Pass ACLS Tip of the Day

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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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.<...

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...

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...

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.<...

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...

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...

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.

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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.

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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...

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...

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...

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...

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 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 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...

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 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...

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...

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...

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...

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 should bypass a...

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.

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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...

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 s...

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 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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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.

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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.

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.

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