In this episode, we unpack the 2025 ACLS medication updates from the American Heart Association and what they mean for real-world cardiac arrest care. Epinephrine remains the standard for improving short-term survival, but evidence is still limited when it comes to long-term neurological outcomes. Alternative vasopressors and high-dose strategies show no clear advantage and routine use of calcium, sodium bicarbonate, and magnesium is not recommended. We also explore the nuanced role of amiodarone and lidocaine in select shockable arrests. Above all, the guidelines reinforce what saves lives most: rapid defibrillation, high-quality CPR, and getting the basics right.