CPR and early defibrillation.
The most common dysrhythmia present during the first few minutes of cardiac arrest is ventricular fibrillation.
The chance of successful defibrillation decreases every minute that passes.
How our chance of successfully defibrillating a patient into a perfusing rhythm significantly changes when good CPR is delivered vs when it isn't.
Examples of in-hospital and out-of-hospital cardiac arrest (OHCA) outcomes when CPR is performed until defibrillation vs defibrillation without CPR.
The role of the CPR coach.
Five tips to aid us in limiting CPR interruptions to less than 10 seconds so we can maintain a chest compression fraction (CCF) of at least 80%.
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Quantitative waveform capnography is used in ACLS as a way to confirm good CPR and placement of an endotracheal tube; identify return of spontaneous circulation; and during post-cardiac arrest care.
We can use waveform capnography with, and without, an advanced airway in place.
Monitoring end tidal CO2 during rescue breathing.
Use of capnography to objectively measure good CPR.
Capnography is a preferred method of confirming endotracheal tube (ETT) placement over x-ray during a code.
During CPR, a sudden increase in ETCO2 may indicate ROSC.
Quantitative waveform capnography is used post-cardiac arrest to aid us in maintaining an ETCO2 of 35-45 mm Hg.
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Patients with a narrow complex tachycardia with a rate over 150 BPM are in SVT.
Unstable patients in SVT, or V-Tach with a pulse, should be cardioverted with a synchronized shock.
Assessment & treatment of stable tachycardic patients.
Commonly used vagal techniques.
A less common technique to stimulate the vagus nerve is the dive reflex.
Indications and use of Adenosine for stable patients in SVT refractory to vagal maneuvers.
Possible treatments for patients found to be in A-Fib or A-Flutter with RVR after administration of Adenosine.
Carotid sinus massage.
Additional medical podcasts that have episodes on tachycardia can be found on the pod resources page at passacls.com.
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Remembering all the different energy setting needed for synchronized cardioversion and defibrillation used to be confusing for a lot of people.
Defibrillators can be broken down into three basic categories:
-
Automated External Defibrillator (AED);
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Biphasic defibrillators; and
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Monophasic defibrillators.
Because AEDs are designed to be used by first responders, and lay people with only minimal medical training, the controls are kept simple and are pre-programmed into the machine.
Use of an AED to rapidly deliver a shock.
Biphasic defibrillators automatically measure the impedance between the defib pads and will adjust the energy to deliver the shock needed based on the patient.
Biphasic defibrillator use and energy setting.
For monophasic defibrillators, use 360J to defibrillate V-Fib or pulseless V-Tach.
AEDs must not be used on patients with a pulse.
Cardioversion of patients in unstable SVT or V-Tach with a pulse using biphasic vs monophasic monitor/defibrillators.
Team safety when performing synchronized cardioversion.
Energy needed to cardiovert unstable patients with a narrow vs wide complex tachycardia.
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Patients with a heart rate less than 60 are bradycardic. Some people can have a resting heart rate in the 40s without any compromise. For others, a heart rate of 50 or less could signify the need for immediate intervention and warrants additional assessment.
Signs & symptoms that indicate a bradycardic patient is unstable.
Monitoring oxygen saturation with pulse oximetry and indications for administration of oxygen.
Calcium channel blockers and beta blocker medication as treatable causes of bradycardia.
The indications and dosage of Atropine.
Precautions for Atropine use in patients with second or third degree AV blocks.
The use of transcutaneous pacing (TCP) for unstable bradycardic patients refractory to Atropine.
The use and dosing of Dopamine and Epinephrine drips.
For additional information about causes and treatment of bradycardia, check out the pod resources page at PassACLS.com.
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The goal of CPR is to keep the brain and vital organs perfused until return of spontaneous circulation (ROSC) is achieved.
Post-arrest care and recovery are the final two links in the chain of survival.
Identification of ROSC during CPR.
Initial patient management goals after identifying ROSC.
The patient’s GCS/LOC should be evaluated to determine if targeted temperature management (TTM) is indicated.
Patients that cannot obey simple commands should receive TTM for at least 24 hours.
Monitoring the patient’s core temperature during TTM.
Patients can undergo EEG, CT, MRI, & PCI while receiving TTM.
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The chain of survival for ACLS is the same as was learned in your BLS class.
The beginning steps of the Cardiac Emergency and Stroke chain of survival are the
same.
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Recognizing the symptoms of a cardiac emergency or stroke;
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Activating an emergency response by calling 9-1-1, or a specialized code team if in the healthcare setting;
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Rapid assessment including 12 lead ECG for cardiac patients or FAST assessment for suspected stroke emergencies;
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Provide ALS care and transport to the most appropriate facility; for
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Early reperfusion.
ACLS's timed goals for first medical contact to PCI for STEMI and door-to-needle for ischemic stroke.
Areas with strong EMS relationships, well-defined transport protocols, and specialized teams that care for the patient in the hospital have significantly better patient outcomes.
The cardiac arrest chain of survival adds: high quality CPR, early defibrillation, and advanced resuscitation as the next critical links followed by post arrest care and recovery.
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Heart muscle contraction and repolarization is dependent on Sodium, Calcium, Magnesium, and Potassium ions crossing cellular membranes.
When a patient’s potassium levels get too low or too high, hypokalemia or hyperkalemia results respectively.
Two things that may lead us to suspect hypo or hyperkalemia.
Medical conditions & medications that can cause potassium imbalance.
ECG changes seen in hypo and hyperkalemia.
Critical lab values that would indicate a need for treatment.
Emergent, ACLS interventions for hypokalemia and hyperkalemia.
Additional information on causes of hypo and hyperkalemia can be found on Ninja Nerd podcast. Check out the pod resources page at passacls.com.
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When treating patients having an MI or stroke, more minutes equals more dead cells.
Because the majority of strokes are the ischemic type, the treatment for stroke is similar to an MI – to reestablish perfusion to the ischemic tissues.
Review the first four steps in the Stroke Chain of Survival.
Time criteria for the administration of tPA or EVT of LVO strokes.
Stroke benchmarks for door to:
- assessment;
- completing a non-contrast CT; and
- administration of tPA (door-to-needle).
EMS interaction with stroke teams and destination protocols to reduce time to definitive care.
The difference for timed goals for the identification & treatment of AMI vs Stroke.
Additional information about timed goals for stroke and how EMS affects outcomes, can be found on the PassACLS.com pod resources page.
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Adenosine is the first IV medication given to stable patients with sustained supraventricular tachycardia (SVT) refractory to vagal maneuvers.
Symptoms indicating a stable vs unstable patient.
Common causes of tachycardia.
Cardiac effects of Adenosine.
Indications for use in the ACLS Tachycardia algorithm.
Considerations and contraindications.
Adenosine as a diagnostic for patients in A-Fib or A-Flutter with RVR.
Dosing and administration.
Other podcasts that cover common ACLS antiarrhythmics in more detail and another covering Brugata Criteria used to differentiate V-Tach from SVT with an aberrancy can be found on the Pod Resources page at passacls.com.
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Website: https://passacls.com
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Good luck with your ACLS class!
To pass the written ACLS exam and mega code, students need to be able to identify basic ECG dysrhythmias, including the two types of second-degree heart block.
One method of ECG rhythm identification is to ask a series of questions such as:
- What's the rate (<60, 60-100, 101-149, or >150);
- Is the rhythm regular or irregular;
- What's the shape and frequency of P waves and QRS complexes; and
- What's the P-R interval and is it constant?
ECG characteristics of a second-degree Mobitz type I (Wenckebach).
Identification of unstable bradycardia and its treatment with Atropine.
ECG characteristics of a second-degree Mobitz type II.
Possible effect of using Atropine on patients with a second-degree type II AV block.
Treatment of unstable bradycardic patients refractory to Atropine using TCP, Dopamine, or Epinephrine drip.
Starting dose and titration of Dopamine and Epinephrine drips.
Connect with me:
Website: https://passacls.com
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@Pass-ACLS-Podcast on LinkedIn
Give back & support the show:
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Good luck with your ACLS class!
The Curious Clinicians: History of Doctor Wenckebach & Mobitz
When treating patients with Acute Coronary Syndrome (ACS), MONA is an acronym sometimes used to help us remember the initial interventions.
The O in MONA is Oxygen.
When we should administer oxygen to ACS patients.
When O2 administration is unnecessary based on an accurate pulse ox.
Monitoring patient's oxygen saturation (SaO2) using a pulse oximeter.
Review two common ACLS pre-arrest mega code scenarios.
Oxygen administration during CPR and post cardiac arrest.
You can find additional medical podcasts that cover ACLS-related topics, on the Pod Resources page at PassACLS.com
Connect with me:
Website: https://passacls.com
@PassACLS on Twitter
@Pass-ACLS-Podcast on LinkedIn
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Good luck with your ACLS class!
Along with early defibrillation, high quality CPR with minimal interruptions is one of the two factors that has been shown to improve cardiac arrest outcomes.
How do we know if high quality, effective CPR is being performed?
Objective measures of high-quality CPR include:
- Compression rate of 100-120 per minute;
- Compression depth of at least 5 cm;
- Allowing for full chest recoil;
- Maintaining an ETCO2 of at least 10 mm Hg; and
- Keeping interruptions to less than 10 seconds to obtain a chest compression fraction (CCF) of 80%.
The role of the CPR coach position on the code team.
The advantages and use of real-time feedback devices to monitor the rate, depth, and chest recoil of CPR compressions.
The use of end tidal waveform capnography.
A no-tech way to monitor effective CPR if no compression feedback device or ETCO2 capnography is available.
The 2020 ACLS guidelines updated the dose for administration of Atropine and Dopamine for the treatment of unstable bradycardia.
The signs & symptoms of unstable bradycardia.
Atropine's new dose and maximum.
The use of atropine when a patient is in a second degree type II or third degree heart block.
ECG changes that indicate subsequent doses of atropine are likely to be ineffective.
The 2020 update to the starting dose of Dopamine.
The use of Dopamine for bradycardia as an interim until TCP vs hypotension.
The use of Atropine and Dopamine in patients with myocardial ischemia.
Podcasts with additional (advanced-provider level) information about bradycardia, Atropine, & Dopamine can be found on the PassACLS.com Pod Resources page.
Connect with me:
Website: https://passacls.com
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@Pass-ACLS-Podcast on LinkedIn
Give back & support the show:
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Good luck with your ACLS class!
The tongue is the most common airway obstruction in an unconscious patient.
Insertion an oropharyngeal airway helps keep the patient’s tongue from falling to the back of the pharynx and causing an airway obstruction.
The oropharyngeal airway is sometimes called an OPA or simply an oral airway.
Indications for using an oral airway.
Contraindication for an oral airway and an alternative that can be used instead.
Measuring an OPA and possible complications from inserting one that's too small or too large.
Two techniques to properly insert an OPA and avoid complications.
The use of an oral airway during CPR.
The use of an OPA as a bite block after a patient has an advanced airway placed.
Connect with me:
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Good luck with your ACLS class!
Hypoxia is a state of low oxygen levels in the blood.
Determining hypoxia using a pulse oximeter or arterial blood gasses (ABGs).
A goal of ACLS is to recognize signs of hypoxia and provide timely treatment to prevent an arrest.
Examples of some things that might lead us to think of hypoxia as a cause of cardiac arrest.
Why we should not rely on pulse ox to give accurate readings during CPR.
Delivering ventilations with near 100% oxygen concentration using a BVM attached to supplemental O2 and a reservoir.
Using end tidal waveform capnography to assess the quality of CPR.
Changes to ventilation rates, tidal volume, and O2 concentration affects a patient's oxygen, carbon dioxide, and pH.
The danger of excessive ventilation of a patient in cardiac arrest.
Connect with me:
Website: https://passacls.com
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@Pass-ACLS-Podcast on LinkedIn
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Good luck with your ACLS class!
ECG characteristics of supraventricular tachycardia (SVT) vs. sinus tachycardia.
Signs & symptoms that indicate a patient is unstable.
Delivery of a synchronized shock for the treatment of unstable SVT using a biphasic vs monophasic defibrillator.
Consideration for team safety while performing synchronized cardioversion.
Actions to take immediately if an unstable patient we’ve cardioverted goes into a pulseless rhythm.
Management of stable patients in SVT.
For more on narrow complex tachycardias, check out the pod resource page at passacls.com.
Connect with me:
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Good luck with your ACLS class!
When working to resuscitate a patient in sudden cardiac arrest, Epinephrine is the first IV medication we administer.
When we give the first dose of epinephrine depends on whether the patient is in a shockable or non-shockable rhythm.
When to give the first dose of epinephrine and its frequency for patients in asystole or PEA following the right side of the Adult Cardiac Arrest algorithm.
When to give the first dose of epi and its frequency for patients in V-Fib or pulseless V-Tach following the left side of the Adult Cardiac Arrest algorithm.
Example chronology of events for a scenario where a patient is found unresponsive, pulseless, and only gasping/agonal breathing.
Administration of epi via the IO or endotracheal route in the absence of an IV.
The maximum cumulative dose of epinephrine that can be administered to patients in cardiac arrest.
When do we stop administering epinephrine.
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If a person suddenly develops symptoms such as weakness, slurred or garbled speech, loss of balance, or a massive & severe headache; it’s possible they could be having a stroke.
The Cincinnati Prehospital Stroke Scale uses the acronym FAST to assess Facial droop – Arm Drift - Speech – and Time.
There are several conditions that can mimic a stroke.
Identification & Treatment of hypoglycemia or hyperglycemia.
Identification & Treatment of hypoxia using a pulse oximeter.
Some seizures, electrolyte imbalance, sepsis, brain tumors, and Bell’s Palsy can also mimic a stroke.
Prehospital providers should transport suspected stroke patients to a stroke center following their local protocols.
Hospital providers should active their stroke team to ensure rapid assessment and treatment.
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Good luck with your ACLS class!
Most ACLS medications are given IV push. But, what happens if we can't get an IV?
When IV access isn't available, we should consider administering our IV medications via intraosseous (IO)or endotracheal tube (ETT) route.
Why IO is better for than ETT as an alternative route.
The locations we should place an IO when running a code and a location we should avoid.
The ACLS medications that can be given intraosseous.
Where you can find more information about intraosseous access during resuscitation efforts.
In the absence of an IV or IO, some medications may be given down the endotracheal tube.
The disadvantages of medication administration via ETT.
Review of the medications that can be given down the tube and how they should be given.
Medications should not be given down the tube when anything other than an endotracheal tube is used as an advanced airway.
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Good luck with your ACLS class!
The chain of survival for a cardiac emergency and stroke start the same:
-
preparedness & recognition of an emergency;
-
activation of EMS;
-
delivery of Advanced Life Support; and
-
transporting to the most appropriate facility.
Depending on where you live, Emergency Medical Services (EMS) may provide prehospital Advanced Life Support (ALS).
ALS ambulances are staffed with paramedics who have training in ACLS skills.
Paramedics can perform an assessment, obtain a medical history, and provide life-saving care within minutes of recognition.
Why EMS "Destination Protocols" for suspected stroke and STEMI make a difference.
- ACLS’s timed benchmarks for:
- point of first medical contact to PCI for ST elevation MI;
- door to tPA for ischemic stroke; and
- onset of symptoms to EVT for LVO strokes.
EMS may bypass a close hospital to transport a STEMI or suspected stroke patient to a hospital capable of 24/7 PCI or a certified stroke center; because time is heart muscle or brain cells.
Check out the Pod Resource page at passacls.com for links to the "EMS On Air" podcast for links to episodes that look at EMS's role in stroke outcomes in the rural vs urban area.
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Good luck with your ACLS class!
The chain of survival for ACLS is the same as was learned in your BLS class.
The beginning steps of the Cardiac Emergency and Stroke chain of survival are the
same.
- Recognizing the symptoms of a cardiac emergency or stroke;
- Activating an emergency response by calling 9-1-1, or a specialized code team if in the healthcare setting;
- Rapid assessment including 12 lead ECG for cardiac patients or FAST assessment for suspected stroke emergencies;
- Provide ALS care and transport to the most appropriate facility; for
- Early reperfusion.
ACLS's timed goals for first medical contact to PCI for STEMI and door-to-needle for ischemic stroke.
Areas with strong EMS relationships, well-defined transport protocols, and specialized teams that care for the patient in the hospital have significantly better patient outcomes.
The cardiac arrest chain of survival adds: high quality CPR, early defibrillation, and advanced resuscitation as the next critical links followed by post arrest care and recovery.
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Heart muscle contraction and repolarization is dependent on Sodium, Calcium, Magnesium, and Potassium ions crossing cellular membranes.
When a patient’s potassium levels get too low or too high, hypokalemia or hyperkalemia results respectively.
Two things that may lead us to suspect hypo or hyperkalemia include the patient's medical history and changes to the T wave on the ECG.
Medical conditions & medications that can cause potassium imbalance.
ECG changes seen in hypo and hyperkalemia.
