Pass ACLS Tip of the Day
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 three-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 a few weeks prior to your ACLS class will help cement the core concepts that have been shown to improve outcomes in patients suffering a heart attack...
Which ACLS Algorithm?
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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Beta Blockers
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...
Advanced Airways
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 yo...
Antiarrhythmic Use After ROSC
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...
Hydrogen Ions as a H&T Reversible Cause of Cardiac Arrest
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...
Adult Cardiac Arrest Code Flow
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...
Medication Review: Aspirin
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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First & Third Degree AV Blocks
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...
Lidocaine & Amiodarone Review
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...
Nasopharyngeal Airway (NPA) Review
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.
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Tamponade: An H&T Reversible Cause of Cardiac Arrest
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.
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Team Leader Role and Use of Quick Reference Cards
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.<...
Why Early CPR & Defibrillation is Important
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...
Quantitative Waveform Capnography
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...
Vagal Maneuvers
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.<...
Defibrillator Energy Settings
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...
Unstable Bradycardia
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...
Post-Arrest Care & Targeted Temperature Management (TTM)
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.
P...
The Stroke & Cardiac Chain of Survival
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
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Hypokalemia & Hyperkalemia as a H&T Reversible Cause
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...
Time Goals for Assessment & Treatment of Stroke
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.
St...
Medication Review: Adenosine
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...
Characteristics of Second-Degree AV Blocks and Their Treatment
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...
Oxygen Administration and SaO2 Monitoring
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...
Objective Measures of Good CPR
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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Bradycardia Dosing for Atropine & Dopamine
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...
Oropharyngeal Airway (OPA) Review
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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Hypoxia: An H&T Reversible Cause of Cardiac Arrest
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 BV...
Supraventricular Tachycardia (SVT)
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 pa...
Epinephrine Administration During Cardiac Arrest
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...
