Pass ACLS Tip of the Day

Improved stroke outcomes have been shown when EMS transports to a stroke center and patients receive assessment, CT, & thrombolytics within these time frames.

When treating patients having a stroke, more minutes equals more dead brain 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 steps in the Stroke Chain of Survival.

Stroke benchmarks for door to:

• assessment;
• completing a non-contrast CT; and
• administration of a fibrinolytic medication (door-to-needle);
• endovascular therapy (EVT) of LVO strokes, and
• administration to a stroke or neuro unit (door-to-admission).

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.

Links:

Pass ACLS: Find ACLS classes near you and discover other podcasts with ACLS-related episodes. https://passacls.com/

Buy Me a Coffee: To give back. https://buymeacoffee.com/paultaylor

American Cancer Society: Fundraiser for breast cancer. Link is valid through October 31st. Together, we will beat cancer! https://secure.acsevents.org/goto/paultaylor

Safe Meds VIP: Patient-facing information about medication safety and a free drug discount card to save money on prescription medications for you and your pets.https://safemeds.vip

Review the indications, dosing, & administration of Adenosine for patients in supraventricular tachycardia (SVT) following ACLS's Tachycardia algorithm.

Common causes of tachycardia.

Symptoms indicating a stable vs unstable patient.

Adenosine is the first IV medication given to stable patients with sustained supraventricular tachycardia (SVT) refractory to vagal maneuvers.

Cardiac effects of Adenosine.

Indications for use in the ACLS Tachycardia algorithm.

Considerations and contraindications.

Dosing and administration.

Adenosine as a diagnostic for patients in A-Fib or A-Flutter with RVR.

Links:

Pass ACLS: Find ACLS classes near you and discover other podcasts with ACLS-related episodes. https://passacls.com/

Buy Me a Coffee: To give back. https://buymeacoffee.com/paultaylor

American Cancer Society: Fundraiser for breast cancer. Link is valid through October 31st. Together, we will beat cancer! https://secure.acsevents.org/goto/paultaylor

Safe Meds VIP: Patient-facing information about medication safety and a free drug discount card to save money on prescription medications for you and your pets.https://safemeds.vip

Identifying the characteristics of second-degree AV blocks on an ECG and the treatment of unstable bradycardia patients with them.

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.

ECG characteristics of a second-degree Mobitz type I (Wenckebach).

ECG characteristics of a second-degree Mobitz type II.

Identification of unstable bradycardia and treatment with Atropine.

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.

Links:

Pass ACLS: Find ACLS classes near you and discover other podcasts with ACLS-related episodes. https://passacls.com/

Buy Me a Coffee: To give back. https://buymeacoffee.com/paultaylor

American Cancer Society: Fundraiser for breast cancer. Link is valid through October 31st. Together, we will beat cancer! https://secure.acsevents.org/goto/paultaylor

Safe Meds VIP: Patient-facing information about medication safety and a free drug discount card to save money on prescription medications for you and your pets. https://safemeds.vip

The Curious Clinicians: History of Doctor Wenckebach & Mobitz. https://curiousclinicians.com/2022/07/06/episode-52-way-back-wenckebach/

Dialed Medics: Practice ECGs with rationale. https://dialedmedics.com/

Review the indications for oxygen administration and monitoring O2 saturation with pulse oximetry for patients in various ACLS algorithms.

In the ACS algorithm, the O in MONA is Oxygen.

When we should administer oxygen to ACS, bradycardia, & tachycardia patients.

When O2 administration is unnecessary based on an accurate pulse ox.

Monitoring patient's oxygen saturation (SpO2) 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

Links:

Pass ACLS: Find ACLS classes near you and discover other podcasts with ACLS-related episodes. https://passacls.com/

Buy Me a Coffee: To give back. https://buymeacoffee.com/paultaylor

American Cancer Society: Fundraiser for breast cancer. Link is valid through October 31st. Together, we will beat cancer! https://secure.acsevents.org/goto/paultaylor

Safe Meds VIP: Patient-facing information about medication safety and a free drug discount card to save money on prescription medications for you and your pets.https://safemeds.vip

Objective measures of high-quality CPR and how ACLS providers use waveform capnography and feedback devices to monitor effective chest compressions.

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.

Objective measures of high-quality CPR.

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)

Insertion of an advanced airway.

A no-tech way to monitor effective CPR if no compression feedback device or ETCO2 capnography isn’t available.