Critical lab values that would indicate a need for treatment.
Emergent, ACLS interventions for hypokalemia and hyperkalemia.
Additional information on causes of hypo and hyperkalemia can be found on Ninja Nerd podcast. Check out the pod resources page at passacls.com.
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When treating patients having an MI or stroke, more minutes equals more dead cells. Because the majority of strokes are the ischemic type, the treatment for stroke is similar to an MI – to reestablish perfusion to the ischemic tissues.
Review the first four steps in the Stroke Chain of Survival.
Time criteria for the administration of tPA or EVT of LVO strokes.
Stroke benchmarks for door to:
- assessment;
- completing a non-contrast CT; and
- administration of tPA (door-to-needle).
EMS interaction with stroke teams and destination protocols to reduce time to definitive care.
The difference for timed goals for the identification & treatment of AMI vs Stroke.
Additional information about timed goals for stroke and how EMS affects outcomes, can be found on the PassACLS.com Pod Resources page.
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Good luck with your ACLS class!
Adenosine is the first IV medication given to stable patients with sustained supraventricular tachycardia (SVT) refractory to vagal maneuvers.
Common causes of tachycardia.
Symptoms indicating a stable vs unstable patient.
Cardiac effects of Adenosine.
Indications for use in the ACLS Tachycardia algorithm.
Considerations and contraindications.
Adenosine as a diagnostic for patients in A-Fib or A-Flutter with RVR.
Dosing and administration.
Other podcasts that cover common ACLS antiarrhythmics in more detail and another covering Brugata Criteria used to differentiate V-Tach from SVT with an aberrancy can be found on the Pod Resources page at passacls.com.
Connect with me:
Website: https://passacls.com
@PassACLS on Twitter
@Pass-ACLS-Podcast on LinkedIn
Give back & support the show:
via PayPal
Good luck with your ACLS class!
To pass the written ACLS exam and mega code, students need to be able to identify basic ECG dysrhythmias, including the two types of second-degree heart block.
One method of ECG rhythm identification is to ask a series of questions such as:
- What's the rate (<60, 60-100, 101-149, or >150);
- Is the rhythm regular or irregular;
- What's the shape and frequency of P waves and QRS complexes; and
- What's the P-R interval and is it constant?
ECG characteristics of a second-degree Mobitz type I (Wenckebach).
Identification of unstable bradycardia and its treatment with Atropine.
ECG characteristics of a second-degree Mobitz type II.
Possible effect of using Atropine on patients with a second-degree type II AV block.
Treatment of unstable bradycardic patients refractory to Atropine using TCP, Dopamine, or Epinephrine drip.
Starting dose and titration of Dopamine and Epinephrine drips.
Connect with me:
Website: https://passacls.com
@PassACLS on Twitter
@Pass-ACLS-Podcast on LinkedIn
Give back & support the show:
via PayPal
Good luck with your ACLS class!
The Curious Clinicians: History of Doctor Wenckebach & Mobitz
When treating patients with Acute Coronary Syndrome (ACS), MONA is an acronym sometimes used to help us remember the initial interventions.
The O in MONA is Oxygen.
When should we administer oxygen to ACS patients.
When is O2 administration unnecessary.
Monitoring patient's oxygen saturation (SaO2) using a pulse oximeter.
Review two common ACLS mega code scenarios.
Oxygen administration during CPR and post cardiac arrest.
Monitoring oxygen saturation with pulse oximetry.
You can find additional ACLS-related podcasts, including a link to an episode on the dangers of hyperoxygenation, on the Pod Resources page at PassACLS.com
Connect with me:
Website: https://passacls.com
@PassACLS on Twitter
@Pass-ACLS-Podcast on LinkedIn
Give back & support the show:
via PayPal
Good luck with your ACLS class!
Along with early defibrillation, high quality CPR with minimal interruptions is one
of the two factors that has been shown to improve cardiac arrest outcomes.
How do we know if high quality, effective CPR is being performed?
Objective measures of high-quality CPR include:
- Compression rate of 100-120 per minute;
- Compression depth of at least 5 cm;
- Allowing for full chest recoil;
- Maintaining an ETCO2 of at least 10 mm Hg; and
- Keeping interruptions to less than 10 seconds to obtain a chest compression fraction (CCF) of 80%.
The CPR coach as a new position of the code team.
The advantages and use of real-time feedback devices to monitor the rate, depth, and chest recoil of CPR compressions.
The use of end tidal waveform capnography.
A no-tech way to monitor effective CPR if no feedback devices are available.
Connect with me:
Website: https://passacls.com
@PassACLS on Twitter
@Pass-ACLS-Podcast on LinkedIn
Give back & support the show:
via PayPal
Good luck with your ACLS class!
The 2020 ACLS guidelines updated the dose for administration of Atropine and Dopamine for the treatment of unstable bradycardia.
The signs & symptoms of unstable bradycardia.
Atropine's new dose and maximum.
The use of atropine when a patient is in a second degree type II or third degree heart block.
ECG changes that indicate subsequent doses of atropine are likely to be ineffective.
The 2020 update to the starting dose of Dopamine.
The use of Dopamine for bradycardia as an interim until TCP vs hypotension.
The use of Atropine and Dopamine in patients with myocardial ischemia.
Podcasts with additional (advanced-provider level) information about bradycardia, Atropine, & Dopamine can be found on the PassACLS.com Pod Resources page.
Connect with me:
Website: https://passacls.com
@PassACLS on Twitter
@Pass-ACLS-Podcast on LinkedIn
Give back & support the show:
via PayPal
Good luck with your ACLS class!
The tongue is the most common airway obstruction in an unconscious patient.
Insertion an oropharyngeal airway helps keep the patient’s tongue from falling to the back of the pharynx and causing an airway obstruction.
The oropharyngeal airway is sometimes called an OPA or simply an oral airway.
Indications for using an oral airway.
Contraindication for an oral airway and an alternative that can be used instead.
Measuring an OPA and possible complications from inserting one that's too small or too large.
Two techniques to properly insert an OPA and avoid complications.
The use of an oral airway during CPR.
The use of an OPA as a bite block after a patient has an advanced airway placed.
Connect with me:
Website: https://passacls.com
@PassACLS on Twitter
@Pass-ACLS-Podcast on LinkedIn
Give back & support the show:
via PayPal
Good luck with your ACLS class!
Hypoxia is a state of low oxygen levels in the blood.
Determining hypoxia using a pulse oximeter or arterial blood gasses (ABGs).
A goal of ACLS is to recognize signs of hypoxia and provide timely treatment to prevent an arrest.
Examples of some things that might lead us to think of hypoxia as a cause of cardiac arrest.
Why we should not rely on pulse ox to give accurate readings during CPR.
Delivering ventilations with near 100% oxygen concentration using a BVM attached to supplemental O2 and a reservoir.
Using end tidal waveform capnography to assess the quality of CPR.
Changes to ventilation rates, tidal volume, and O2 concentration affects a patient's oxygen, carbon dioxide, and pH.
The danger of over ventilating a patient in cardiac arrest.
Connect with me:
Website: https://passacls.com
@PassACLS on Twitter
@Pass-ACLS-Podcast on LinkedIn
Give back & support the show:
via PayPal
Good luck with your ACLS class!
ECG characteristics of supraventricular tachycardia (SVT) vs. sinus tachycardia.
Signs & symptoms that indicate a patient is unstable.
Delivery of a synchronized shock for the treatment of unstable SVT using a biphasic vs monophasic defibrillator.
Consideration for team safety while performing synchronized cardioversion.
Management of stable patients in SVT.
For more on narrow complex tachycardias, check out the pod resource page at passacls.com.
Connect with me:
Website: https://passacls.com
@PassACLS on Twitter
@Pass-ACLS-Podcast on LinkedIn
Give back & support the show:
via PayPal
Good luck with your ACLS class!
When working to resuscitate a patient in sudden cardiac arrest, Epinephrine is the first IV medication we administer.
When we give the first dose of epinephrine depends on whether the patient is in shockable or non-shockable rhythm.
When to give the first dose of epinephrine and its frequency for patients in asystole or PEA following the right side of the Adult Cardiac Arrest algorithm.
When to give the first dose of epi and its frequency for patients in V-Fib or pulseless V-Tach following the left side of the Adult Cardiac Arrest algorithm.
Example chronology of events for a scenario where a patient is found unresponsive, pulseless, and only gasping/agonal breathing.
Administration of epi via the IO or endotracheal route in the absence of an IV.
The maximum cumulative dose of epinephrine that can be administered to patients in cardiac arrest.
When do we stop administering epinephrine.
Connect with me:
Website: https://passacls.com
@PassACLS on Twitter
@Pass-ACLS-Podcast on LinkedIn
Give back & support the show:
via PayPal
Good luck with your ACLS class!
If a person suddenly develops symptoms such as weakness, slurred or garbled speech, loss of balance, or a massive & severe headache; it’s possible they could be having a stroke.
The Cincinnati Prehospital Stroke Scale uses the acronym FAST to assess Facial droop – Arm Drift - Speech – and Time.
There are several conditions that can mimic a stroke.
Identification & Treatment of hypoglycemia or hyperglycemia.
Identification & Treatment of hypoxia using a pulse oximeter.
Some seizures, electrolyte imbalance, sepsis, brain tumors, and Bell’s Palsy can also mimic a stroke.
Prehospital providers should transport suspected stroke patients to a stroke center following their local protocols.
Hospital providers should active their stroke team to ensure rapid assessment and treatment.
Connect with me:
Website: https://passacls.com
@PassACLS on Twitter
@Pass-ACLS-Podcast on LinkedIn
Give back & support the show:
via PayPal
Good luck with your ACLS class!
Most ACLS medications are given IV push. But, what happens if we
can't get an IV?
When IV access isn't available, we should consider administering our IV medications via intraosseous (IO)or endotracheal tube (ETT) route.
Why IO is better for than ETT as an alternative route.
The locations we should place an IO when running a code and a location we should avoid.
The ACLS medications that can be given intraosseous.
Where you can find more information about intraosseous access during resuscitation efforts.
In the absence of an IV or IO, some medications may be given down the endotracheal tube.
The disadvantages of medication administration via ETT.
Review of the medications that can be given down the tube and how they should be given.
Medications should not be given down the tube when anything other than an endotracheal tube is used as an advanced airway.
Connect with me:
Website: https://passacls.com
@PassACLS on Twitter
@Pass-ACLS-Podcast on LinkedIn
Give back & support the show:
via PayPal
Good luck with your ACLS class!
The chain of survival for a cardiac emergency and stroke start the same:
-
preparedness & recognition of an emergency;
-
activation of EMS;
-
delivery of Advanced Life Support; and
-
transporting to the most appropriate facility.
Depending on where you live, Emergency Medical Services (EMS) may provide prehospital Advanced Life Support (ALS).
ALS ambulances are staffed with paramedics who have training in ACLS skills. Paramedics can perform an assessment, obtain a medical history, and provide life-saving care within minutes of recognition.
Why EMS "Destination Protocols" for suspected stroke and STEMI make a
difference.
ACLS’s timed benchmarks for:
- point of first medical contact to PCI for ST elevation MI;
- door to tPA for ischemic stroke; and
- onset of symptoms to EVT for LVO strokes.
EMS may bypass a close hospital to transport a STEMI or suspected stroke patient to a hospital capable of 24/7 PCI or a certified stroke center; because time is heart muscle or brain cells.
Check out the Pod Resource page at passacls.com for links to the "EMS On Air" podcast for links to episodes that look at EMS's role in stroke outcomes in the rural vs urban area.
Connect with me:
Website: https://passacls.com
@PassACLS on Twitter
@Pass-ACLS-Podcast on LinkedIn
Give back & support the show:
via PayPal
Good luck with your ACLS class!
Performing good CPR and delivering a shock as soon as possible to a patient in Ventricular Fibrillation or pulseless V-Tach are the two most critical interventions that have been shown to increase survival from sudden cardiac arrest.
Studies have demonstrated significantly better out-of-hospital cardiac arrest survival outcomes in communities with robust public CPR training and public access/first responder AEDs.
The general use of AED including: indications for use; attaching the AED pads; following verbal prompts; and safely administering a shock.
Following the Adult Cardiac Arrest algorithm while using an AED.
Contraindications to AED use.
General safety considerations to remember.
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For apneic patients without a carotid pulse or pulseless patients with only gasping/agonal respirations, we will follow the Adult Cardiac Arrest algorithm.
For pulseless patients that the AED doesn't advise a shock, the patient's ECG shows asystole, or a non-perfusing organized rhythm (PEA), we will follow the right side of the algorithm.
Initial steps are aimed at delivery of high-quality CPR to keep the brain and vital organs alive.
Epinephrine administration.
Placement of an advanced airway.
Considering possible reversible H & T causes of cardiac arrest including three common causes of PEA and their emergent interventions.
When we should discontinue resuscitation efforts and call the code.
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Providing good, high quality, CPR with minimal interruptions and early defibrillation are two keys to improved cardiac arrest outcomes.
A training tool used in many CPR and ACLS classes is to use a song (or a song list) with a tempo of 100 to 120 beats per minute to help the person doing chest compressions maintain an adequate rate.
Characteristics of good songs that will help us.
Advantages & disadvantages of using a song during CPR.
Selected songs from various genres and time periods from AHA's "Don’t Drop The Beat" playlist on Spotify.
https://open.spotify.com/playlist/2mU2FNAhSOtQwW0hBgQMaK
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A patient’s medical history will help us identify things that may be causing (or contributing) to their current condition as well as guide our decisions so we provide the safest evidence-based care possible.
Examples of information obtained in a medical history that will impact the treatment we provide. E.g. Not giving nitro to patients taking PDE inhibitors.
There are several mnemonics and memory aids that people use to guide their history taking.
Review the SAMPLE PQRST medical history format.
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Although magnesium can be used in the treatment of other medical conditions such as eclampsia, asthma, & digitalis toxicity; for ACLS, magnesium is primarily used to treat Torsades de Pointes.
Identification of Torsades on the ECG.
Administration of a magnesium infusion for stable patients vs slow IV push for patients in cardiac arrest.
Procainamide use for stable patients with a monomorphic wide-complex tachycardia.
Procainamide dosing and when to stop the infusion.
Tip for determining whether magnesium or Procainamide should be used when treating stable patients with V-Tach.
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When a patient loses excessive amounts of fluids, we say that they are in a state of hypovolemia.
The most obvious cause of hypovolemia is from bleeding.
Bleeding can be internal or external and caused by trauma, pathology, or iatrogenic.
Classic signs & symptoms of hypovolemic shock.
Volume replacement with crystalloids vs blood.
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MONA is the acronym sometimes used to help us remember the interventions to consider for patients with Acute Coronary Syndrome.
Morphine's use in the Acute Coronary Syndrome (ACS) algorithm.
Why Morphine is helpful for patients with ACS.
Contraindications and considerations for the safe administration of Morphine.
Morphine as an alternative to nitro for patients with chest pain that take PDE inhibitors.
Common dosing & administration of Morphine.
Monitoring of the patient's level of consciousness, pain, blood pressure, and respirations after administration.
Possible side effects of Morphine administration.
Narcan as an antidote to Morphine if needed.
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Even good CPR is far less efficient at circulating blood than a functioning heart.
The indicators of high-quality CPR that were identified at the 2012 AHA CPR Quality Summit in order of importance include:
- Chest compression fraction (CCF);
- Chest compression rate;
- Chest compression depth;
- Allowing for full recoil; and
- Adequate ventilations.
Using real-time feedback devices and ETCO2 to assess CPR quality.
Tips to limit pauses in CPR compressions to 10 seconds or less include:
-
Pre-charge the defibrillator before completion of a 2 minute cycle;
-
Continuing chest compressions until the defibrillator is fully charged;
-
Continuing chest compressions during insertion of an advanced airway; and
-
Performing other activities simultaneously during scheduled pauses.
Limiting interruptions to chest compressions to less than 10 seconds so we can maintain a CCF of 80% requires teamwork and communication.
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Epinephrine and Dopamine are adrenergic agonist used in several ACLS algorithms.
The use of epinephrine for severe anaphylaxis or unstable bradycardia.
Review epinephrine’s effects on blood vessels and bronchioles.
Why epinephrine is helpful for patients with anaphylaxis.
Using an epi drip for unstable bradycardia.
Epinephrine administration during cardiac arrest.
Starting and epinephrine or Dopamine drip for patients that have ROSC.
Review the effects of Dopamine based on mcg/kg/min dosing.
Monitoring the patient and titrating epi or Dopamine drips to prevent harm.
For more information on ACLS medications, check out the pod resource page at passacls.com.
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Providing rescue breathing to apneic patients with a palpable pulse.
Normal end tidal CO2 for patients with a pulse.
Identification of cardiac arrest and our immediate actions.
Providing artificial ventilations during CPR without an advanced airway vs with an advanced airway in place.
Using quantitative waveform capnography to confirm placement of an advanced airway, assess the quality of CPR, and identify ROSC.
