Pass ACLS Tip of the Day
Like a daily 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 Flash Briefing-style episode covers one of the skills needed to recognize a stroke or cardiac emergency and work as a high-performing team to deliver quality care. Listening to a tip-of-the-day for 14-30 days prior to a class will help cement 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...
Rescue Breathing & CPR Ventilation Ratios
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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H&T Reversible Causes of Cardiac Arrest: Hypothermia
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 seve...
Medication Review: Calcium Channel Blockers
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...
Post-Arrest Care & Targeted Temperature Management (TTM)
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...
Nitroglycerine Use in ACLS
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 ho...
Atrial Fibrillation or Flutter with RVR
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 pa...
Tablets & Toxins: An H&T Reversible Cause of Cardiac Arrest
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 Asso...
When To Use Which ACLS Algorithm
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 repe...Beta Blocker Use in ACLS Algorithms
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 instance...
Advanced Airways
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...
