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...

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...

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: ...

Although magnesium can be used in the treatment of other medical conditions such as eclampsia, asthma, & digitalis toxicity; for ACLS, magnesium is primarily used to treat Torsades de Pointes. 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...

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. Connect with me: Website:  https://passacls.com @PassACLS on X (formally known as Twitter) @Pass-ACLS-Podcast on LinkedIn Give back - buy Paul a bubble tea...

MONA is the acronym sometimes used to help us remember the interventions to consider for patients with Acute Coronary Syndrome or ACS. 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. Morphine as an alternative to nitro for patients with chest pain that take PDE inhibitors. Common dosing & administration of Morphine. Monitoring of the patient's...

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 in order of importance include: Chest compression fraction (CCF);Chest compression rate; Chest compression depth; Allowing for full recoil; andAdequate ventilations. Using real-time feedback devices and ETCO2 to assess CPR quality. Three tips to limit pauses in CPR compressions to 10 seconds or less. Limiting...

Epinephrine and Dopamine are adrenergic agonist used in several ACLS algorithms. The use of epinephrine for severe anaphylaxis or unstable bradycardia. Review epinephrine’s effects on blood vessels and bronchioles. Why epinephrine is helpful for patients with anaphylaxis. Using an epi drip for unstable bradycardia. Epinephrine administration during cardiac arrest. Starting and epinephrine or Dopamine drip for patients that have ROSC. Review the effects of Dopamine based on mcg/kg/min...

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. Connect with...

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...

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...

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....

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...

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...

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...

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...

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...

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...

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...

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...

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: Website: ...

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; and Practice 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...

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...

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...