The effects of hyperventilating patients in cardiac arrest.
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Hypothermic patients aren't dead until they are warm and dead.
When a patient’s core body temperature drops below 96.8 F (36 C), they are
hypothermic. As the body’s temperature drops below 36 C, hypothermia may further be classified as moderate or severe:
- Moderate if the patient’s body core temp is between 30-34 C; and
- Severe if it's below 30 C.
Modifying the ACLS Adult Cardiac Arrest algorithm for patients with severe hypothermia.
Following the ACLS algorithm for patients with a body core temperature above 30 C.
Methods for rewarming patients with moderate vs severe hypothermia.
Continuation of CPR and ACLS efforts until the patient’s body core temp is above 36 C.
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Calcium is one of the ions that move across the cellular membrane during cardiac contraction and relaxation.
The primary use of calcium channel blockers in ACLS is for the treatment of stable, narrow-complex tachycardias refractory to Adenosine and to lower the blood pressure of ischemic stroke patients with severe hypertension.
Use of calcium channel blockers for SVT refractory to Adenosine and A-Fib or A-Flutter with RVR.
Contraindications of calcium channel blockers.
Nicardipine use during the treatment of ischemic strokes.
For more information on ACLS medications, tachycardia, or stroke check out the pod resource page at passacls.com.
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While running a code, the thing we hope for is Return of Spontaneous Circulation (ROSC), followed by recovery so the patient can return to a normal life.
ACLS's Post-Cardiac Arrest Care algorithm provides us with evidence-based guidance for the initial stabilization phase as well as continued management activities.
Our primary focus immediately following ROSC is aimed at ensuring adequate perfusion of the body’s vital organs.
Management of O2 and CO2 concentrations.
Administration of Atropine for symptomatic bradycardia.
Maintaining a systolic BP of at least 90 and MAP of 65 mm Hg or more.
Use of Dopamine, Levophed, and Epinephrine drips to maintain blood pressure.
Starting targeted temperature management (TTM) for at least 24 hours based on the patient's ability to obey simple commands.
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Nitroglycerine is vasodilator that affects peripheral blood vessels and coronary arteries.
Because of its widespread dilation effects on blood vessels, nitro can quickly lower a patient’s blood pressure, sometimes to the point of making a patient hypotensive.
Assessment of vital signs prior to administering nitro is necessary to ensure patient safety.
ACLS's indications for use of nitroglycerine.
Nitroglycerine's contraindications & considerations for use.
Effects of nitro on patients taking PDE inhibitors.
Administration of nitroglycerine to patients with ischemic chest pain.
Monitoring patient's pain and vital signs after nitro administration.
Considerations for patients that took their home nitroglycerine.
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In atrial fibrillation (A-Fib) and atrial flutter (A-Flutter) the electrical impulse for cardiac contraction is in the atria but isn't the normal pacemaker of the heart, the SA node.
The ECG characteristics of A-Fib and A-Flutter.
Recognition and treatment of unstable patients in A-Fib/Flutter with rapid ventricular response (RVR).
Suggested energy settings for synchronized cardioversion of stable patients with a narrow complex tachycardia.
Team safety when cardioverting an unstable patient in A-FIB.
Adenosine’s role for stable SVT patients with atrial rhythms.
Treatment of stable patients in A-Fib/Flutter with RVR.
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Patients with a heart rate less than 60 are bradycardic. Some people can have a resting heart rate in the 40s without any compromise. For others, a heart rate of 50 or less could signify the need for immediate intervention and warrants additional assessment.
Signs & symptoms that indicate a bradycardic patient is unstable.
Monitoring oxygen saturation with pulse oximetry and indications for administration of oxygen.
Calcium channel blockers and beta blocker medication as treatable causes of bradycardia.
The indications and dosage of Atropine.
Precautions for Atropine use in patients with second or third degree AV blocks.
The use of transcutaneous pacing (TCP) for unstable bradycardic patients refractory to Atropine.
The use and dosing of Dopamine and Epinephrine drips.
For additional information about causes and treatment of bradycardia, check out the pod resources page at PassACLS.com.
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Two factors to cardiac arrest survivability that have been clearly shown to make the biggest difference is continuous high quality CPR and early defibrillation.
The most common dysrhythmia present during the first few minutes of cardiac arrest is ventricular fibrillation.
The chance of successful defibrillation decreases every minute that passes.
How our chance of successfully defibrillating a patient into a perfusing rhythm significantly changes when good CPR is delivered vs when it isn't.
Examples of in-hospital and out-of-hospital cardiac arrest (OHCA) outcomes when CPR is performed until defibrillation vs defibrillation without CPR.
The role of the CPR coach.
Three tips to aid us in limiting CPR interruptions so we can maintain a chest compression fraction (CCF) of at least 80%.
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The chain of survival for ACLS is the same as was learned in your BLS class.
The beginning steps of the Cardiac Emergency and Stroke chain of survival are the same.
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Recognizing the symptoms of a cardiac emergency or stroke;
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Activating an emergency response by calling 9-1-1, or a specialized code team if in the healthcare setting;
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Rapid assessment including 12 lead ECG for cardiac patients or FAST assessment for suspected stroke emergencies;
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Provide ALS care and transport to the most appropriate facility; for
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Early reperfusion.
ACLS's timed goals for first medical contact to PCI for STEMI and door-to-needle for ischemic stroke.
Areas with strong EMS relationships, well-defined transport protocols, and
specialized teams that care for the patient in the hospital have significantly
better patient outcomes.
The cardiac arrest chain of survival adds: high quality CPR, early defibrillation, and advanced resuscitation as the next critical links followed by post arrest care and recovery.
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Heart muscle contraction and repolarization is dependent on Sodium, Calcium, Magnesium, and Potassium ions crossing cellular membranes.
When a patient’s potassium levels get too low or too high hypokalemia or hyperkalemia results respectively.
Two things that may lead us to suspect hypo or hyperkalemia include:
- the patient's medical history; and
- changes to the T wave on the ECG.
Medical conditions that cause potassium imbalance.
ECG changes seen in hypo and hyperkalemia.
Critical lab values that would indicate a need for treatment.
Emergent, ACLS interventions for hypokalemia and hyperkalemia.
Additional information on hypo and hyperkalemia can be found on Ninja Nerd podcast. Check out the pod resources page at passacls.com.
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When treating patients having an MI or stroke, more minutes equals more dead cells. Because the majority of strokes are the ischemic type, the treatment for stroke is similar to an MI – to reestablish perfusion to the ischemic tissues.
Review the first four steps in the Stroke Chain of Survival.
Time criteria for the administration of tPA or EVT of LVO strokes.
Stroke benchmarks for door to:
- assessment;
- starting a non-contrast CT; and
- administration of tPA (door-to-needle).
EMS interaction with stroke teams and destination protocols to reduce time to definitive care.
Remember that timed goals for cardiac patients start with point of first medical contact while stroke benchmarks start at arrival to the hospital.
Additional information about timed goals for stroke and how EMS affects outcomes can be found on the PassACLS.com Pod Resources page.
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Adenosine is the first IV medication given to stable patients with sustained supraventricular tachycardia (SVT) refractory to vagal maneuvers.
Common causes of tachycardia.
Symptoms indicating a stable vs unstable patient.
Cardiac effects of Adenosine.
Indications for use in the ACLS Tachycardia algorithm.
Considerations and contraindications.
Adenosine as a diagnostic for patients in A-Fib or A-Flutter with RVR.
Dosing and administration.
Other podcasts that cover common ACLS antiarrhythmics in more detail and another covering Brugata Criteria used to differentiate V-Tach from SVT with an aberrancy.
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To pass the written ACLS exam and mega code, students need to be able to identify basic ECG dysrhythmias, including the two types of second-degree heart block.
One method of ECG rhythm identification is to ask a series of questions such as:
- What's the rate (<60, 60-100, 101-149, or >150);
- Is the rhythm regular or irregular;
- What's the shape and frequency of P waves and QRS complexes; and
- What's the P-R interval and is it constant?
ECG characteristics of a second-degree Mobitz type I (Wenckebach).
Identification of unstable bradycardia and it's treatment with Atropine.
ECG characteristics of a second-degree Mobitz type II.
Possible effect of using Atropine on patients with a second-degree type II AV block.
Treatment of unstable patients refractory to Atropine using TCP, Dopamine, or Epinephrine drip.
Starting dose and titration of Dopamine and Epinephrine drips.
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When treating patients with Acute Coronary Syndrome (ACS), MONA is an acronym sometimes used to help us remember the initial interventions.
The O in MONA is Oxygen.
When should we administer oxygen to ACS patients.
When is O2 administration unnecessary.
Monitoring patient's oxygen saturation (SaO2) using a pulse oximeter.
Review two common ACLS mega code scenarios.
Oxygen administration during CPR and post cardiac arrest.
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Along with early defibrillation, high quality CPR with minimal interruptions is one of the two factors that has been shown to improve cardiac arrest outcomes.
How do we know if high quality, effective CPR is being performed?
The CPR coach as a new position of the code team.
Objective measures of high-quality CPR include:
Compression rate of 100-120 per minute;
Compression depth of at least 5 cm;
Allowing for full chest recoil;
Maintaining an ETCO2 of at least 10 mm Hg; and
Keeping interruptions to less than 10 seconds to obtain a chest compression fraction (CCF) of 80%.
The advantages and use of real-time feedback devices to monitor the rate, depth, and chest recoil of CPR compressions.
The use of end tidal waveform capnography.
A no tech way to monitor effective CPR if no feedback devices are available.
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The 2020 ACLS guidelines updated the dose for administration of Atropine and Dopamine for the treatment of unstable bradycardia.
The signs & symptoms of unstable bradycardia.
Atropine's new dose and maximum.
The use of atropine when a patient is in a second degree type II or third degree heart block.
ECG changes that indicate subsequent doses of atropine are likely to be ineffective.
The 2020 update to the starting dose of Dopamine.
The use of Dopamine for bradycardia as an interim until TCP vs hypotension.
The use of Atropine and Dopamine in patients with myocardial ischemia.
Podcasts with additional (advanced-provider level) information about Atropine, Dopamine, and bradycardia can be found on the Pass ACLS pod resources page.
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The tongue is the most common airway obstruction in an unconscious patient.
Insertion an oropharyngeal airway helps keep the patient’s tongue from falling to the back of the pharynx and causing an airway obstruction.
The oropharyngeal airway is sometimes called an OPA or simply an oral airway.
Indications for using an oral airway.
Contraindication for an oral airway and an alternative that can be used instead.
Measuring an OPA and possible complications from inserting one that's too small or too large.
Two techniques to properly insert an OPA and avoid complications.
The use of an oral airway during CPR.
The use of an OPA as a bite block after a patient has an advanced airway placed.
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Hypoxia is a state of low oxygen levels in the blood.
Determining hypoxia using a pulse oximeter or arterial blood gasses (ABGs).
A goal of ACLS is to recognize signs of hypoxia and provide timely treatment to prevent an arrest.
Examples of some things that might lead us to think of hypoxia as a cause of cardiac arrest.
Why we should not rely on pulse ox to give accurate readings during CPR.
Delivering ventilations with near 100% oxygen concentration using a BVM attached to supplemental O2 and a reservoir.
Using end tidal waveform capnography to assess the quality of CPR.
Changes to ventilation rates, tidal volume, and O2 concentration affects a patient's oxygen, carbon dioxide, and pH.
The danger of over ventilating a patient in cardiac arrest.
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ECG characteristics of supraventricular tachycardia (SVT) vs. sinus tachycardia.
Signs & symptoms that indicate a patient is unstable.
Treatment of unstable SVT using a biphasic vs monophasic defibrillator.
Consideration for team safety while performing synchronized cardioversion.
Stable patients in SVT.
For more on narrow complex tachycardias, check out the pod resource page at passacls.com.
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When working to resuscitate a patient in sudden cardiac arrest, Epinephrine is the first IV medication we administer.
When do we give the first dose of epinephrine for patient is in shockable vs non-shockable rhythm.
When to give the first dose of epinephrine and its frequency for patients in asystole or PEA following the right side of the Adult Cardiac Arrest algorithm.
When to give the first dose of epi and its frequency for patients in V-Fib or pulseless V-Tach following the left side of the Adult Cardiac Arrest algorithm.
Example chronology of events for a scenario where a patient is found unresponsive, pulseless, and only gasping/agonal breathing.
Administration of epi via the IO or endotracheal route in the absence of a patent IV.
The maximum cumulative dose of epinephrine that can be administered to patients in cardiac arrest.
When do we stop administering epinephrine.
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If a person suddenly develops symptoms such as weakness, slurred or garbled speech, loss of balance, or a massive & severe headache; it’s possible they could be having a stroke.
The Cincinnati Prehospital Stroke Scale uses the acronym FAST to assess Facial droop – Arm Drift - Speech – and Time.
There are several conditions that can mimic a stroke.
Identification & Treatment of hypoglycemia or hyperglycemia.
Identification & Treatment of hypoxia using a pulse oximeter.
Some seizures, electrolyte imbalance, sepsis, brain tumors, and Bell’s Palsy can also mimic a stroke.
Prehospital providers should transport suspected stroke patients to a stroke center following their local protocols.
Hospital providers should active their stroke team to ensure rapid assessment and treatment.
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Most ACLS medications are given IV push. But, what happens if we can't get an IV?
When IV access isn't available, we should consider administering our IV medications via intraosseous (IO)or endotracheal tube (ETT) route.
Why IO is better for than ETT as an alternative route.
The locations we should place an IO when running a code and a location we should avoid.
The ACLS medications that can be given intraosseous.
Where you can find more information about intraosseous access during resuscitation efforts.
In the absence of an IV or IO, some medications may be given down the endotracheal tube.
The disadvantages of medication administration via ETT.
Review of the medications that can be given down the tube and how they should be given.
Medications should not be given down the tube when anything other than an endotracheal tube is used as an advanced airway.
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The chain of survival for a cardiac emergency and stroke start the same:
-
preparedness & recognition of an emergency;
-
activation of EMS;
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delivery of Advanced Life Support; and
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transporting to the most appropriate facility.
Depending on where you live, Emergency Medical Services (EMS) may provide prehospital Advanced Life Support (ALS).
ALS ambulances are staffed with paramedics who have training in ACLS skills. Paramedics can perform an assessment, obtain a medical history, and provide life-saving care within minutes of recognition.
Why EMS "Destination Protocols" for suspected stroke and STEMI make a
difference.
ACLS’s timed benchmarks for:
- point of first medical contact to PCI for ST elevation MI;
- door to tPA for ischemic stroke; and
- onset of symptoms to EVT for LVO strokes.
EMS may bypass a close hospital to transport a STEMI or suspected stroke patient to a more appropriate hospital - one capable of 24/7 PCI or a certified stroke center; because time is heart muscle or brain cells.
Check out the Pod Resource page at passacls.com for links to the "EMS On Air" podcast for links to episodes that look at EMS's role in stroke outcomes in the rural vs urban area.
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Performing good CPR, and delivering a shock as soon as possible to a patient in Ventricular Fibrillation or pulseless V-Tach are the two most critical interventions that have been shown to increase survival from sudden cardiac arrest.
To aid in the rapid delivery of a shock, an Automated External Defibrillator (AED) should be used in settings where a full monitor/defibrillator isn’t available.
Research has demonstrated significantly better out of hospital cardiac arrest survival outcomes in communities with robust public CPR training and public access/first responder AEDs.
Why an AED makes a difference.
The general use of AED including: indications for use; attaching the AED pads; following verbal prompts; and safely administering a shock.
Following the Adult Cardiac Arrest algorithm while using an AED.
Contraindications to AED use.
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For apneic patients without a carotid pulse or pulseless patients with only gasping/agonal respirations, we will follow the Adult Cardiac Arrest algorithm. For pulseless patients that the AED doesn't advise a shock, the patient's ECG shows asystole, or a non-perfusing organized rhythm (PEA), we will follow the right side of the algorithm. Initial steps are aimed at delivery of high quality CPR to keep the brain and vital organs alive. Epinephrine administration. Placement of an advanced airway. Considering possible reversible H & T causes of cardiac arrest including three common causes of PEA and their emergent interventions. When we should discontinue resuscitation efforts and call the code. Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn Good luck with your ACLS class!
Providing good, high quality, CPR with minimal interruptions and early defibrillation are two keys to improved cardiac arrest outcomes. A training tool used in many CPR and ACLS classes is to use a song (or a song list) with a tempo of 100 to 120 beats per minute to help the person doing chest compressions maintain an adequate rate. Characteristics of good songs that will help us. Advantages & disadvantages of using a song during CPR. Selected songs from various genres and time periods from AHA's "Be The Beat" playlist on Spotify. https://open.spotify.com/playlist/2mU2FNAhSOtQwW0hBgQMaK (https://open.spotify.com/playlist/2mU2FNAhSOtQwW0hBgQMaK) Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn Good luck with your ACLS class!
