Pass ACLS Tip of the Day

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 a stroke, more minutes equals more dead brain 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 steps in the Stroke Chain of Survival.

Stroke benchmarks for door to:

Review the indications, dosing, & administration of Adenosine for patients in supraventricular tachycardia (SVT) following ACLS's Tachycardia algorithm.

Common causes of tachycardia.

Symptoms indicating a stable vs unstable patient.

Adenosine is the first IV medication given to stable patients with sustained supraventricular tachycardia (SVT) refractory to vagal maneuvers.

Cardiac effects of Adenosine.

Indications for use in the ACLS Tachycardia algorithm.

Considerations and contraindications.

Dosing and administration.

Adenosine as a diagnostic for patients in A-Fib or A-Flutter with RVR.

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Identifying the characteristics of second-degree AV blocks on an ECG 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).

ECG characteristics of a second-degree Mobitz type II.

Identification of unstable bradycardia and treatment with Atropine.

Possible effect of using Atropine on patients with a second-degree...

Review the indications for oxygen administration and monitoring O2 saturation with pulse oximetry for patients in various ACLS algorithms.

In the ACS algorithm, the O in MONA is Oxygen.

When we should administer oxygen to ACS, bradycardia, & tachycardia patients.

When O2 administration is unnecessary based on an accurate pulse ox.

Monitoring patient's oxygen saturation (SpO2) using a pulse oximeter.

Review two common ACLS pre-arrest mega code scenarios.

Oxygen administration during CPR and post cardiac arrest.

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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)

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Review the 2025 ACLS guidelines for Atropine and Dopamine in 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 dose and maximum for bradycardia.

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...

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.

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Tips for ACLS providers to consider when evaluating hypoxia as a possible cause of cardiac arrest and what we should 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 BV...

Review the ECG characteristics of sinus tachycardia & SVT and the treatment of unstable patients with cardioversion.

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.

For more free information on narrow complex tachycardias, check out the pod resource page at passacls.com.

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When we give the first dose of epinephrine to a patient in cardiac arrest. Epi’s dose, route, repeat frequency, & maximum dose following ACLS's Adult Cardiac Arrest algorithm.

Epinephrine is the first IV medication we administer to every patient 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 gi...

A brief review of some easily identifiable & treatable medical conditions that can mimic a stroke.

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.

Some seizures, electrolyte imbalance, sepsis, brain tumors, and Bell’s Palsy can also mimic a stroke.

Preh...

The pros and cons of ACLS medication administration via the intraosseous (IO) vs endotracheal tube (ETT) route when IV access can’t be established.

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 ACLS medications that can be gi...

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:

Why EMS sh...

Review the use of an AED including: indications & contraindications; connecting the device; administering a shock; and general safety considerations.

Why we should use an AED.

The general instructions for safe use of AED.

Following the Adult Cardiac Arrest algorithm while using an AED.

Contraindications to AED use.

General safety considerations to remember.

When we should discontinue resuscitation efforts and call the code.

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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 call the code.

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...

Many CPR classes use songs like "Stayin Alive" to help compressors maintain an adequate rate. Advantages, disadvantages, and a selection of CPR songs from the American Heart Association’s play list.

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 a rate of 100-120 per minute.

Characteristics of songs that will help us perform good CP...

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.

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 for stable patients with Torsades vs 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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Review of hypovolemia as a H&T reversable cause of cardiac arrest including: causes, signs & symptoms, and treatment.

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.

Common conditions other than bleeding that can cause hypovolemia.

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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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 re...

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.

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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 ef...

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...

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 cor...

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...

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!

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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!

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.

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.

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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!

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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.

Cont...