Episodi
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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.
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 made via Buy Me a Coffee at https://buymeacoffee.com/paultaylor are appreciated.
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Good luck with your ACLS class!
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Episodi mancanti?
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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.
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 made via Buy Me a Coffee at https://buymeacoffee.com/paultaylor are appreciated.
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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 made via Buy Me a Coffee at https://buymeacoffee.com/paultaylor are appreciated.
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Good luck with your ACLS class!
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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 common ACLS antiarrhythmics in more detail and another covering Brugata Criteria used to differentiate V-Tach from SVT with an aberrancy, can be found on 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 made via Buy Me a Coffee at https://buymeacoffee.com/paultaylor are appreciated.
Make a difference in the fight against breast cancer by donating to my Men Wear Pink fundraiser for the American Cancer Society (ACS) at http://main.acsevents.org/goto/paultaylor Every dollar helps in the battle with breast cancer.
Good luck with your ACLS class!
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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 is to ask a series of questions such as:
What's the rate (<60, 60-100, 101-149, or >150);
Is the rhythm regular or irregular;
What's the shape, width, and frequency of P waves and QRS complexes; and
What's the P-R interval and is it constant?
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 patients with a second-degree type II AV block.
Treatment of unstable bradycardic patients refractory to Atropine using TCP, Dopamine, or Epinephrine drip.
Starting dose and titration of Dopamine and Epinephrine drips.
Connect with me:
Website: https://passacls.com
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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 made via Buy Me a Coffee at https://buymeacoffee.com/paultaylor are appreciated.
Make a difference in the fight against breast cancer by donating to my Men Wear Pink fundraiser for the American Cancer Society (ACS) at http://main.acsevents.org/goto/paultaylor Every dollar helps in the battle with breast cancer.
Good luck with your ACLS class!
The Curious Clinicians: History of Doctor Wenckebach & Mobitz
https://curiousclinicians.com/2022/07/06/episode-52-way-back-wenckebach/
Practice ECGs with rationale at Dialed Medics:
https://dialedmedics.com/
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When treating patients with Acute Coronary Syndrome (ACS), MONA is an acronym sometimes used to help us remember the initial interventions.
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 PassACLS.com
Connect with me:
Website: https://passacls.com
@Pass-ACLS-Podcast on LinkedIn
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 made via Buy Me a Coffee at https://buymeacoffee.com/paultaylor are appreciated.
Make a difference in the fight against breast cancer by donating to my Men Wear Pink fundraiser for the American Cancer Society (ACS) at http://main.acsevents.org/goto/paultaylor Every dollar helps in the battle with breast cancer.
Good luck with your ACLS class!
Check out ConveyMed.io for more free online medical education (FOAMed) opportunities.
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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.
How do we know if high quality, effective CPR is being performed?
Objective measures of high-quality CPR include:
Compression rate; Compression depth & recoil; ETCO2; and Chest Compression Fraction (CCF).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)
A no-tech way to monitor effective CPR if no compression feedback device or ETCO2 capnography isn’t available.
Connect with me:
Website: https://passacls.com
@Pass-ACLS-Podcast on LinkedIn
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 made via Buy Me a Coffee at https://buymeacoffee.com/paultaylor are appreciated.
Make a difference in the fight against breast cancer by donating to my Men Wear Pink fundraiser for the American Cancer Society (ACS) at http://main.acsevents.org/goto/paultaylor Every dollar helps in the battle with breast cancer.
Good luck with your ACLS class!
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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 hypotension.
The use of Atropine and Dopamine in patients with myocardial ischemia.
Podcasts with additional (advanced-provider level) information about bradycardia, Atropine, & Dopamine can be found on the Pass ACLS Pod Resources page.
Connect with me:
Website: https://passacls.com
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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 made via Buy Me a Coffee at https://buymeacoffee.com/paultaylor are appreciated.