A patient’s medical history will help us identify things that may be causing (or contributing) to their current condition as well as guide our decisions so we provide the safest evidence-based care possible. Examples of information obtained in a medical history that will impact the treatment we provide. E.g. Not giving nitro to patients taking PDE inhibitors. There are several mnemonics and memory aids that people use to guide their history taking. Review the SAMPLE PQRST medical history format. Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn Good luck with your ACLS class!
Although magnesium can be used in the treatment of other medical conditions such as eclampsia, asthma, & digitalis toxicity; for ACLS, magnesium is primarily used to treat Torsades de Pointes. Identification of torsades on the ECG. Administration of a magnesium infusion for stable patients vs slow IV push for patients in cardiac arrest. Procainamide use for stable patients with a monomorphic wide-complex tachycardia. Procainamide dosing and when to stop the infusion. Tip for determining whether magnesium or Procainamide should be used when treating stable patients with V-Tach. For more information on antiarrhythmics, check out the Pod Resource Page at passacls.com. The podcast episodes from Ninja Nerd and Coffee Break HEMS are great. Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn Good luck with your ACLS class!
When a patient loses excessive amounts of fluids, we say that they are in a state of hypovolemia. The most obvious cause of hypovolemia is from bleeding. Bleeding can be internal or external and caused by trauma, pathology, or iatrogenic. Classic signs & symptoms of hypovolemic shock. Volume replacement with crystalloids vs blood. Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn
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MONA is the acronym sometimes used to help us remember the interventions to consider for patients with Acute Coronary Syndrome or ACS. Morphine's use in the Acute Coronary Syndrome (ACS) algorithm. Why Morphine is helpful for patients with ACS. Contraindications and considerations for the safe administration of Morphine. Morphine as an alternative to nitro for patients with chest pain that take PDE inhibitors. Side effects of Morphine administration. Narcan can be given as an antidote to Morphine if needed. Common dosing & administration of Morphine. Monitoring of the patient's level of consciousness, pain, blood pressure, and respirations after administration. Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn Good luck with your ACLS class!
Even good CPR is far less efficient at circulating blood than a functioning heart. The indicators of high-quality CPR that were identified at the 2012 AHA CPR Quality Summit in order of importance include: Chest compression fraction (CCF); Chest compression rate; Chest compression depth; Allowing for full recoil; and Adequate ventilations.
Using real-time feedback devices and ETCO2 to assess CPR quality. Three tips to limit pauses in CPR compressions to 10 seconds or less include: Continuing chest compressions while charging the defibrillator; Continuing chest compressions during intubation; and Performing other activities during scheduled pauses.
Limiting interruptions to chest compressions to less than 10 seconds so we can maintain a CCF of 80% requires teamwork and communication. The Pharmacist’s Voice Podcast: https://www.thepharmacistsvoice.com/podcast/10-poisoning-prevention-tips-for-halloween-2022/ (10 Poisoning prevention tips for Halloween 2022). **American Cancer Society (ACS) Fundraiser This is the fourth year that I'm participating in Real Men Wear Pink to increase breast cancer awareness and raise money for the American Cancer Society's life-saving mission. I hope you'll consider contributing. Every donation makes a difference in the fight against breast cancer! http://main.acsevents.org/goto/paultaylor (Paul Taylor's ACS Fundraiser) THANK YOU! Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn Good luck with your ACLS class!
Epinephrine and Dopamine are adrenergic agonist used in several ACLS algorithms. The use of epinephrine for severe anaphylaxis or unstable bradycardia. Review epinephrine’s effects on blood vessels and bronchioles. Why epinephrine is helpful for patients with anaphylaxis. Using an epi drip for unstable bradycardia. Epinephrine administration every 3-5 minutes during cardiac arrest. Starting and epinephrine or Dopamine drip for patients that have ROSC. Review the effects of Dopamine based on mcg/kg/min dosing. Monitoring the patient and titrating epi & Dopamine drips to prevent harm. For more information on ACLS medications, check out the pod resource page at passacls.com. The Pharmacist’s Voice Podcast: https://www.thepharmacistsvoice.com/podcast/10-poisoning-prevention-tips-for-halloween-2022/ (10 Poisoning prevention tips for Halloween 2022). **American Cancer Society (ACS) Fundraiser This is the fourth year that I'm participating in Real Men Wear Pink to increase breast cancer awareness and raise money for the American Cancer Society's life-saving mission. I hope you'll consider contributing. Every donation makes a difference in the fight against breast cancer! http://main.acsevents.org/goto/paultaylor (Paul Taylor's ACS Fundraiser) THANK YOU! Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn Good luck with your ACLS class!
Providing rescue breathing to apneic patients with a palpable pulse. Normal end tidal CO2 for patients with a pulse. Identification of cardiac arrest and our immediate actions. Providing artificial ventilations during CPR without an advanced airway vs with an advanced airway in place. Using quantitative waveform capnography to confirm placement of an advanced airway, assess the quality of CPR, and identify ROSC. The effects of hyperventilating patients in cardiac arrest. **American Cancer Society (ACS) Fundraiser This is the fourth year that I'm participating in Real Men Wear Pink to increase breast cancer awareness and raise money for the American Cancer Society's life-saving mission. I hope you'll consider contributing. Every donation makes a difference in the fight against breast cancer! http://main.acsevents.org/goto/paultaylor (Paul Taylor's ACS Fundraiser) THANK YOU! Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn Good luck with your ACLS class!
When a patient’s core body temperature drops below 96.8 F (36 C), they are hypothermic. As the body’s temperature drops below 36 C, hypothermia may further be classified as moderate or severe: moderate if the patient’s body core temp is between 30-34 C; and severe if it's below 30 C.
Hypothermic patients aren't dead until they are warm and dead. Modifying the ACLS Adult Cardiac Arrest algorithm for patients with severe hypothermia. Following the ACLS algorithm for patients with a body core temperature above 30 C. Methods for rewarming patients with moderate vs severe hypothermia. **American Cancer Society (ACS) Fundraiser This is the fourth year that I'm participating in Real Men Wear Pink to increase breast cancer awareness and raise money for the American Cancer Society's life-saving mission. I hope you'll consider contributing. Every donation makes a difference in the fight against breast cancer! http://main.acsevents.org/goto/paultaylor (Paul Taylor's ACS Fundraiser) THANK YOU! Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn Good luck with your ACLS class!
Calcium is one of the ions that move across the cellular membrane during cardiac contraction and relaxation. The primary use of calcium channel blockers in ACLS is for the treatment of stable, narrow complex tachycardias refractory to Adenosine and to lower the blood pressure of ischemic stroke patients with severe hypertension. Use of calcium channel blockers for SVT refractory to Adenosine and A-Fib or A-Flutter with RVR. Contraindications of calcium channel blockers. Nicardipine use during the treatment of ischemic strokes. For more information on ACLS medications check out the pod resource page at passacls.com. **American Cancer Society (ACS) Fundraiser This is the fourth year that I'm participating in Real Men Wear Pink to increase breast cancer awareness and raise money for the American Cancer Society's life-saving mission. I hope you'll consider contributing. Every donation makes a difference in the fight against breast cancer! http://main.acsevents.org/goto/paultaylor (Paul Taylor's ACS Fundraiser) THANK YOU! Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn Good luck with your ACLS class!
While running a code, the thing we hope for is Return of Spontaneous Circulation (ROSC), followed by recovery so the patient can return to a normal life. ACLS's Post-Cardiac Arrest Care algorithm provides us with evidence-based guidance for the initial stabilization phase as well as continued management activities. Our primary focus immediately following ROSC is aimed at ensuring adequate perfusion of the body’s vital organs. Management of O2 and CO2 concentrations. Administration of Atropine for symptomatic bradycardia. Maintaining a systolic BP of at least 90 and MAP of 65 mm Hg or more. Use of Dopamine, Levophed, and Epinephrine drips to maintain blood pressure. Starting targeted temperature management (TTM) for 24 hours based on the patient's level of consciousness. **American Cancer Society (ACS) Fundraiser This is the fourth year that I'm participating in Real Men Wear Pink to increase breast cancer awareness and raise money for the American Cancer Society's life-saving mission. I hope you'll consider contributing. Every donation makes a difference in the fight against breast cancer! http://main.acsevents.org/goto/paultaylor (Paul Taylor's ACS Fundraiser) THANK YOU! Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn Good luck with your ACLS class!
Nitroglycerine is vasodilator that affects peripheral blood vessels and coronary arteries. Because of its widespread dilation effects on blood vessels, nitro can quickly lower a patient’s blood pressure, sometimes to the point of making a patient hypotensive. Assessment of vital signs prior to administering nitro to ensure patient safety. Indications for use of nitroglycerine. Effects of nitro on patients taking PDE inhibitors. Nitroglycerine's contraindications & considerations for use. Administration of nitroglycerine to patients with ischemic chest pain. Monitoring patient's pain and vital signs after nitro administration. Considerations for patients that took their home nitroglycerine. **American Cancer Society (ACS) Fundraiser This is the fourth year that I'm participating in Real Men Wear Pink to increase breast cancer awareness and raise money for the American Cancer Society's life-saving mission. I hope you'll consider contributing. Every donation makes a difference in the fight against breast cancer! http://main.acsevents.org/goto/paultaylor (Paul Taylor's ACS Fundraiser) THANK YOU! Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn Good luck with your ACLS class!
In atrial fibrillation (A-Fib) and atrial flutter (A-Flutter) the electrical impulse for cardiac contraction is in the atria but isn't the normal pacemaker of the heart, the SA node. The ECG characteristics of A-Fib and A-Flutter. Recognition and treatment of unstable patients in A-Fib/Flutter with rapid ventricular response (RVR). Team safety when cardioverting an unstable patient in A-FIB. Adenosine’s role for stable SVT patients with atrial rhythms. Treatment of stable patients in A-Fib/Flutter with RVR. **American Cancer Society (ACS) Fundraiser This is the fourth year that I'm participating in Real Men Wear Pink to increase breast cancer awareness and raise money for the American Cancer Society's life-saving mission. I hope you'll consider contributing. Every donation makes a difference in the fight against breast cancer! http://main.acsevents.org/goto/paultaylor (Paul Taylor's ACS Fundraiser) THANK YOU! Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn Good luck with your ACLS class!
As an ACLS provider you do not need to be familiar with all of the different signs of various types of poisoning. The majority of toxins don’t have a specific antidote. There are a few toxins for which we have emergency interventions and ACLS providers should be familiar with. Reviewing the patient's medical history for indicators that may lead us to suspect a tablet/toxin cause of cardiac arrest. Administration of Narcan for suspected narcotics overdose following the Opioid Associated Emergency algorithm. Other common ACLS Tablet Toxin scenarios with possible treatments. Medications commonly used to treat specific toxins that are regularly stocked on crash carts or carried in EMS med bags. ACLS providers that suspect a specific toxin should consult with their Pharmacy or call Poison Control for treatment directions. **American Cancer Society (ACS) Fundraiser This is the fourth year that I'm participating in Real Men Wear Pink to increase breast cancer awareness and raise money for the American Cancer Society's life-saving mission. I hope you'll consider contributing. Every donation makes a difference in the fight against breast cancer! http://main.acsevents.org/goto/paultaylor (Paul Taylor's ACS Fundraiser) THANK YOU! Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn Good luck with your ACLS class!
The ACLS algorithms are designed to make it easier to remember the key interventions we should deliver, and the order in which they should be delivered, to provide the best evidence-based care possible. Generally speaking, if there’s a change in a patient’s condition, we should ensure we’re using the correct algorithm. Three key points to remember when using ACLS algorithms: 1. If a patient’s condition changes, we should do an assessment and use the algorithm that matches the patient’s current state. 2. If an action was already done, we don’t need to repeat it. 3. We only do actions that are clinically appropriate and within our scope of practice. Walk through of an example mega code scenario with explanations of when and why we change to a different ACLS algorithm. **American Cancer Society (ACS) Fundraiser This is the fourth year that I'm participating in Real Men Wear Pink to increase breast cancer awareness and raise money for the American Cancer Society's life-saving mission. I hope you'll consider contributing. Every donation makes a difference in the fight against breast cancer! http://main.acsevents.org/goto/paultaylor (Paul Taylor's ACS Fundraiser) THANK YOU! Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn Good luck with your ACLS class!
Beta blocking medications attach to Beta receptors to inhibit or “block” the effects of epinephrine (adrenaline)and norepinephrine in the body. Review the primary locations of Beta I, II, and III receptors. Effects of epinephrine & norepinephrine stimulation of beta receptors in the heart. Beta blockers affects on the heart. When we should consider the use of beta blockers in the Acute Coronary Syndrome (ACS)and Tachycardia algorithms. Contraindications to the use of beta blocker medications. More detailed information about beta blocker’s mechanism of action and specific instances for use can be found on the Pod Resource page at PassACLS.com. **American Cancer Society (ACS) Fundraiser This is the fourth year that I'm participating in Real Men Wear Pink to increase breast cancer awareness and raise money for the American Cancer Society's life-saving mission. I hope you'll consider contributing. Every donation makes a difference in the fight against breast cancer! http://main.acsevents.org/goto/paultaylor (Paul Taylor's ACS Fundraiser) THANK YOU! Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn Good luck with your ACLS class!
This episode we are reviewing the use of advanced airways in the Adult Cardiac Arrest algorithm. When we should consider insertion of an advanced airway for patients in a shockable vs non-shockable rhythm. In addition to an endotracheal tube (ETT), other ACLS advanced airways include the Laryngeal Mask Airway (LMA) and the Laryngeal Tube airway. The advantages of using an advanced airway over basic airway maneuvers. Use of end tidal CO2 waveform capnography to confirm placement and assess the adequacy of CPR. Identification and management of a misplaced ET tube. **American Cancer Society (ACS) Fundraiser This is the fourth year that I'm participating in Real Men Wear Pink to increase breast cancer awareness and raise money for the American Cancer Society's life-saving mission. I hope you'll consider contributing. Every donation makes a difference in the fight against breast cancer! http://main.acsevents.org/goto/paultaylor (Paul Taylor's ACS Fundraiser) THANK YOU! Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn Good luck with your ACLS class!
Our primary focus immediately following return of spontaneous circulation (ROSC) is aimed at ensuring adequate perfusion of the patient’s vital organs and decreasing cerebral damage. After we have assessed and addressed O2 saturation, ETCO2, and BP, we may consider the use of an antiarrhythmic infusion if the patient has ventricular ectopy on the ECG. Indications for use of an antiarrhythmic after ROSC. Determining which antiarrhythmic to use post cardiac arrest. Administration of Amiodarone or Lidocaine to control ventricular ectopy after ROSC. The use of Amiodarone post arrest if no antiarrhythmics were administered prior to obtaining ROSC. Links to other medical podcasts that cover antiarrhythmics and other ACLS-related topics are on the Pod Resource page at PassACLS.com. **American Cancer Society (ACS) Fundraiser This is the fourth year that I'm participating in Real Men Wear Pink to increase breast cancer awareness and raise money for the American Cancer Society's life-saving mission. I hope you'll consider contributing. Every donation makes a difference in the fight against breast cancer! http://main.acsevents.org/goto/paultaylor (Paul Taylor's ACS Fundraiser) THANK YOU! Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn Good luck with your ACLS class!
Hydrogen ions is on one of the Hs in ACLS's H&T reversible causes of cardiac arrest. When considering hydrogen ions as a cause, what we’re looking at is the patient’s pH, or acid/base balance, and conditions that affect it. The body's normal serum pH is 7.35-7.45. Using ABGs to determine acidosis or alkalosis. Common conditions/causes that may lead us to suspect acidosis. Common conditions/causes that may lead us to suspect alkalosis. Correcting acidosis by changing the rate of ventilations. The indications, dose, and considerations for use of Sodium Bicarbonate. Treatment of alkalosis depends on the type (metabolic or respiratory) and is aimed at correcting the underlying cause. Other podcasts that cover acid/base balance and conditions that cause acidosis or alkalosis can be found on the Pod Resource Page at PassACLS.com. **American Cancer Society (ACS) Fundraiser This is the fourth year that I'm participating in Real Men Wear Pink to increase breast cancer awareness and raise money for the American Cancer Society's life-saving mission. I hope you'll consider contributing. Every donation makes a difference in the fight against breast cancer! http://main.acsevents.org/goto/paultaylor (Paul Taylor's ACS Fundraiser) THANK YOU! Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn Good luck with your ACLS class!
Being the team leader during a cardiac arrest is challenging. Using an algorithm helps by standardizing & prioritizing our interventions using an If/Then methodology. Review of BLS steps for determining if rescue breathing or CPR is needed and use of an AED for patients in cardiac arrest. If the patient is in a non-shockable rhythm on the ECG such as PEA or asystole, we will go down the right side of the Adult Cardiac Arrest Algorithm. If the patient is in a shockable rhythm on the ECG such as V-Fib or V-Tach, we will go down the left side of the Adult Cardiac Arrest Algorithm. An example of a code's flow for shockable rhythms when an antiarrhythmic such as Amiodarone or Lidocaine is administered. We will follow the algorithm until the patient has ROSC or we call the code. **American Cancer Society (ACS) Fundraiser This is the fourth year that I'm participating in Real Men Wear Pink to increase breast cancer awareness and raise money for the American Cancer Society's life-saving mission. I hope you'll consider contributing. Every donation makes a difference in the fight against breast cancer! http://main.acsevents.org/goto/paultaylor (Paul Taylor's ACS Fundraiser) THANK YOU! Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn Good luck with your ACLS class!