Links:

Pass ACLS: Find ACLS classes near you and discover other podcasts with ACLS-related episodes. https://passacls.com/

Buy Me a Coffee: To give back. https://buymeacoffee.com/paultaylor

American Cancer Society: Fundraiser for breast cancer. Link is valid through October 31st. Together, we will beat cancer! https://secure.acsevents.org/goto/paultaylor

Safe Meds VIP: Patient-facing information about medication safety and a free drug discount card to save money on prescription medications for you and your pets.https://safemeds.vip

LinkedIn: @Pass-ACLS-Podcast. https://www.linkedin.com/company/pass-acls-podcast/

Review the 2025 ACLS guidelines for Atropine and Dopamine in the treatment of unstable bradycardia, including: dosing, administration, and precautions.

When we should use the bradycardia algorithm.

The signs & symptoms of unstable bradycardia.

Atropine's dose and maximum for bradycardia.

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.

Podcasts with additional (advanced-provider level) information about bradycardia, Atropine, & Dopamine can be found on the Pass ACLS Pod Resources page.

Links:

Pass ACLS: Find ACLS classes near you and discover other podcasts with ACLS-related episodes. https://passacls.com/

Buy Me a Coffee: To give back. https://buymeacoffee.com/paultaylor

American Cancer Society: Fundraiser for breast cancer. Link is valid through October 31st. Together, we will beat cancer! https://secure.acsevents.org/goto/paultaylor

Safe Meds VIP: Patient-facing information about medication safety and a free drug discount card to save money on prescription medications for you and your pets. https://safemeds.vip

LinkedIn: @Pass-ACLS-Podcast. https://www.linkedin.com/company/pass-acls-podcast/

Review the appropriate & safe use of an oropharyngeal airway (OPA) to keep an unresponsive patient's tongue from blocking their airway.

The tongue is the most common airway obstruction in an unconscious patient.

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 is 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.

Links:

Pass ACLS: Find ACLS classes near you and discover other podcasts with ACLS-related episodes. https://passacls.com/

Buy Me a Coffee: To give back. https://buymeacoffee.com/paultaylor

American Cancer Society: Fundraiser for breast cancer. Link is valid through October 31st. Together, we will beat cancer! https://secure.acsevents.org/goto/paultaylor

Prescription Discount Card: Get your free drug discount card to save money on prescription medications for you and your pets. https://nationaldrugcard.com/ndc3506/

LinkedIn: @Pass-ACLS-Podcast. https://www.linkedin.com/company/pass-acls-podcast/

Tips for ACLS providers to consider when evaluating hypoxia as a possible cause of cardiac arrest and what we should do to correct it.

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 pulse ox doesn’t give accurate readings during CPR.

Delivering ventilations with near 100% oxygen concentration using a BVM attached to supplemental O2.

Using waveform capnography to assess the quality of CPR.

Providing artificial ventilations with vs without placement of an advanced airway.

Effects of changes to ventilation rates, tidal volume, and O2 concentration.

The danger of excessive ventilation of a patient in cardiac arrest.

Links:

Pass ACLS: Find ACLS classes near you and discover other podcasts with ACLS-related episodes. https://passacls.com/

Buy Me a Coffee: To give back. https://buymeacoffee.com/paultaylor

American Cancer Society: Fundraiser for breast cancer. Link is valid through October 31st. Together, we will beat cancer! https://secure.acsevents.org/goto/paultaylor

Prescription Discount Card: Get your free drug discount card to save money on prescription medications for you and your pets. https://nationaldrugcard.com/ndc3506/

@Pass-ACLS-Podcast on LinkedIn: https://www.linkedin.com/company/pass-acls-podcast/

Review the ECG characteristics of sinus tachycardia & SVT and the treatment of unstable patients with cardioversion.

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.

For more free information on narrow complex tachycardias, check out the pod resource page at passacls.com.

Links:

Pass ACLS: Find ACLS classes near you and discover other podcasts with ACLS-related episodes. https://passacls.com/

Buy Me a Coffee: To give back. https://buymeacoffee.com/paultaylor

Prescription Discount Card: Get your free drug discount card to save money on prescription medications for you and your pets. https://nationaldrugcard.com/ndc3506/

@Pass-ACLS-Podcast on LinkedIn. https://www.linkedin.com/company/pass-acls-podcast/

When we give the first dose of epinephrine to a patient in cardiac arrest. Epi’s dose, route, repeat frequency, & maximum dose following ACLS's Adult Cardiac Arrest algorithm.

Epinephrine is the first IV medication we administer to every patient in cardiac arrest.

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 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.

Links:

Pass ACLS: Find ACLS classes near you and discover other podcasts with ACLS-related episodes. https://passacls.com/

Buy Me a Coffee: To give back. https://buymeacoffee.com/paultaylor

Prescription Discount Card: Get your free drug discount card to save money on prescription medications for you and your pets. https://nationaldrugcard.com/ndc3506/

@Pass-ACLS-Podcast on LinkedIn. https://www.linkedin.com/company/pass-acls-podcast/