Make a difference in the fight against breast cancer by donating to my Men Wear Pink fundraiser for the American Cancer Society (ACS) at http://main.acsevents.org/goto/paultaylor Every dollar helps in the battle with breast cancer.
Good luck with your ACLS class!
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The tongue is the most common airway obstruction in an unconscious patient.
Insertion an oropharyngeal airway helps keep the patient’s tongue from falling to the back of the pharynx, causing an airway obstruction.
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's too small or too large.
Two techniques to properly insert an OPA.
The use of an oral airway during CPR.
The use of an OPA as a bite block after a patient has an advanced airway placed.
Connect with me:
Website: https://passacls.com
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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 made via Buy Me a Coffee at https://buymeacoffee.com/paultaylor are appreciated.
Make a difference in the fight against breast cancer by donating to my Men Wear Pink fundraiser for the American Cancer Society (ACS) at http://main.acsevents.org/goto/paultaylor Every dollar helps in the battle with breast cancer.
Good luck with your ACLS class!
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Hypoxia is a state of low oxygen levels in the blood.
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 we should not rely on pulse ox to give accurate readings during CPR.
Delivering ventilations with near 100% oxygen concentration using a BVM attached to supplemental O2 and a reservoir.
Using end tidal waveform capnography to assess the quality of CPR.
Changes to ventilation rates, tidal volume, and O2 concentration affects a patient's oxygen, carbon dioxide, and pH.
The danger of excessive ventilation of a patient in cardiac arrest.
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 made via Buy Me a Coffee at https://buymeacoffee.com/paultaylor are appreciated.
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Good luck with your ACLS class!
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ECG characteristics of supraventricular tachycardia (SVT) vs. sinus tachycardia.
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 FOAMed on narrow complex tachycardias, check out the pod resource page at passacls.com.
Connect with me:
Website: https://passacls.com
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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 made via Buy Me a Coffee at https://buymeacoffee.com/paultaylor are appreciated.
Make a difference in the fight against breast cancer by donating to my Men Wear Pink fundraiser for the American Cancer Society (ACS) at http://main.acsevents.org/goto/paultaylor Every dollar helps in the battle with breast cancer.
Good luck with your ACLS class!
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When working to resuscitate a patient in sudden cardiac arrest, Epinephrine is the first IV medication we administer.
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 for patients in V-Fib or pulseless V-Tach following the left side of the Adult Cardiac Arrest algorithm.
Example chronology of events for a scenario where a patient is found unresponsive with only gasping/agonal breathing.
Administration of epi via the IO or endotracheal route in the absence of an IV.
The maximum cumulative dose of epinephrine that can be administered to patients in cardiac arrest.
When do we stop administering epinephrine.
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 made via Buy Me a Coffee at https://buymeacoffee.com/paultaylor are appreciated.
Make a difference in the fight against breast cancer by donating to my Men Wear Pink fundraiser for the American Cancer Society (ACS) at http://main.acsevents.org/goto/paultaylor Every dollar helps in the battle with breast cancer.
Good luck with your ACLS class!
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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 using a pulse oximeter.
Some seizures, electrolyte imbalance, sepsis, brain tumors, and Bell’s Palsy can also mimic a stroke.
Prehospital providers should transport suspected stroke patients to a stroke center following their local protocols.
Hospital providers should active their stroke team to ensure rapid assessment and treatment.
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 made via Buy Me a Coffee at https://buymeacoffee.com/paultaylor are appreciated.
Make a difference in the fight against breast cancer by donating to my Men Wear Pink fundraiser for the American Cancer Society (ACS) at http://main.acsevents.org/goto/paultaylor Every dollar helps in the battle with breast cancer.
Good luck with your ACLS class!
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Most ACLS medications are given IV push. But, what happens if we can't get an IV?
Why IO is better than ETT as an alternative route.
The locations we should place an IO when running a code and a location we should avoid.
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 medications that can be given down the tube and how they should be given.
Medications should not be given down the tube when anything other than an endotracheal tube is used as an advanced airway.