For patients exhibiting symptoms consistent with myocardial ischemia, Aspirin is one of the first medications we should consider along with morphine, oxygen, and nitroglycerine; if indicated & safe. Aspirin's mechanism of action & benefits for Acute Coronary Syndrome (ACS) patients. Contraindications and considerations for aspirin use. The dose and route of administration of aspirin for ACS patients. The use of aspirin in the ACLS Stroke algorithm. **American Cancer Society (ACS) Fundraiser This is the fourth year that I'm participating in Real Men Wear Pink to increase breast cancer awareness and raise money for the American Cancer Society's life-saving mission. I hope you'll consider contributing. Every donation makes a difference in the fight against breast cancer! http://main.acsevents.org/goto/paultaylor (Paul Taylor's ACS Fundraiser) THANK YOU! Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn Good luck with your ACLS class!
To pass ACLS, you will need to be able to identify common rhythms on a monitor during your mega code and ECG strips on your written exam. If you don't normally monitor patients as part of your job, I suggest two things: 1. Find a system for ECG interpretation that works well for you; and 2. Practice reading ECGs every day for a few weeks before your class. Review of normal ECG morphology of P wave, QRS complex, and T wave in lead II. Characteristics of first degree heart block. Characteristics of third degree (complete) AV block. Treatment of unstable patients in third degree block following the ACLS Bradycardia algorithm. Special considerations for use of Atropine when patients are in a third degree heart block. The use of TCP, Dopamine, & Epinephrine drip for unstable bradycardic patients refractory to Atropine. **American Cancer Society (ACS) Fundraiser This is the fourth year that I'm participating in Real Men Wear Pink to increase breast cancer awareness and raise money for the American Cancer Society's life-saving mission. I hope you'll consider contributing. Every donation makes a difference in the fight against breast cancer! http://main.acsevents.org/goto/paultaylor (Paul Taylor's ACS Fundraiser) THANK YOU! Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn Good luck with your ACLS class!
In the Adult Cardiac Arrest algorithm, we should administer an antiarrhythmic medication to patients in V-Fib or pulseless ventricular tachycardia approximately two minutes after the first dose of epinephrine. The two first-line ACLS antiarrhythmics that are generally used are Amiodarone and Lidocaine. Review of Lidocaine dosing and administration to patients in persistent V-Fib or pulseless V-Tach. Review of Amiodarone dosing and administration to patients in persistent V-Fib or pulseless V-Tach. Use of antiarrhythmic infusions post-cardiac arrest to suppress ventricular ectopy. Amiodarone use & dosing for stable patients in V-Tach with a pulse refractory to vagal maneuvers. **American Cancer Society (ACS) Fundraiser This is the fourth year that I'm participating in Real Men Wear Pink to increase breast cancer awareness and raise money for the American Cancer Society's life-saving mission. I hope you'll consider contributing. Every donation makes a difference in the fight against breast cancer! http://main.acsevents.org/goto/paultaylor (Paul Taylor's ACS Fundraiser) THANK YOU! Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn Good luck with your ACLS class!
The tongue is the most common airway obstruction in an unconscious patient. For patients with a decreased level of consciousness that can't control their airway, yet have an intact gag reflex, the nasopharyngeal airway (NPA) can be used as an alternative to the oropharyngeal airway (OPA). Examples of when a NPA should be considered. Contraindications and considerations for nasal airway insertion. Measuring a nasal airway for appropriate length and diameter. Insertion of a nasopharyngeal airway. Patients with a NPA in place can receive supplemental O2, be ventilated with a BVM, have ETCO2 monitored, and have their upper airway suctioned as needed. **American Cancer Society (ACS) Fundraiser This is the fourth year that I'm participating in Real Men Wear Pink to increase breast cancer awareness and raise money for the American Cancer Society's life-saving mission. I hope you'll consider contributing. Every donation makes a difference in the fight against breast cancer! http://main.acsevents.org/goto/paultaylor (Paul Taylor's ACS Fundraiser) THANK YOU! Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn Good luck with your ACLS class!
When blood, or other fluids, accumulate in the sac around the heart it’s called a cardiac tamponade or pericardial tamponade. Effects of tamponade on the electrical system and chambers of the heart. Cardiac tamponade can be acute or chronic and caused by traumatic, iatrogenic, or pathological etiologies. Common traumatic events, medical procedures, and diseases that can result in a pericardial tamponade. Signs & symptoms of cardiac tamponade. PEA is common because the electrical system of the heart is fine. Treatment of cardiac tamponade is pericardiocentesis by appropriately trained professionals working within their scope of practice. For additional information on cardiac tamponade, check out the Pod Resources page at PassACLS.com. I've placed a link to a Ninja Nerd podcast episode that discusses this topic. **American Cancer Society (ACS) Fundraiser This is the fourth year that I'm participating in Real Men Wear Pink to increase breast cancer awareness and raise money for the American Cancer Society's life-saving mission. I hope you'll consider contributing. Every donation makes a difference in the fight against breast cancer! http://main.acsevents.org/goto/paultaylor (Paul Taylor's ACS Fundraiser) THANK YOU! Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn Good luck with your ACLS class!
Two things have changed in recent years to aid students that don't use ACLS in their daily practice. The role of the team leader; and The ability to use your quick reference cards.
The team leader is responsible for assigning tasks and overall direction of the team but may ask team members for help to confirm the ECG, suggest medications, identify possible reversible causes of cardiac arrest, and to speak up if they identify something that's unsafe. Students may use their book and quick reference cards during the mega code as well as the written exam. **American Cancer Society (ACS) Fundraiser This is the fourth year that I'm participating in Real Men Wear Pink to increase breast cancer awareness and raise money for the American Cancer Society's life-saving mission. I hope you'll consider contributing. Every donation makes a difference in the fight against breast cancer! http://main.acsevents.org/goto/paultaylor (Paul Taylor's ACS Fundraiser) THANK YOU! Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn Good luck with your ACLS class! If you represent a training center, vendor, or other healthcare-related service and would like to exchange links or discuss opportunities to sponsor upcoming episodes; contact me to discuss.
The goal of CPR is to keep the brain and vital organs perfused until return of spontaneous circulation (ROSC) is achieved. Post-arrest care and recovery are the final two links in the chain of survival. Identification of ROSC during CPR. Initial patient management goals after identifying ROSC. The patient’s GCS/level of consciousness should be evaluated to determine if targeted temperature management (TTM) is indicated. Patients that cannot obey simple commands should receive TTM for 24 hours. Why we should cool unresponsive post-arrest patients. Patients can undergo EEG, CT, MRI, & PCI while receiving TTM.
Patients with a narrow complex tachycardia with a rate over 150 BPM are in SVT. Unstable patients in SVT, or V-Tach with a pulse, should be cardioverted with a synchronized shock. Assessment & treatment of stable tachycardic patients. Commonly used vagal techniques. A less common technique to stimulate the vagus nerve is the dive reflex. Indications and use of Adenosine for stable patients in SVT refractory to vagal maneuvers. Possible treatments for patients found to be in A-Fib or A-Flutter with RVR after administration of Adenosine. Carotid sinus massage. Additional medical podcasts that have episodes on tachycardia can be found on the pod resources page at passacls.com. **American Cancer Society (ACS) Fundraiser This is the fourth year that I'm participating in Real Men Wear Pink to increase breast cancer awareness and raise money for the American Cancer Society's life-saving mission. I hope you'll consider contributing. Every donation makes a difference in the fight against breast cancer! http://main.acsevents.org/goto/paultaylor (Paul Taylor's ACS Fundraiser) THANK YOU! Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn Good luck with your ACLS class!
Remembering all the different energy setting needed for synchronized cardioversion and defibrillation used to be confusing for a lot of people. Defibrillators can be broken down into three basic categories: Automated External Defibrillator (AED); Biphasic defibrillators; and Monophasic defibrillators.
Because AEDs are designed to be used by first responders, and lay people with only minimal medical training, the controls are kept simple and are pre-programmed into the machine. Use of an AED to rapidly deliver a shock. Biphasic defibrillators automatically measure the impedance between the defib pads and will adjust the energy to deliver the shock needed based on the patient. Biphasic defibrillator use and energy setting. For older, monophasic defibrillators, use 360J to defibrillate V-Fib or pulseless V-Tach. AEDs must not be used on patients with a pulse. Cardioversion of patients in unstable SVT or V-Tach with a pulse using biphasic vs monophasic monitor/defibrillators. Team safety when performing synchronized cardioversion. Energy needed to cardiovert unstable patients with a narrow vs wide complex tachycardia. **American Cancer Society (ACS) Fundraiser This is the fourth year that I'm participating in Real Men Wear Pink to increase breast cancer awareness and raise money for the American Cancer Society's life-saving mission. I hope you'll consider contributing. Every donation makes a difference in the fight against breast cancer! http://main.acsevents.org/goto/paultaylor (Paul Taylor's ACS Fundraiser) THANK YOU! Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn Good luck with your ACLS class!
Patients with a heart rate less than 60 are bradycardic. Some people can have a resting heart rate in the 40s without any compromise. For others, a heart rate of 50 or less could signify the need for immediate intervention and warrants additional assessment. Signs & symptoms that indicate a bradycardic patient is unstable. Monitoring oxygen saturation with pulse oximetry and indications for administration of oxygen. Calcium channel blockers and beta blocker medication as treatable causes of bradycardia. The indications and dosage of Atropine. Precautions for Atropine use in patients with second or third degree AV blocks. The use of transcutaneous pacing (TCP) for unstable bradycardic patients refractory to Atropine. The use and dosing of Dopamine and Epinephrine drips. For additional information about causes and treatment of bradycardia, check out the pod resources page at PassACLS.com. **American Cancer Society (ACS) Fundraiser This is the fourth year that I'm participating in Real Men Wear Pink to increase breast cancer awareness and raise money for the American Cancer Society's life-saving mission. I hope you'll consider contributing. Every donation makes a difference in the fight against breast cancer! http://main.acsevents.org/goto/paultaylor (Paul Taylor's ACS Fundraiser) THANK YOU! Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn Good luck with your ACLS class!
Two factors to cardiac arrest survivability that have been clearly shown to make the biggest difference is continuous high quality CPR and early defibrillation. The most common dysrhythmia present during the first few minutes of cardiac arrest is ventricular fibrillation. The chance of successful defibrillation decreases every minute that passes. How our chance of successfully defibrillating a patient into a perfusing rhythm significantly changes when good CPR is delivered vs when it isn't. Examples of in-hospital and out-of-hospital cardiac arrest (OHCA) outcomes when CPR is performed until defibrillation vs defibrillation without CPR. The role of the CPR coach. Three tips to aid us in limiting CPR interruptions to less than 10 seconds so we can maintain a chest compression fraction (CCF) of at least 80%. Feedback on the show, suggestions for episodes, and donations are appreciated. **American Cancer Society (ACS) Fundraiser This is the fourth year that I'm participating in Real Men Wear Pink to increase breast cancer awareness and raise money for the American Cancer Society's life-saving mission. I hope you'll consider contributing. Every donation makes a difference in the fight against breast cancer! http://main.acsevents.org/goto/paultaylor (Paul Taylor's ACS Fundraiser) THANK YOU! Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn Good luck with your ACLS class!
The chain of survival for ACLS is the same as was learned in your BLS class. The beginning steps of the Cardiac Emergency and Stroke chain of survival are the same. Recognizing the symptoms of a cardiac emergency or stroke; Activating an emergency response by calling 9-1-1, or a specialized code team if in the healthcare setting; Rapid assessment including 12 lead ECG for cardiac patients or FAST assessment for suspected stroke emergencies; Provide ALS care and transport to the most appropriate facility; for Early reperfusion.
ACLS's timed goals for first medical contact to PCI for STEMI and door-to-needle for ischemic stroke. Areas with strong EMS relationships, well-defined transport protocols, and specialized teams that care for the patient in the hospital have significantly better patient outcomes. The cardiac arrest chain of survival adds: high quality CPR, early defibrillation, and advanced resuscitation as the next critical links followed by post arrest care and recovery. **American Cancer Society (ACS) Fundraiser This is the fourth year that I'm participating in Real Men Wear Pink to increase breast cancer awareness and raise money for the American Cancer Society's life-saving mission. I hope you'll consider contributing. Every donation makes a difference in the fight against breast cancer! http://main.acsevents.org/goto/paultaylor (Paul Taylor's ACS Fundraiser) THANK YOU! Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn Good luck with your ACLS class!
Heart muscle contraction and repolarization is dependent on Sodium, Calcium, Magnesium, and Potassium ions crossing cellular membranes. When a patient’s potassium levels get too low or too high hypokalemia or hyperkalemia results respectively. Two things that may lead us to suspect hypo or hyperkalemia include the patient's medical history and changes to the T wave on the ECG. Medical conditions that cause potassium imbalance. ECG changes seen in hypo and hyperkalemia. Critical lab values that would indicate a need for treatment. Emergent, ACLS interventions for hypokalemia and hyperkalemia. Additional information on hypo and hyperkalemia can be found on Ninja Nerd podcast. Check out the pod resources page at passacls.com. **American Cancer Society (ACS) Fundraiser This is the fourth year that I'm participating in Real Men Wear Pink to increase breast cancer awareness and raise money for the American Cancer Society's life-saving mission. I hope you'll consider contributing. Every donation makes a difference in the fight against breast cancer! http://main.acsevents.org/goto/paultaylor (Paul Taylor's ACS Fundraiser) THANK YOU! Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn Good luck with your ACLS class!
When treating patients having an MI or stroke, more minutes equals more dead cells. Because the majority of strokes are the ischemic type, the treatment for stroke is similar to an MI – to reestablish perfusion to the ischemic tissues. Review the first four steps in the Stroke Chain of Survival. Time criteria for the administration of tPA or EVT of LVO strokes. Stroke benchmarks for door to: assessment; starting a non-contrast CT; and administration of tPA (door-to-needle).
EMS interaction with stroke teams and destination protocols to reduce time to definitive care. Remember that timed goals for cardiac patients start with point of first medical contact while stroke benchmarks start at arrival to the hospital. Additional information about timed goals for stroke and how EMS affects outcomes can be found on the PassACLS.com pod resources page. Not ACLS but something I'm just as passionate about is the battle against cancer. This is the fourth year that I'm participating in Real Men Wear Pink and have pledged to wear pink every day in October to: raise awareness of breast cancer; connect with breast cancer patients & survivors; and raise money for the American Cancer Society's life-saving mission.
Chances are that you know someone that has fought breast cancer or have lost a loved one to this insidious disease. Please consider making a donation to my American Cancer Society fundraiser and make a difference in the fight against breast cancer. Donations go directly to the American Cancer Society and can be made anonymously to protect your privacy. http://main.acsevents.org/goto/paultaylor (Paul Taylor's Real Men Wear Pink ACS Fundraiser) THANK YOU! Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn Good luck with your ACLS class!
Adenosine is the first IV medication given to stable patients with sustained supraventricular tachycardia (SVT) refractory to vagal maneuvers. Common causes of tachycardia. Symptoms indicating a stable vs unstable patient. Cardiac effects of Adenosine. Indications for the use of Adenosine in the ACLS Tachycardia algorithm. Considerations and contraindications for Adenosine use. Adenosine as a diagnostic for patients in A-Fib or A-Flutter with RVR. Dosing and administration of Adenosine. Other podcasts that cover common ACLS antiarrhythmics in detail. Not ACLS but something I'm just as passionate about is the battle against cancer. This is the fourth year that I'm participating in Real Men Wear Pink and have pledged to wear pink every day in October to: raise awareness of breast cancer; connect with breast cancer patients & survivors; and raise money for the American Cancer Society's life-saving mission.
Chances are that you know someone that has fought breast cancer or have lost a loved one to this insidious disease. Please consider making a donation to my American Cancer Society fundraiser and make a difference in the fight against breast cancer. Donations go directly to the American Cancer Society and can be made anonymously to protect your privacy. http://main.acsevents.org/goto/paultaylor (Paul Taylor's Real Men Wear Pink ACS Fundraiser) THANK YOU! Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn Good luck with your ACLS class!
To pass the written ACLS exam and mega code, students need to be able to identify basic ECG dysrhythmias, including the two types of second-degree heart block. One method of ECG rhythm identification is to ask a series of questions such as: What's the rate (<60, 60-100, 101-149, or >150); Is the rhythm regular or irregular; What's the shape and frequency of P waves and QRS complexes; and What's the P-R interval and is it constant?
