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:

1.  If a patient’s condition changes, we should do an assessment and use the algorithm that matches the patient’s current state.

2.  If an action was already done, we don’t need to repeat it.

3.  We only do actions that are clinically appropriate and within our scope of practice.

Walk through of an example mega code scenario with explanations of when and why we change to a different ACLS algorithm. 

Good luck with your ACLS class!

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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 medications.

More detailed information about beta blocker’s mechanism of action and specific instances for their use can be found on the Pod Resource page at PassACLS.com.

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This episode we review 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 the adequacy of CPR.

Identification and management of a misplaced ET tube.

Good luck with your ACLS class!

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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 were administered prior to obtaining ROSC.

Links to other medical podcasts that cover antiarrhythmics and other ACLS-related topics are on the Pod Resource page at PassACLS.com.

Good luck with your ACLS class!

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Practice ECG rhythms at Dialed Medics - https://dialedmedics.com/

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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 rate of ventilations.

The indications, dose, and considerations for use of Sodium Bicarbonate.

Treatment of alkalosis depends on the type (metabolic or respiratory) and is aimed at correcting the underlying cause.

Other podcasts that cover acid/base balance and conditions that cause acidosis or alkalosis can be found on the Pod Resource Page at PassACLS.com.

Good luck with your ACLS class!

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Being the team leader during a cardiac arrest is challenging.  Using an algorithm helps by standardizing & prioritizing our interventions using an If/Then methodology.

Review of BLS steps for determining if rescue breathing or CPR is needed and use of an AED for patients in cardiac arrest.

If the patient is in a non-shockable rhythm on the ECG such as PEA or asystole, we will go down the right side of the Adult Cardiac Arrest Algorithm.

If the patient is in a shockable rhythm on the ECG such as V-Fib or V-Tach, we will go down the left side of the Adult Cardiac Arrest Algorithm.

An example of a code's flow for shockable rhythms when an antiarrhythmic such as Amiodarone or Lidocaine is administered.

We will follow the algorithm until the patient has ROSC or we call the code.

Good luck with your ACLS class!

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Other Pass ACLS episodes mentioned

Objective Measures of Good CPR https://passacls.com/bls/objective-measures-of-good-cpr

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.

Good luck with your ACLS class!

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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:

1.  Find a system for ECG interpretation that works well for you; and

2.  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 of third degree (complete) AV block.

Treatment of unstable patients in third degree block following the ACLS Bradycardia algorithm.

Special considerations for use of Atropine when patients are in a third degree heart block.

The use of TCP, Dopamine, & Epinephrine drip for unstable bradycardic patients refractory to Atropine.

Good luck with your ACLS class!

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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 V-Tach.

Use of antiarrhythmic infusions post-cardiac arrest to suppress ventricular ectopy.

Amiodarone use & dosing for stable patients in V-Tach with a pulse.

Good luck with your ACLS class!

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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 airway into the right vs left nostril.

Patients with a NPA in place can receive supplemental O2, be ventilated with a BVM, have ETCO2 monitored, and have their upper airway suctioned as needed.

Good luck with your ACLS class!

Buy Me a Coffee at https://buymeacoffee.com/paultaylor

Practice ECG rhythms at Dialed Medics - https://dialedmedics.com/

Free Prescription Discount Card - Download your free drug discount card to save money on prescription medications for you and your pets: https://safemeds.vip

Pass ACLS Web Site - Episode archives & other ACLS-related podcasts:  https://passacls.com

@Pass-ACLS-Podcast on LinkedIn