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 made via Buy Me a Coffee at https://buymeacoffee.com/paultaylor are appreciated.
Make a difference in the fight against breast cancer by donating to my Men Wear Pink fundraiser for the American Cancer Society (ACS) at http://main.acsevents.org/goto/paultaylor Every dollar helps in the battle with breast cancer.
Good luck with your ACLS class!
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The chain of survival for a cardiac emergency and stroke start the same:
1. preparedness & recognition of an emergency;
2. activation of EMS;
3. delivery of Advanced Life Support; and
4. transporting to the most appropriate facility.
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:
point of first medical contact to PCI for ST elevation MI;door to tPA for ischemic stroke; andonset of symptoms to EVT for LVO strokes.Why EMS should bypass a close hospital to transport a STEMI or suspected stroke patient to a hospital capable of 24/7 PCI or a certified stroke center.
Check out the Pod Resource page at passacls.com for links to the "EMS On Air" podcast for links to episodes that look at EMS's role in stroke outcomes in the rural vs urban area.
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 made via Buy Me a Coffee at https://buymeacoffee.com/paultaylor are appreciated.
Make a difference in the fight against breast cancer by donating to my Men Wear Pink fundraiser for the American Cancer Society (ACS) at http://main.acsevents.org/goto/paultaylor Every dollar helps in the battle with breast cancer.
Good luck with your ACLS class!
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Performing good CPR and delivering a shock as soon as possible to a patient in Ventricular Fibrillation or pulseless V-Tach are the two most critical interventions that have been shown to increase survival from sudden cardiac arrest.
Studies have demonstrated significantly better out-of-hospital cardiac arrest survival outcomes in communities with robust public CPR training and public access/first responder AEDs.
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.
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 made via Buy Me a Coffee at https://buymeacoffee.com/paultaylor are appreciated.
Make a difference in the fight against breast cancer by donating to my Men Wear Pink fundraiser for the American Cancer Society (ACS) at http://main.acsevents.org/goto/paultaylor Every dollar helps in the battle with breast cancer.
Good luck with your ACLS class!
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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 alive.
Epinephrine administration.
Placement of an advanced airway.
Considering possible reversible H & T causes of cardiac arrest including three common causes of PEA and their emergent interventions.
When we should discontinue resuscitation efforts and call the code.
Connect with me:
Website: https://passacls.com
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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 made via Buy Me a Coffee at https://buymeacoffee.com/paultaylor are appreciated.
Make a difference in the fight against breast cancer by donating to my Men Wear Pink fundraiser for the American Cancer Society (ACS) at http://main.acsevents.org/goto/paultaylor Every dollar helps in the battle with breast cancer.
Good luck with your ACLS class!
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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) with a tempo of 100 to 120 beats per minute to help the person doing chest compressions maintain an adequate rate.
Characteristics of good songs that will help us.
Advantages & disadvantages of using a song during CPR.
Selected songs from various genres and time periods from AHA's "Don’t Drop The Beat" playlist on Spotify. (https://open.spotify.com/playlist/2mU2FNAhSOtQwW0hBgQMaK)
Connect with me:
Website: https://passacls.com
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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 made via Buy Me a Coffee at https://buymeacoffee.com/paultaylor are appreciated.
Make a difference in the fight against breast cancer by donating to my Men Wear Pink fundraiser for the American Cancer Society (ACS) at http://main.acsevents.org/goto/paultaylor Every dollar helps in the battle with breast cancer.
Good luck with your ACLS class!
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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 format.
Connect with me:
Website: https://passacls.com
@Pass-ACLS-Podcast on LinkedIn
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 made via Buy Me a Coffee at https://buymeacoffee.com/paultaylor are appreciated.
Make a difference in the fight against breast cancer by donating to my Men Wear Pink fundraiser for the American Cancer Society (ACS) at http://main.acsevents.org/goto/paultaylor Every dollar helps in the battle with breast cancer.
Good luck with your ACLS class!
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