ECG characteristics of a second-degree Mobitz type I (Wenckebach). Identification of unstable bradycardia and it's treatment with Atropine. ECG characteristics of a second-degree Mobitz type II. Possible effect of using Atropine on patients with a second-degree type II AV block. Treatment of unstable patients refractory to Atropine using TCP, Dopamine, or Epinephrine drip. Starting dose and titration of Dopamine and Epinephrine drips. Not ACLS but something I'm just as passionate about is the battle against cancer. This is the fourth year that I'm participating in Real Men Wear Pink and have pledged to wear pink every day in October to: raise awareness of breast cancer; connect with breast cancer patients & survivors; and raise money for the American Cancer Society's life-saving mission.
Chances are that you know someone that has fought breast cancer or have lost a loved one to this insidious disease. Please consider making a donation to my American Cancer Society fundraiser and make a difference in the fight against breast cancer. Donations go directly to the American Cancer Society and can be made anonymously to protect your privacy. http://main.acsevents.org/goto/paultaylor (Paul Taylor's Real Men Wear Pink ACS Fundraiser) THANK YOU! Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn Good luck with your ACLS class!
When treating patients with Acute Coronary Syndrome (ACS), MONA is an acronym sometimes used to help us remember the initial interventions. The O in MONA is Oxygen. When should we administer oxygen to ACS patients. When is O2 administration unnecessary. Monitoring patient's oxygen saturation (SaO2) using a pulse oximeter. Review two common ACLS mega code scenarios. Oxygen administration during CPR and post cardiac arrest. Not ACLS but something I'm just as passionate about is the battle against cancer. This is the fourth year that I'm participating in Real Men Wear Pink and have pledged to wear pink every day in October to: raise awareness of breast cancer; connect with breast cancer patients & survivors; and raise money for the American Cancer Society's life-saving mission.
Chances are that you know someone that has fought breast cancer or have lost a loved one to this insidious disease. Please consider making a donation to my American Cancer Society fundraiser and make a difference in the fight against breast cancer. Donations go directly to the American Cancer Society and can be made anonymously to protect your privacy. http://main.acsevents.org/goto/paultaylor (Paul Taylor's Real Men Wear Pink ACS Fundraiser) THANK YOU! Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn Good luck with your ACLS class!
Quantitative waveform capnography is used in ACLS as a way to confirm good CPR and placement of an endotracheal tube; identify return of spontaneous circulation (ROSC); and during post-cardiac arrest care. We can use waveform capnography with, and without, an advanced airway in place. Monitoring end tidal CO2 during rescue breathing. Use of capnography to objectively measure good CPR. Capnography is a preferred method of confirming endotracheal tube (ETT) placement over x-ray during a code. During CPR, a sudden increase in ETCO2 may indicate return of spontaneous circulation (ROSC). Quantitative waveform capnography is used post-cardiac arrest to aid us in maintaining an ETCO2 of 35-45 mm Hg. Not ACLS but something I'm just as passionate about is the battle against cancer. This is the fourth year that I'm participating in Real Men Wear Pink and have pledged to wear pink every day in October to: raise awareness of breast cancer; connect with breast cancer patients & survivors; and raise money for the American Cancer Society's life-saving mission.
Chances are that you know someone that has fought breast cancer or have lost a loved one to this insidious disease. Please consider making a donation to my American Cancer Society fundraiser and make a difference in the fight against breast cancer. Donations go directly to the American Cancer Society and can be made anonymously to protect your privacy. http://main.acsevents.org/goto/paultaylor (Paul Taylor's Real Men Wear Pink ACS Fundraiser) THANK YOU! Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn Good luck with your ACLS class!
Along with early defibrillation, high-quality CPR with minimal interruptions is one of the two factors that has been shown to improve cardiac arrest outcomes. How do we know if high-quality, effective CPR is being performed? The CPR coach as a new position of the code team. Objective measures of high-quality CPR include: Compression rate of 100-120 per minute; Compression depth of at least 5 cm; Allowing for full chest recoil; Maintaining an ETCO2 of at least 10 mm Hg; and Keeping interruptions to less than 10 seconds to obtain a chest compression fraction (CCF) of 80%.
The advantages and use of real-time feedback devices to monitor the rate, depth, and chest recoil of CPR compressions. The use of end tidal waveform capnography. A no tech way to monitor effective CPR if no feedback devices are available. Not ACLS but something I'm just as passionate about is the battle against cancer. This is the fourth year that I'm participating in Real Men Wear Pink and have pledged to wear pink every day in October to: raise awareness of breast cancer; connect with breast cancer patients & survivors; and raise money for the American Cancer Society's life-saving mission.
Chances are that you know someone that has fought breast cancer or have lost a loved one to this insidious disease. Please consider making a donation to my American Cancer Society fundraiser and make a difference in the fight against breast cancer. Donations go directly to the American Cancer Society and can be made anonymously to protect your privacy. http://main.acsevents.org/goto/paultaylor (Paul Taylor's Real Men Wear Pink ACS Fundraiser) THANK YOU! Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn Good luck with your ACLS class!
The 2020 ACLS guidelines updated the dose for administration of Atropine and Dopamine for the treatment of unstable bradycardia. The signs & symptoms of unstable bradycardia. Atropine's new dose and maximum. The use of atropine when a patient is in a second degree type II or third degree heart block. ECG changes that indicate subsequent doses of atropine are likely to be ineffective. The 2020 update to the starting dose of Dopamine. The use of Dopamine for bradycardia as an interim until TCP vs hypotension. The use of Atropine and Dopamine in patients with myocardial ischemia. Podcasts with additional (advanced-provider level) information about Atropine, Dopamine, and bradycardia can be found on the Pass ACLS pod resources page. Not ACLS but something I'm just as passionate about is the battle against cancer. This is the fourth year that I'm participating in Real Men Wear Pink and have pledged to wear pink every day in October to: raise awareness of breast cancer; connect with breast cancer patients & survivors; and raise money for the American Cancer Society's life-saving mission.
Chances are that you know someone that has fought breast cancer or have lost a loved one to this insidious disease. Please consider making a donation to my American Cancer Society fundraiser and make a difference in the fight against breast cancer. Donations go directly to the American Cancer Society and can be made anonymously to protect your privacy. http://main.acsevents.org/goto/paultaylor (Paul Taylor's Real Men Wear Pink ACS Fundraiser) THANK YOU! Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn Good luck with your ACLS class!
The tongue is the most common airway obstruction in an unconscious patient. Insertion an oropharyngeal airway helps keep the patient’s tongue from falling to the back of the pharynx and causing an airway obstruction. The oropharyngeal airway is sometimes called an OPA or simply an oral airway. Indications for using an oral airway. Contraindication for an oral airway and an alternative that can be used instead. Measuring an OPA and possible complications from inserting one that's too small or too large. Two techniques to properly insert an OPA and avoid complications. The use of an oral airway during CPR. The use of an OPA as a bite block after a patient has an advanced airway placed. Not ACLS but something I'm just as passionate about is the battle against cancer. This is the fourth year that I'm participating in Real Men Wear Pink and have pledged to wear pink every day in October to: raise awareness of breast cancer; connect with breast cancer patients & survivors; and raise money for the American Cancer Society's life-saving mission.
Chances are that you know someone that has fought breast cancer or have lost a loved one to this insidious disease. Please consider making a donation to my American Cancer Society fundraiser and make a difference in the fight against breast cancer. Donations go directly to the American Cancer Society and can be made anonymously to protect your privacy. http://main.acsevents.org/goto/paultaylor (Paul Taylor's Real Men Wear Pink ACS Fundraiser) THANK YOU! Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn Good luck with your ACLS class!
Hypoxia is a state of low oxygen levels in the blood. Determining hypoxia using a pulse oximeter or arterial blood gasses (ABGs). A goal of ACLS is to recognize signs of hypoxia and provide timely treatment to prevent an arrest. Examples of some things that might lead us to think of hypoxia as a cause of cardiac arrest. Why we should not rely on pulse ox to give accurate readings during CPR. Delivering ventilations with near 100% oxygen concentration using a BVM attached to supplemental O2 and a reservoir. Using end tidal waveform capnography to assess the quality of CPR. Changes to ventilation rates, tidal volume, and O2 concentration affects a patient's oxygen, carbon dioxide, and pH. The danger of over ventilating a patient in cardiac arrest. Not ACLS but something I'm just as passionate about is the battle against cancer. This is the fourth year that I'm participating in Real Men Wear Pink and have pledged to wear pink every day in October to: raise awareness of breast cancer; connect with breast cancer patients & survivors; and raise money for the American Cancer Society's life-saving mission.
Chances are that you know someone that has fought breast cancer or have lost a loved one to this insidious disease. Please consider making a donation to my American Cancer Society fundraiser and make a difference in the fight against breast cancer. Donations go directly to the American Cancer Society and can be made anonymously to protect your privacy. http://main.acsevents.org/goto/paultaylor (Paul Taylor's Real Men Wear Pink ACS Fundraiser) THANK YOU! Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn Good luck with your ACLS class!
ECG characteristics of supraventricular tachycardia (SVT) vs. sinus tachycardia. Signs & symptoms that indicate a patient is unstable. Treatment of unstable SVT using a biphasic vs monophasic defibrillator. Consideration for team safety while performing synchronized cardioversion. Treatment of stable patients in SVT. Not ACLS but something I'm just as passionate about is the battle against cancer. This is the fourth year that I'm participating in Real Men Wear Pink and have pledged to wear pink every day in October to: raise awareness of breast cancer; connect with breast cancer patients & survivors; and raise money for the American Cancer Society's life-saving mission.
Chances are that you know someone that has fought breast cancer or have lost a loved one to this insidious disease. Please consider making a donation to my American Cancer Society fundraiser and make a difference in the fight against breast cancer. Donations go directly to the American Cancer Society and can be made anonymously to protect your privacy. http://main.acsevents.org/goto/paultaylor (Paul Taylor's Real Men Wear Pink ACS Fundraiser) THANK YOU! Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn Good luck with your ACLS class!
When working to resuscitate a patient in sudden cardiac arrest, Epinephrine is the first IV medication we administer. When do we give the first dose of epinephrine for patient is in shockable vs non-shockable rhythm. When to give the first dose of epinephrine and its frequency for patients in asystole or PEA following the right side of the Adult Cardiac Arrest algorithm. When to give the first dose of epi and its frequency for patients in V-Fib or pulseless V-Tach following the left side of the Adult Cardiac Arrest algorithm. Example chronology of events for a scenario where a patient is found unresponsive, pulseless, and only gasping/agonal breathing. Administration of epi via the IO or endotracheal route in the absence of a patent IV. The maximum cumulative dose of epinephrine that can be administered to patients in cardiac arrest. When do we stop administering epinephrine. Not ACLS but something I'm just as passionate about is the battle against cancer. This is the fourth year that I'm participating in Real Men Wear Pink and have pledged to wear pink every day in October to: raise awareness of breast cancer; connect with breast cancer patients & survivors; and raise money for the American Cancer Society's life-saving mission.
Chances are that you know someone that has fought breast cancer or have lost a loved one to this insidious disease. Please consider making a donation to my American Cancer Society fundraiser and make a difference in the fight against breast cancer. Donations go directly to the American Cancer Society and can be made anonymously to protect your privacy. http://main.acsevents.org/goto/paultaylor (Paul Taylor's Real Men Wear Pink ACS Fundraiser) THANK YOU! Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn Good luck with your ACLS class!
If a patient fails one of the FAST tests in the Cincinnati Prehospital Stroke Scale, there's a 72% chance they're having a stroke. We should assume a stroke unless we identify another condition that could be causing the symptoms. There are several medical conditions that can mimic a stroke. Some are easy to identify with point-of-care testing while others require labs, imaging, or other specialized tests. Identifying and treating hypoglycemia, hyperglycemia, hypoxia, and seizures with simple testing and reviewing the patient's medical history. Electrolyte imbalance, sepsis, brain tumors, and Bell’s Palsy require labs, imaging, and specialized testing to diagnose and treat. Using EMS destination protocols or hospital rapid response teams to quickly identify and treat suspected stroke patients. Not ACLS but something I'm just as passionate about is the battle against cancer. This is the fourth year that I'm participating in Real Men Wear Pink and have pledged to wear pink every day in October to: raise awareness of breast cancer; connect with breast cancer patients & survivors; and raise money for the American Cancer Society's life-saving mission.
Chances are that you know someone that has fought breast cancer or have lost a loved one to this insidious disease. Please consider making a donation to my American Cancer Society fundraiser and make a difference in the fight against breast cancer. Donations go directly to the American Cancer Society and can be made anonymously to protect your privacy. http://main.acsevents.org/goto/paultaylor (Paul Taylor's Real Men Wear Pink ACS Fundraiser) THANK YOU! Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn Good luck with your ACLS class!
Most ACLS medications are given IV push. But, what happens if we can't get an IV? When IV access isn't available, we should consider administering our IV medications via intraosseous (IO)or endotracheal tube (ETT) route. Why IO is better for than ETT as an alternative route. The locations we should place an IO when running a code and a location we should avoid. The ACLS medications that can be given intraosseous. Where you can find more information about intraosseous access during resuscitation efforts. In the absence of an IV or IO, some medications may be given down the endotracheal tube. The disadvantages of medication administration via ETT. Review of the medications that can be given down the tube and how they should be given. Medications should not be given down the tube when anything other than an endotracheal tube is used as an advanced airway. Not ACLS but something I'm just as passionate about is the battle against cancer. This is the fourth year that I'm participating in Real Men Wear Pink and have pledged to wear pink every day in October to: raise awareness of breast cancer; connect with breast cancer patients & survivors; and raise money for the American Cancer Society's life-saving mission.
Chances are that you know someone that has fought breast cancer or have lost a loved one to this insidious disease. Please consider making a donation to my American Cancer Society fundraiser and make a difference in the fight against breast cancer. Donations go directly to the American Cancer Society and can be made anonymously to protect your privacy. http://main.acsevents.org/goto/paultaylor (Paul Taylor's Real Men Wear Pink ACS Fundraiser) THANK YOU! Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn
Good luck with your ACLS class!
The chain of survival for a cardiac emergency and stroke start the same: preparedness & recognition of an emergency; activation of EMS; delivery of Advanced Life Support; and transporting to the most appropriate facility.
Depending on where you live, Emergency Medical Services (EMS) may provide prehospital Advanced Life Support (ALS). ALS ambulances are staffed with paramedics who have training in ACLS skills. Paramedics can perform an assessment, obtain a medical history, and provide life-saving care within minutes of recognition. Why EMS "Destination Protocols" for suspected stroke and STEMI make a difference. Review ACLS timed benchmarks for: point of first medical contact to PCI for ST elevation MI; door to CT for suspected stroke; door to tPA for ischemic stroke; and onset of symptoms to EVT for LVO strokes.
EMS may bypass a close hospital to transport a STEMI or suspected stroke patient to a more appropriate hospital - one capable of 24/7 PCI or a certified stroke center; because time is heart muscle or brain cells. Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn
Good luck with your ACLS class!
Performing good CPR, and delivering a shock as soon as possible to a patient in Ventricular Fibrillation or pulseless V-Tach are the two most critical interventions that have been shown to increase survival from sudden cardiac arrest. To aid in the rapid delivery of a shock, an Automated External Defibrillator (AED) should be used in settings where a full monitor/defibrillator isn’t available. Research has demonstrated significantly better out of hospital cardiac arrest survival outcomes in communities with robust public CPR training and public access/first responder AEDs. Why an AED makes a difference. The general use of AED including: indications for use; attaching the AED pads; following verbal prompts; and safely administering a shock. Following the Adult Cardiac Arrest algorithm while using an AED. Contraindications to AED use. Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn
Good luck with your ACLS class!
For apneic patients without a carotid pulse or pulseless patients with only gasping/agonal respirations, we will follow the Adult Cardiac Arrest algorithm. For pulseless patients that the AED doesn't advise a shock, the patient's ECG shows asystole, or a non-perfusing organized rhythm (PEA), we will follow the right side of the algorithm. Initial steps are aimed at delivery of high quality CPR to keep the brain and vital organs alive. Epinephrine administration. Placement of an advanced airway. Considering possible reversible H & T causes of cardiac arrest including three common causes of PEA and their emergent interventions. When we should discontinue resuscitation efforts and call the code. Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn
Good luck with your ACLS class!
Providing good, high quality, CPR with minimal interruptions and early defibrillation are two keys to improved cardiac arrest outcomes. A training tool used in many CPR and ACLS classes is to use a song (or a song list) with a tempo of 100 to 120 beats per minute to help the person doing chest compressions maintain an adequate rate. Characteristics of good songs that will help us. Advantages & disadvantages of using a song during CPR. Selected songs from various genres and time periods from AHA's "Be The Beat" playlist on Spotify. https://open.spotify.com/playlist/2mU2FNAhSOtQwW0hBgQMaK (https://open.spotify.com/playlist/2mU2FNAhSOtQwW0hBgQMaK) Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn
Good luck with your ACLS class!
