Episodi
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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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Episodi mancanti?
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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.
Connect with me:
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Your support helps cover the monthly cost of software and podcast & website hosting so that others can benefit from these ACLS tips as well. Donations via Buy Me a Coffee at https://buymeacoffee.com/paultaylor are appreciated.
Good luck with your ACLS class!
Discover medical podcasts with CE at https://conveymed.io
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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.
Connect with me:
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Other Pass ACLS episodes mentioned:
Objective Measures of Good CPR at https://passacls.com/bls/objective-measures-of-good-cpr
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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.
Connect with me:
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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; andPractice 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.
Connect with me:
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Your support helps cover the monthly cost of software and podcast & website hosting so that others can benefit from these ACLS tips as well. Donations via Buy Me a Coffee at https://buymeacoffee.com/paultaylor are appreciated.
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Practice ECGs at Dialed Medics: https://dialedmedics.com/
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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.
Connect with me:
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Your support helps cover the monthly cost of software and podcast & website hosting so that others can benefit from these ACLS tips as well. Donations via Buy Me a Coffee at https://buymeacoffee.com/paultaylor are appreciated.
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.
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Give Back & Help Others:
Your support helps cover the monthly cost of software and podcast & website hosting so that others can benefit from these ACLS tips as well. Donations via Buy Me a Coffee at https://buymeacoffee.com/paultaylor are appreciated.
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.
Connect with me:
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Your support helps cover the monthly cost of software and podcast & website hosting so that others can benefit from these ACLS tips as well. Donations via Buy Me a Coffee at https://buymeacoffee.com/paultaylor are appreciated.
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.
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 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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Your support helps cover the monthly cost of software and podcast & website hosting so that others can benefit from these ACLS tips as well. Donations via Buy Me a Coffee at https://buymeacoffee.com/paultaylor are appreciated.
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 80% or more.
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Good luck with your ACLS class!
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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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Your support helps cover the monthly cost of software and podcast & website hosting so that others can benefit from these ACLS tips as well. Donations via Buy Me a Coffee at https://buymeacoffee.com/paultaylor are appreciated.
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 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:
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Your support helps cover the monthly cost of software and podcast & website hosting so that others can benefit from these ACLS tips as well. Donations via Buy Me a Coffee at https://buymeacoffee.com/paultaylor are appreciated.
Good luck with your ACLS class!
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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:
1. Automated External Defibrillator (AED);
2. Biphasic defibrillators; and
3. 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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Your support helps cover the monthly cost of software and podcast & website hosting so that others can benefit from these ACLS tips as well. Donations via Buy Me a Coffee at https://buymeacoffee.com/paultaylor are appreciated.
Good luck with your ACLS class!
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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.
Connect with me:
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Give Back & Help Others:
Your support helps cover the monthly cost of software and podcast & website hosting so that others can benefit from these ACLS tips as well. Donations via Buy Me a Coffee at https://buymeacoffee.com/paultaylor are appreciated.
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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Good luck with your ACLS class!
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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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Your support helps cover the monthly cost of software and podcast & website hosting so that others can benefit from these ACLS tips as well. Donations via Buy Me a Coffee at https://buymeacoffee.com/paultaylor are appreciated.
Good luck with your ACLS class!
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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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Your support helps cover the monthly cost of software and podcast & website hosting so that others can benefit from these ACLS tips as well. Donations via Buy Me a Coffee at https://buymeacoffee.com/paultaylor are appreciated.
Good luck with your ACLS class!
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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; andadministration 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.
Connect with me:
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Your support helps cover the monthly cost of software and podcast & website hosting so that others can benefit from these ACLS tips as well. Donations via Buy Me a Coffee at https://buymeacoffee.com/paultaylor are appreciated.
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