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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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:
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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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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
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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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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.
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Good luck with your ACLS class!
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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 determining whether magnesium or Procainamide should be used when treating stable patients with V-Tach.
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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 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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Good luck with your ACLS class!
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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 level of consciousness, pain, blood pressure, and respirations after administration.
Possible side effects of Morphine administration.
Narcan as an antidote to Morphine if needed.
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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 interruptions to chest compressions to less than 10 seconds so we can maintain a CCF of 80% requires teamwork and communication.
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Good luck with your ACLS class!
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Epinephrine and Dopamine are adrenergic agonist used in several ACLS algorithms.
The use of epinephrine for severe anaphylaxis and 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 dosing.
Monitoring the patient and titrating epi or Dopamine drips to prevent harm.
For more information on ACLS medications, check out the pod resource page at passacls.com.
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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 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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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 severe hypothermia.
Continuation of CPR and ACLS efforts until the patient’s body core temp is above 36 C.
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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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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 check out the pod resource 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.
Monitoring the patient’s core temperature during TTM.
Why we should cool unresponsive post-arrest patients.
Patients can undergo EEG, CT, MRI, & PCI while receiving TTM.
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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 home nitroglycerine.
Monitoring patient's pain and vital signs after nitro administration.
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!
- Visa fler