A patient’s medical history will help us identify things that may be causing (or contributing) to their current condition as well as guide our decisions so we provide the safest evidence-based care possible. Examples of information obtained in a medical history that will impact the treatment we provide. E.g. Not giving nitro to patients taking PDE inhibitors. There are several mnemonics and memory aids that people use to guide their history taking. Review of the SAMPLE PQRST medical history. Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn Good luck with your ACLS class!
Although magnesium can be used in the treatment of other medical conditions such as eclampsia, asthma, & digitalis toxicity; for ACLS, magnesium is primarily used to treat Torsades de Pointes. Identification of torsades on the ECG. Administration of a magnesium infusion for stable patients vs slow IV push for patients in cardiac arrest. Procainamide use for stable patients with a monomorphic wide-complex tachycardia. Procainamide dosing and when to stop the infusion. Tip for determining whether magnesium or Procainamide should be used when treating stable patients with V-Tach. Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn
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When a patient loses excessive amounts of fluids, they are in a state of hypovolemia. Bleeding is not the only cause of fluid loss that can lead to low fluid volume. Bleeding may be internal or external and have traumatic, pathogenic, or iatrogenic etiology. Other common conditions that can lead to hypovolemia. Review the signs & symptoms of hypovolemic shock that may be present before cardiac arrest and lead us to suspect hypovolemia as a cause. Treatment of hypovolemia with administration of crystalloid IV solutions or blood. Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn
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Morphine is a relatively safe medication used in the ACS algorithm. Morphine should be considered for patients with severe ischemic chest pain that is unresolved after the safe administration of aspirin, oxygen, and nitroglycerine. Why its analgesic and vasodilation effects are helpful for patients with ischemic chest pain. Morphine use for ACS patients patients taking PDE inhibitors. Dosing, administration, and monitoring of patients. Reversal of Morphine's untoward effects with Narcan. Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn
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Studies in the early 2010’s correlated CPR compressions to coronary perfusion pressures and improved outcomes as measured by Return of Spontaneous Circulation (ROSC) and survival to discharge. Minimizing interruptions to chest compressions so that we can maintain a chest compression fraction of at least 80% is the first indicator of high-quality CPR that was identified at the 2012 AHA CPR Quality Summit. We should use end tidal CO2 waveform capnography and other real-time feedback devices to monitor the effectiveness of CPR compressions and ventilations. Ideally, we should limit pauses to chest compressions as much as possible and resume compressions within 10 seconds. To do this we should: Limit pauses during defibrillation; Don't stop compressions while inserting an advanced airway; and Perform activities that require a pause at the same time.
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Epinephrine is the most commonly used medication in ACLS. Epi is used to treat certain conditions to prevent cardiac arrest, during a cardiac arrest, and post arrest. Epinephrine's use for treatment of anaphylaxis and unstable bradycardia. Administration of epi in the Adult Cardiac Arrest algorithm. Use of Epinephrine or Dopamine drip for hypotension post cardiac arrest. Review the dose-dependent effects of Dopamine. Use of Dopamine for unstable bradycardia.
Providing rescue breathing to apneic patients with a palpable pulse. Normal end tidal CO2 for patients with a pulse. Identification of cardiac arrest and our immediate actions. Providing artificial ventilations during CPR without an advanced airway vs with an advanced airway in place. Using quantitative waveform capnography to confirm placement of an advanced airway, assess the quality of CPR, and identify ROSC. The effects of hyperventilating patients in cardiac arrest. Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn
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When a patient’s core body temperature drops below 96.8 F (36 C), they are hypothermic. As the body’s temperature drops below 36 C, hypothermia may further be classified as moderate or severe: Moderate if the patient’s body core temp is between 30-34 C; and Severe if it's below 30 C.
Why hypothermic patients aren't dead until they are warm and dead. Modifying the ACLS Adult Cardiac Arrest algorithm for patients with severe hypothermia. Following the ACLS algorithm for patients with a body core temperature above 30 C. Methods for rewarming patients with moderate vs severe hypothermia. Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn
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Calcium is one of the ions that move across the cellular membrane during cardiac contraction and relaxation. For ACLS, the primary use of calcium channel blockers is for the treatment of stable, narrow complex tachycardias refractory to vagal maneuvers and Adenosine. Nicardipine may also be used to lower the blood pressure of ischemic stroke patients with severe hypertension. Use of calcium channel blockers for SVT refractory to Adenosine and A-Fib or A-Flutter with RVR. Contraindications of calcium channel blockers. Nicardipine's use during the treatment of ischemic strokes. Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn
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While running a code, the thing we hope for is Return of Spontaneous Circulation (ROSC), followed by recovery so the patient can return to a normal life. The actions we take after identifying ROSC has a significant impact on a patient’s eventual outcome. The Post-Cardiac Arrest Care algorithm provides us with evidence-based guidance for the initial stabilization phase as well as continued management activities. Our primary focus immediately following ROSC is aimed at ensuring adequate perfusion of the body’s vital organs. Management of O2 and CO2 concentrations. Administration of Atropine for symptomatic bradycardia. Maintaining a systolic BP of at least 90 and MAP of 65 mm Hg or more. Use of Dopamine, Levophed, and Epinephrine drips. Starting targeted temperature management (TTM) for 24 hours based on the patient's level of consciousness. Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn
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Nitroglycerine is one of the front-line medications used in the Acute Coronary Syndrome (ACS) algorithm. Nitro's effect on peripheral blood vessels and coronary arteries. Indications for use of nitroglycerine. Contraindications and when it should be used with caution. Nitroglycerine dosage & administration. Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn
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In atrial fibrillation (A-Fib) and atrial flutter (A-Flutter) the electrical impulse for cardiac contraction is in the atria but isn't the normal pacemaker of the heart, the SA node. The ECG characteristics of A-Fib and A-Flutter. Recognition and treatment of unstable patients in A-Fib/Flutter with rapid ventricular response (RVR). Team safety when cardioverting a patient in A-FIB with RVR. Treatment of stable patients in A-Fib/Flutter with RVR. Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn
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As an ACLS provider you do not need to be familiar with all of the different signs of various types of poisoning. You should be able to obtain a history and know to order toxicology. The majority of toxins don’t have a specific antidote. There are a few toxins for which we have emergency interventions and ACLS providers should be familiar with. Reviewing the patient's medical history for indicators that may lead us to suspect a tablet/toxin cause of cardiac arrest. Administration of Narcan for suspected narcotics overdose following the Opioid Associated Emergency algorithm. Other common ACLS Tablet Toxin scenarios with possible treatments include: tricyclic antidepressants, digoxin; beta blockers; calcium channel blockers; cocaine; organophosphates; and benzodiazepines. Medications commonly used to treat specific toxins that are regularly stocked on crash carts or carried in EMS med bags include: sodium bicarb, calcium chloride, magnesium sulfate, benzodiazepines, atropine, and glucagon. ACLS providers that suspect a specific toxin should consult with their Pharmacy or call Poison Control for treatment directions. Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn
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The ACLS algorithms are designed to make it easier to remember the key interventions we should deliver, and the order in which they should be delivered, to provide the best evidence-based care possible. Generally speaking, if there’s a change in a patient’s condition, we should ensure we’re using the correct algorithm. Three key points to remember when using ACLS algorithms: If a patient’s condition changes, we should do an assessment and use the algorithm that matches the patient’s current state. If an action was already done, we don’t need to repeat it. We only do actions that are clinically appropriate and within our scope of practice.
Walk through of an example mega code scenario with explanations of when and why we change to a different ACLS algorithm. Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn
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Beta blocking medications attach to Beta receptors to inhibit or “block” the effects of epinephrine and norepinephrine in the body. Review the primary locations of Beta I, II, and III receptors. Epinephrine & norepinephrine stimulation of beta I receptors in the heart results in an increase of the heart's rate and force of contractions; increasing the workload of the heart. Beta blockers affects on the heart. When we should consider the use of beta blockers in the Acute Coronary Syndrome (ACS) and Tachycardia algorithms. Contraindications to the use of beta blocker medications. Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn
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This episode we are reviewing the use of advanced airways in the Adult Cardiac Arrest algorithm. When we should consider insertion of an advanced airway for patients in a shockable vs non-shockable rhythm. In addition to an endotracheal tube (ETT), other ACLS advanced airways include the Laryngeal Mask Airway (LMA) and the Laryngeal Tube airway. The advantages of using an advanced airway over basic airway maneuvers. Use of end tidal CO2 waveform capnography to confirm placement and assess the adequacy of CPR. Identification and management of a misplaced ET tube. Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn
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Our primary focus immediately following return of spontaneous circulation (ROSC) is aimed at ensuring adequate perfusion of the patient’s vital organs and decreasing cerebral damage. After we have assessed and addressed O2 saturation, ETCO2, and BP, we may consider the use of an antiarrhythmic infusion if the patient has ventricular ectopy on the ECG. Determining which antiarrhythmic to use depends on what medications were given before the patient converted. The use of Amiodarone for ventricular ectopy post arrest if no antiarrhythmics were administered prior to obtaining ROSC. The indications, dose, and administration of Amiodarone or Lidocaine to control ventricular ectopy after ROSC.
Hydrogen ions is on one of the Hs in ACLS's H&T reversible causes of cardiac arrest. When considering hydrogen ions as a cause, what we’re looking at is the patient’s pH, or acid/base balance, and conditions that affect it. The body's normal serum pH is 7.35-7.45. Using ABGs to determine acidosis or alkalosis. Common conditions/causes that may lead us to suspect acidosis. Common conditions/causes that may lead us to suspect alkalosis. Correcting acidosis by changing the rate of ventilations. The indications, dose, and considerations for use of Sodium Bicarbonate. Treatment of alkalosis depends on the type (metabolic or respiratory) and is aimed at correcting the underlying cause. Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn
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Being the team leader during a cardiac arrest is challenging. Using an algorithm helps by standardizing & prioritizing our interventions using an If/Then methodology. Review of BLS steps for determining if rescue breathing or CPR is needed and attaching the AED or defib pads as soon as it arrives at the patient’s side. If the patient is in a non-shockable rhythm on the ECG such as PEA or systole, we will go down the right side of the adult cardiac arrest algorithm. If the patient is in a shockable rhythm on the ECG such as V-Fib or V-Tach, we will go down the left side of the adult cardiac arrest algorithm. An example of a code's flow for shockable rhythms where an antiarrhythmic such as Amiodarone or Lidocaine is administered. We will follow the algorithm until the patient has ROSC or we call the code. Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn
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For patients exhibiting symptoms consistent with myocardial ischemia, Aspirin is one of the first medications we should consider along with morphine, oxygen, and nitroglycerine; if indicated & safe. Aspirin's mechanism of action & benefits for Acute Coronary Syndrome (ACS) patients. Contraindications and considerations for aspirin use. The dose and route of administration of aspirin for ACS patients. Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn
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To pass ACLS, you will need to be able to identify common rhythms on a monitor during your mega code and ECG strips on your written exam. If you don't normally monitor patients as part of your job, I suggest two things: Find a system for ECG interpretation that works well for you; and Practice reading ECGs every day for a few weeks before your class.
Review of normal ECG morphology of P wave, QRS complex, and T wave in lead II. Characteristics of first degree heart block. Characteristics of third degree (complete) AV block. Treatment of unstable patients in third degree block following the ACLS Bradycardia algorithm. Special considerations for use of Atropine when patients are in a third degree heart block. Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn
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In the Adult Cardiac Arrest algorithm, we should administer an antiarrhythmic medication to patients in V-Fib or pulseless ventricular tachycardia approximately two minutes after the first dose of epinephrine. The two first-line ACLS antiarrhythmics that are generally used are Amiodarone and Lidocaine. Review of Lidocaine dosing and administration to patients in persistent V-Fib or pulseless V-Tach. Review of Amiodarone dosing and administration to patients in persistent V-Fib or pulseless V-Tach. For patients that have return of spontaneous circulation (ROSC) and have ventricular ectopy on the ECG after we've ensured adequate oxygenation, an antiarrhythmic drip may be indicated. Review drip rates for Amiodarone and Lidocaine infusion post cardiac arrest to suppress ventricular ectopy. Amiodarone dosing and use for stable patients in V-Tach with a pulse refractory to vagal maneuvers. Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn
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The tongue is the most common airway obstruction in an unconscious patient. For patients with a decreased level of consciousness that can't control their airway, yet have an intact gag reflex, the nasopharyngeal airway (NPA) can be used as an alternative to the oropharyngeal airway (OPA). Examples of times when a NPA should be considered. Contraindications and considerations for nasal airway insertion. Selecting the appropriate length and diameter NPA for the patient's size. Insertion of a nasopharyngeal airway. Patients with a NPA in place can receive supplemental O2, be ventilated with a BVM, have ETCO2 monitored, and have their upper airway suctioned as needed.
When blood, or other fluids, accumulate in the sac around the heart it’s called a pericardial tamponade. As little as 50 ml of blood, or a little under 1/4 cup, can cause a pericardial tamponade. Pathophysiology of cardiac tamponade. Iatrogenic causes of tamponade. Signs & symptoms that we observe prior to a patient arresting. Differentiating between a cardiac tamponade and a tension pneumothorax; another H&T reversible cause with some shared signs. Emergency treatment of cardiac tamponade with pericardiocentesis. Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn
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Two things have changed in recent years to aid students that don't use ACLS in their daily practice. 1. The role of the team leader; and 2. The ability to use your quick reference cards. The team leader is responsible for assigning tasks and overall direction of the team but may ask team members for help to confirm the ECG, suggest medications, identify possible reversible causes of cardiac arrest, and to speak up if they identify something that's unsafe. Students may use their book and quick reference cards of the mega code as well as the written exam. Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn
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The goal of CPR is to keep the brain and vital organs perfused until return of spontaneous circulation (ROSC) is achieved. Post-arrest care and recovery are the final two links in the ACLS chain of survival. Once ROSC is obtained, the goals of ACLS are aimed at establishing & maintaining: Pulse of 60 – 100; Systolic BP > 90 mm Hg; MAP > 65 mm Hg; SaO2 of 92-98%; and ETCO2 of 35-45 mm Hg
Patients with an identified ST elevation MI (STEMI) should have a cardiology consult and be taken to the cath lab as soon as possible for PCI. Non-ST elevation MI patients should be admitted to ICU for close monitoring. The patient’s GCS (level of consciousness) should be evaluated to determine if targeted temperature management (TTM) is indicated. Patients that cannot obey simple commands should be cooled to 32-36 C for 24 hours. Patients can undergo PCI, CT, and MRI while being cooled. Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn
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Patients with a narrow complex tachycardia with a rate over 150 BPM are in SVT. Unstable patients in SVT or A-Fib/Flutter with RVR should be cardioverted with a synchronized shock. Stable patients should have an IV established, oxygen if the SaO2 is less than 90%, and a 12 lead ECG before attempting vagal stimulation. Commonly used vagal techniques. Less common techniques include stimulation of the dive reflex and carotid sinus massage (if within your scope of practice). The use of Adenosine for stable patients in SVT refractory to vagal maneuvers. For patients found to be in A-Fib or A-Flutter with RVR we should consider use of a calcium channel blocker or beta blocker. Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn Good luck with your ACLS class!
Remembering the different suggested energy settings for cardioversion and defibrillation when using different models or types of defibrillators has been made easier with biphasic & AED technology. AEDs are preprogrammed with a set energy setting to maximize the effectiveness of defibrillation. Biphasic defibrillators measure the impedance between the pads and will calculate the suggested energy for us. For monophasic defibrillators, set the energy at 360j and leave it. Cardioversion is similar when using a biphasic defibrillator; the machine does the calculation. Energy setting for narrow and wide complex tachycardias with a pulse using a monophasic defibrillator. AEDs should not be used on patients with a pulse! Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn
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Patients with a heart rate less than 60 are bradycardic. Some patients may tolerate a pulse of 40 without any symptoms. For others, a pulse of 50 or less could require treatment. Signs and symptoms that indicate an unstable patient that should receive ACLS interventions. Atropine is our first-line medication used in the treatment of unstable bradycardia. Review of atropine's actions, dosage, and administration. Patients with a heart transplant or in a second degree type II or third degree heart block may not respond to atropine. Unstable bradycardic patients refractory to atropine should have TCP started as soon as it's available. If there's a delay in TCP, a Dopamine or Epinephrine drip may be started. Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn
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The most common dysrhythmia during the first few minutes of cardiac arrest is ventricular fibrillation (V-Fib). The rapid delivery of a shock to convert a fibrillating heart is the intervention needed to convert the patient into a perfusing rhythm. Rapid defibrillation and early, high quality CPR are two factors that have been shown to improve defibrillation success. Review of inpatient and out-of-hospital cardiac arrests (OHCA) and the difference that CPR has on potential for successful defibrillation. Why public CPR and EMS dispatcher CPR instructions are important to improving OHCA survival outcomes. Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn
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The chain of survival taught in BLS and ACLS classes highlight the key interventions that have been demonstrated to improve patient outcomes. The first few links in the chain (recognition & calling for help) are the same in the cardiac emergency and stroke chain of survival. Discussion of similarities in the chains and why they make a difference. Review the 2020 STEMI benchmark for first medical contact to PCI and stroke benchmark for door to tPA. Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn
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Along with sodium, calcium, & magnesium; potassium is one of the ions necessary for cardiac contraction. A low potassium (hypokalemia) or high potassium (hyperkalemia) should be considered while reviewing the H & T reversible causes of cardiac arrest. Two things that may aid us in identifying hypo or hyperkalemia include the patient's medical history and changes to the T wave on the ECG. Review of conditions and medications that may result in potassium imbalance. A serum potassium less than 3 or greater than 6 should be treated. Emergency treatment of hypokalemia and hyperkalemia. Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn
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For patients having a stroke, the longer to reperfusion the more dead cells. Similar to heart attack, the 2020 ACLS guidelines has established some timed goals based on outcome-based studies. Unlike the ACLS cardiac goals which start at point of first medical contact, stroke goals begin when the patient reaches the hospital. For patients with suspected stroke, EMS may bypass a close hospital to get their patient to a certified stroke center within 30 minutes. Review the timed goals for: Door to assessment; Door to CT; and Door to tPA administration (door-to-needle).
