ALS Insights – Life Support Institute of Australia

Your patient has an implanted defibrillator, and mid-code, it starts firing. Is it working? Is it safe to keep your hands on the chest? And what do you actually do about it?

In this episode, we break down what's really happening when an ICD fires during CPR — including a documented case where a device fired repeatedly on a rhythm that was actually asystole the whole time, because chest compressions can generate artifact these devices aren't built to filter out.

We cover:

• Why the device firing tells you nothing reliable about the underlying rhythm
• Whether it's actually safe to keep touching the patient (yes — and here's why)
• The magnet trick: when it works, and when it doesn't
• ANZCOR's guidance on pad placement if you need to defibrillate externally
• The moment repeated shocks with no result should make you stop trusting the device and start hunting the 4 Hs and 4 Ts

Whatever the ICD is doing — firing, staying silent, firing on a loop — the algorithm doesn't change. This episode explains why, and what to actually do with the device itself.

Read the full companion article at lifesupportinstitute.com.au

ANZCOR-aligned. Part of the ALS Insights series from Life Support Institute of Australia.

Should every patient go to the cath lab after cardiac arrest? "Rush everyone" is the wrong answer — and this episode explains why.

We walk through the post-ROSC coronary decision: considering ACS in every post-arrest patient, how the 12-lead ECG drives it, immediate angiography for ST-elevation, and what the COACT and TOMAHAWK trials showed for patients without ST-elevation — plus the high-risk features that still warrant urgent cath.

ANZCOR-aligned reasoning for paramedics, nurses and doctors.

Read the companion article (with references): https://lifesupportinstitute.com.au/blog/cath-lab-after-cardiac-arrest

Full online ALS course (10 CPD hours): https://lifesupportinstitute.com.au

In pre-arrest arrhythmia management, one clinical question sits above all others — and your answer to it determines whether you have time to think or need to act right now.

In this episode we break down the haemodynamic stability assessment: what "unstable" actually means in an ALS algorithm (it's narrower than most clinicians assume), the four adverse features that define it, and why getting this distinction right stops you from either under-treating a deteriorating patient or over-treating a stable one who just needs time and a 12-lead.

We also cover the "symptomatic vs unstable" trap — one of the most common sources of clinical confusion in pre-arrest arrhythmia management — and walk through how the ABCD assessment anchors every decision that follows.

This episode pairs with our blog article Defining Haemodynamic Stability: The Critical Decision Point in Australian Cardiac Care at lifesupportinstitute.com.au/blog/stable-vs-unstable

One Cent Miracles: How Aspirin Matched the Power of Clot Busters

In emergency medicine, some of the most powerful interventions don’t come from expensive drugs or high-tech equipment — they come from a simple pill that costs cents.

In this episode we dive into the landmark ISIS-2 trial that changed cardiology forever. Aspirin alone reduced mortality by 23% — nearly matching the powerful clot-buster streptokinase. When used together, they delivered a remarkable 42% reduction in deaths.

We break down:

• How aspirin stops platelets from clumping and worsening a heart attack
• Why it remains a Grade A recommendation in ANZCOR and ARC guidelines
• The correct 300mg dose and why it should be chewed
• When not to give aspirin

A powerful reminder that great medicine isn’t always complicated — it’s about doing the simple things right, at the right time.

Essential listening for paramedics, emergency nurses, and doctors.

Why You Should Stop Using Pulse Checks to Gauge CPR Quality

In the middle of a cardiac arrest, it’s tempting to reach for a pulse to see if your compressions are working. But what if that reassuring pulse you feel isn’t what you think it is?

In this episode, we explore why manual pulse checks during CPR are often unreliable. Evidence shows they can be misleading in up to 50% of cases, frequently detecting retrograde venous pulsations rather than true arterial flow. This false confidence can lead teams to unintentionally ease off on compression quality when it matters most.

We break down:

• Why ANZCOR no longer recommends pulse checks as a measure of CPR quality
• The superiority of waveform capnography (ETCO2) for monitoring resuscitation effectiveness
• How a sudden rise in ETCO2 is one of the best early signs of ROSC
• Practical team strategies to maintain high-quality CPR without unnecessary interruptions

If you’ve ever paused or adjusted compressions based on a pulse check, this episode will change how you approach resuscitation forever.

Listen now for clear, ANZCOR-aligned insights you can apply on your very next shift.

#CPR #PulseCheck #ETCO2 #Capnography #ALS #Resuscitation #ANZCOR #FOAMed #AdvancedLifeSupport

Adrenaline (epinephrine) is a key drug in ANZCOR-aligned ALS for cardiac arrest — but what's really happening? Its alpha-adrenergic effects cause vasoconstriction, boosting coronary and cerebral perfusion to improve ROSC chances. The beta-adrenergic side ramps up heart rate and contractility... which can spike myocardial oxygen demand and contribute to poorer neurological outcomes in survivors.

We cover the basics: standard 1 mg dosing, timing in shockable rhythms, and why evidence shows ROSC gains but often no long-term neuro benefit — or even risks. Quick, practical insights for paramedics, nurses, and doctors.

Is induced hypothermia dead? In this episode, we dive into the shifting paradigm of Advanced Life Support (ALS) post-resuscitation care. Following the TTM-2 trial and updated ILCOR/ANZCOR guidelines, the focus has shifted from deep therapeutic hypothermia (32–34°C) to strict fever prevention and targeted normothermia (36°C) for comatose post-cardiac arrest patients. We discuss the evidence, the dangers of over-cooling, and how to implement effective post-arrest care to improve neurological outcomes. 

Topics Covered:

• Why the "cool everything" approach failed.
• Targeted Temperature Management (TTM) vs. Therapeutic Hypothermia.
• Fever prevention as the new standard (≤37.5°C).
• Management of shivering and rewarming strategies. 

Episode 4 of ALS Insights: now we bring it all together with the One-Stop Shock Protocol – the advanced, ANZCOR-aligned team flow that minimizes interruptions and delivers the shock safely and fast. Builds directly on Episodes 1–3 (high-quality CPR, AED mechanics, shock physiology) to show how to integrate rhythm analysis, clear commands, hands-off safety, and immediate post-shock CPR. Perfect for paramedics, nurses, and rural/remote teams wanting seamless arrest management. From Life Support Institute – flexible online ALS course (10 CPD hours, personalised certificate, study from anywhere). Enrol at lifesupportinstitute.com.au.

Episode 3 of ALS Insights: a deeper physiological look at why AED shocks actually stop the heart during VF/pulseless VT. Explains ion channel effects, depolarization, critical mass theory, and how stopping chaotic rhythm allows the SA node to restart. ANZCOR-aligned insights for paramedics, nurses, and doctors. Builds on Episode 2's mechanics with more science. From Life Support Institute – flexible online ALS course (10 CPD hours, personalised certificate, study from anywhere). Enrol at lifesupportinstitute.com.au.