Patients with suspected large vessel occlusion (LVO) should be transported to a facility that can perform endovascular therapy (EVT) within 24 hours of symptom onset. Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn
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Adenosine is indicated for the treatment of stable, narrow-complex supraventricular tachycardia refractory to vagal maneuvers. Review the actions of Adenosine on the SA and AV node of the heart. Contraindications and precautions for use of Adenosine, Adenosine dosing and administration. Adenosine's use in identifying A-Fib or flutter with RVR. Adenosine may be considered for patients with monomorphic wide-complex tachycardias. Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn
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When there is a slowing or disruption through the normal electrical pathways through the heart, we say the patient has a block. Basic rules for ECG interpretation using the rate, regularity, and relationship of P to QRS complexes. ECG characteristics of second degree type I or Wenchebach. Signs and symptoms that indicate an unstable bradycardic patient. Characteristics of second degree type II. Treatment of unstable bradycardic patients with a second degree heart block using Atropine. Patients refractory to Atropine should have TCP. If there's a delay in TCP, a Dopamine or Epinephrine drip may be started until TCP is available. Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn
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Like any of our ACLS interventions, we must assess if it's appropriate and safe. We don't just give a medication because it's part of an algorithm, and oxygen is no different. Oxygen is one of the interventions we should consider giving to patients in the Acute Coronary Syndrome (ACS) algorithm. We should administer O2 if the patient's SaO2 is below 90%. 100% oxygen should be administered to patients in cardiac arrest by using a BVM with a reservoir and oxygen at 10-15 L/min. Patients that experience return of spontaneous circulation (ROSC) should have their O2 sat maintained at 92-98%. Some conditions may cause a pulse oximeter to give inaccurate readings. The pulse shown on the pulse ox should match that on the ECG or palpated. Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn
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In ACLS, end tidal waveform capnography is used in the cardiac arrest and post-arrest algorithms. ETCO2 can be monitored using a BVM only or attached to the universal adapter of an advanced airway. During an arrest, waveform capnography is used to measure the quality of CPR. A waveform of at least 10 mm Hg indicates good CPR. A sudden jump in ETCO2 could indicate ROSC. Capnography is used to confirm ET tube placement. If an ET tube is in the esophagus, we wont see a waveform when ventilating. Post cardiac arrest, an ETCO2 of 35-45 mm Hg is one of the goals of patient management along with blood pressure and oxygen saturation. Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn
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Along with early defibrillation, high quality CPR is one of the two factors that have been shown to improve survival to discharge outcomes. Role of the CPR coach on a code team. Use of real time feedback devices to measure the rate, depth, and chest recoil during CPR compressions. Use of waveform capnography to monitor end tidal CO2. Checking for a femoral or carotid pulse during compressions. Tips to maintaining a chest compression fraction of at least 80%. Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn
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The dose for atropine and dopamine used to treat unstable bradycardia was changed in the 2020 ACLS guidelines. Signs and symptoms indicating a bradycardic patient is unstable. Atropine's new dose in 1.0 mg given rapid IV push. This may be repeated every 5 minutes to a maximum total of 3 mg. Atropine's use for bradycardic patients with a second degree type II or third degree heart block. Dopamine may be used for symptomatic bradycardia refractory to atropine. The starting dose for dopamine was increased from 2 to 5 mcg/kg/min in the 2020 ACLS guidelines. Use caution when using atropine or dopamine in patients with myocardial ischemia as their use increases the workload on the heart. Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn
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The oropharyngeal airway is a basic airway device designed to help hold the tongue away from the back o0f the throat in unresponsive patients without a gag reflex. Other names for the oropharyngeal airway include OPA or simply oral airway. Indications and contraindication for use of the OPA. Sizing of the oral airway is important to ensure that it will hold the tongue while preventing complications. Common complications if an oral airway that's too small or too large is inserted. Until an advanced airway is placed, we continue to deliver 30 compressions to 2 breaths when using an OPA/oral airway. Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn
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Hypoxia is one of the easiest Hs in our H & T reversible causes of cardiac arrest to identify and treat. Patients that are found to be hypoxic as indicated by an accurate pulse ox less than 90% should be administered oxygen to prevent an arrest. Use of pulse oximeter and blood gasses to monitor blood oxygen levels. Correcting hypoxia once a patient has coded. Use of end tidal waveform capnography to measure effective CPR. The danger of over ventilating a patient in cardiac arrest. Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn
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Generally speaking, a rate of 150 or more differentiates SVT from sinus tachycardia. Most patients with a heart rate less than 150 will not require intervention. The treatment provided for patients in SVT depaends if they are stable or unstable. The same criteria for determining if a patient is unstable is used for tachycardia and bradycardia so commit these to memory. The treatment for unstable SVT is delivery of a synchronized shock/cardioversion. What to consider regarding sedation prior to cardioversion and other safety concerns. Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn
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1 mg of 1:10,000 epinephrine rapid IV push is the first medication we give to patients in cardiac arrest. When we give the first dose of epi depends on the patient's ECG rhythm. Epi administration for patients in non-shockable rhythms PEA and asystole. Epinephrine administration for patients in shockable rhythms V-Fib and pulseless V-Tach. Frequency of epinephrine administration, alternative routes, and maximum dose during CPR. Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn
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Patients that fail one of the FAST stroke assessments have a 72% of having a stroke. We should assume a stroke unless our assessment identifies another condition that could be causing the symptoms. Three common conditions that present like a stroke and are easy to assess for include: blood sugar problems (hypo/hyperglycemia); hypoxia; and seizures.
Assessment of patients with stroke-like symptoms should include checking an O2 saturation and blood sugar using a pulse oximeter and glucometer. Other conditions can also mimic a stroke and require advanced testing. EMS providers should consider transporting patients with stroke symptoms to a stroke center following their local protocols. Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn
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Establishing a large-bore IV is near the top of every ACLS algorithm. But, what should we do if an IV can't be started? As an alternative to an IV, medications may be administered via intraosseous (IO) or endotracheal tube (ETT) route. Advantages and placement of IO for fluids and medication administration when an IV cannot be established. The use of endotracheal tube as an alternative when IV and IO access has not yet been established. Using NAVEL to remember the ACLS medications that can be administered down the ET tube. Disadvantages of ETT as a route for medication administration. Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn
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When you review the chain of survival for a cardiac emergency or a stroke outside of the healthcare setting you will notice some similarities. At the start is preparedness & recognition of the emergency, followed by activation of EMS, delivery of Advanced Life Support, and transporting to the most appropriate facility. In a heart attack or stroke, time is heart or brain cells. What are ALS ambulances and what care do paramedics provide in the field. What the research says about EMS bypassing a close hospital in favor of a one with 24/7 CT, PCI, & EVT capabilities. For a more detailed discussion on EMS destination protocols, check out the pod resource page for a link to two EMS On Air podcast episodes that explore patient outcomes in the rural vs urban setting. Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn
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The most common rhythm a patient is in during the first few minutes of cardiac arrest is V-Fib. Performing good CPR and delivering a shock as soon as possible to patients with a shockable rhythm gives us the best chance to convert a patient to a perfusing rhythm. The use of an AED can significantly decrease the time to deliver a shock when a monitor/defibrillator isn't available and can be used by rescuers with minimal training. Review BLS steps for patients found unconscious. Tips for safely using an AED. Tip for purchasing an AED - keep interchangeability in mind. Contraindications for use of an AED. Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn
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For patients without a pulse and V-Fib or V-Tach on the ECG, we will perform high quality CPR with minimal interruptions and go down the left side of ACLS's Adult Cardiac Arrest algorithm. If the patient shows pulseless electrical activity (PEA) or asystole on the ECG, we will go down the right side of the algorithm. Key points of the PEA/Asystole algorithm include: uninterrupted, high-quality CPR; establishing IV access; administration of epinephrine; consideration & treatment of reversible causes Hs & Ts; and placement of an advanced airway.
For patients in asystole, when we should discuss calling the code. Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn
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The American Heart Association CPR guidelines call for fast & deep compressions to be delivered at a rate of 100-120 per minute. Some AED or monitor/defibrillators have a built-in metronome. For others, doing compressions along with a song is helpful. To be effective, the song must have a constant tempo of 100-120 BPM and no long pauses. The American Heart Association (AHA) has a CPR playlist on Spotify: https://open.spotify.com/playlist/2mU2FNAhSOtQwW0hBgQMaK (https://open.spotify.com/playlist/2mU2FNAhSOtQwW0hBgQMaK) Example songs and pros & cons of using songs during a code are discussed. Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn
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There is a plethora of reasons to obtain at least a brief medical history. The patient’s history will help us identify things that may be causing (or contributing) to their current condition as well as guide our decisions so we provide the safest care possible. Knowing the patient's history allows care providers to make informed decisions. Knowing the events that led to an event can assist in identifying H & T reversible causes. A patient's current medications and allergies is needed to safely administer ACLS medications. SAMPLE PQRST is one memory aid to help us obtain a thorough medical history. Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn
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Magnesium can be given for a variety of medical conditions. For the purposes of ACLS, there are two primary indications for its use: torsades de pointes; and hypomagnesemia.
Identifications of torsades on the ECG. Administration of magnesium to stable patients with polymorphic V-tach. Procainamide is used in ACLS for stable patients with monomorphic, wide-complex tachycardia. Administration of Procainamide drip. When we should stop a Procainamide infusion. Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn
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Hypovolemia is one of the Hs in our H & T reversible causes of cardiac arrest. Hypovolemia may result from any severe fluid loss. Causes of hypovolemia from blood or other severe fluid loss. Signs of hypovolemic shock that may be present prior to a cardiac arrest. Treatment of hypovolemia via administration of crystalloid IV fluids and blood. Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn
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Morphine is a relatively safe medication used in ACLS's Acute Coronary Syndrome (ACS) algorithm. Morphine should be considered for patients with severe ischemic chest pain that is unresolved after the safe administration of Aspirin, oxygen, and nitroglycerine. In the treatment of patients with suspected myocardial ischemic pain, Morphine is useful for two reasons: its analgesic effect; and its vasodilation effect.
Patient's pain level, blood pressure, and respiratory status should be evaluated before and after each administration of morphine. Unlike nitro, morphine can be used safely on patients taking PDE inhibitors. Morphine dosage and administration. Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn
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Studies in the early 2010’s correlated CPR compressions to coronary perfusion pressures and improved outcomes as measured by Return of Spontaneous Circulation (ROSC) and survival to discharge. Minimizing interruptions to chest compressions so that we can maintain a chest compression fraction (CCF) of at least 80% is the first indicator of high-quality CPR that was identified in the 2012 AHA’s CPR Quality Summit followed by : Chest compression rate of 100-120 per minute; Chest compression depth of at least 5 cm; Allowing for full chest recoil during diastole; and Providing Adequate ventilations.
Three tips to aid us in achieving an 80% CCF. Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn
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Epinephrine and Dopamine are common medications used in ACLS Epinephrine is used to prevent cardiac arrest, during cardiac arrest, and post arrest. Epinephrine use in anaphylaxis and symptomatic bradycardia to prevent cardiac arrest as well as its use during CPR and post-arrest after ROSC. Actions of epi and precautions for its use in patients with myocardial ischemia. Dopamine is indicated for treatment of symptomatic bradycardia and hypotension after ROSC. The effects of dopamine are dose dependent. We must not exceed the maximum dose of 20 mcg/kg/min. Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn
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Rescue breathing is provided when a patient isn't breathing but does have a palpable pulse. The use of supplemental oxygen and end tidal waveform capnography when delivering artificial ventilations with a BVM. BLS chest compression to breaths ratio for patients in cardiac arrest. Complications of delivering breaths too rapidly. Compression to breath ratio after placement of an advanced airway, such as an endotracheal tube or LMA. Use of ETCO2 waveform capnography monitoring to: Confirm placement of an advanced airway; Monitor the effectiveness of CPR; and Determination of ROSC.
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When a person's core temperature drops below 96.8 F (36 C) they are hypothermic. Hypothermia is further classified as moderate or sever as the patient's temperature falls below 34 C and 30 C respectively. Patients with hypothermia are not dead until they are warm & dead! There are documented cases of prolonged down times greater than 30 minutes where patients were successfully resuscitated and discharged home with little to no neurological deficiency. ACLS guidelines for the treatment of cardiac arrest patients with severe hypothermia. ACLS guidelines for the treatment of cardiac arrest patients with moderate hypothermia. The danger of passively rewarming patients with severe hypothermia. Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn
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Along with Sodium, Potassium, and Magnesium; Calcium is one of the ions that move across the cellular membrane during cardiac contraction and relaxation. ACLS's indications for use of calcium channel blockers is limited to stable tachycardias refractory to vagal maneuvers and Adenosine. There are several calcium channel blockers available so providers need to be familiar with their organization's preferred choice. Contraindications for use. Calcium channel blocker's effects on the heart and blood vessels. Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn
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After establishing return of spontaneous circulation (ROSC) we should assess the patient's O2, CO2, blood pressure, and level of consciousness to guide our next actions. Oxygen and CO2 is maintained by small adjustments to the FiO2, tidal volume, and ventilation rate. Small changes can have big effects so this is best left to respiratory (if you have them) and requires close monitoring. Blood pressure may be affected by administration of a fluid bolus or use of pressor medications such as Dopamine or an Epinephrine drip. Pressors should be started at the lowest suggested dose and titrated up until a systolic BP of 90 mmHg. If, after ensuring O2, CO2, and BP; the patient can't obey simple commands we should start targeted temperature management for 24 hours. CT, MRI, & PCI can be done while patients are being cooled. Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn
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Nitroglycerine (NTG) is part of the MONA interventions for use in the Acute Coronary Syndrome algorithm. Nitro is indicated for use in normotensive patients experiencing ischemic cardiac pain. Nitroglycerine is contraindicated in hypotensive patients and those taking PDE inhibitors. Assessment for safe administration of NTG and its precautions. Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn Good luck with your ACLS class!
Atrial fibrillation (A-Fib) and atrial flutter (A-Flutter) are conditions where the stimulus for atrial contraction is above the ventricles but isn't the SA node. Identifying ECG characteristics of A-Fib and A-Flutter. A-Fib & A-Flutter may result in a rapid ventricular response (RVR) resulting in a heart rate greater than 150, putting us in the tachycardia algorithm. Treatment of unstable A-Fib or Flutter patients is delivery of a synchronized shock. Treatment of stable patients with narrow complex tachycardia including: Adenosine, calcium channel blockers, and beta blocker medications. Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn
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As an ACLS provider you do not need to be familiar with all of the different signs of various types of poisoning. You should be able to obtain a history and know to order toxicology. The majority of toxins don’t have specific antidotes. An algorithm for administration of Narcan for suspected opioid overdose is now included with your quick reference cards. These are some other poisons for which a treatment may be available with medications commonly stocked on crash carts or in EMS med bags. If you suspect a toxin as a cause and aren't sure if there's an antidote or treatment, ask a team mate or call poison control for direction. Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn
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The ACLS algorithms are designed to make it easier to remember the key interventions we should deliver, and the order in which they should be delivered, to provide the best evidence-based care possible. The 6 ACLS algorithms that are most frequently used include: Acute Coronary Syndrome or ACS; Stroke; Bradycardia; Tachycardia; Adult Cardiac Arrest; and Return of Spontaneous Circulation or Post Arrest.
If there’s a change in a patient’s condition, we should ensure we’re using the correct algorithm. Example ACLS mega code scenario with treatment interventions and rationale. Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn
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For ACLS, beta blockers are medications that block the effects of epinephrine & norepinephrine in the body. Beta receptors are found throughout the body. Beta 1 affects the heart while beta 2, the lungs. Beta blocking medications are considered for use in the ACS and stable tachycardia algorithms after MONA and Adenosine respectively. Side effects of use include bradycardia and slowed conduction through the AV node (heart block). Contraindications for use of beta blockers. Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn
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