Pass ACLS Tip of the Day

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.

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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.

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When blood, or other fluids, accumulate in the sac around the heart it’s called a cardiac tamponade or pericardial tamponade.

The effects of tamponade on the electrical system and chambers of the heart.

Cardiac tamponade can be acute or chronic and caused by traumatic, iatrogenic, or pathological etiologies.

Common traumatic events, medical procedures, and diseases that can result in a pericardial tamponade.

Signs & symptoms of cardiac tamponade.

Treatment of cardiac tamponade with pericardiocentesis.

For additional information on cardiac tamponade, check out the Pod Resources page at PassACLS.com. 

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Two things have changed in recent years to aid students that don't use ACLS in their daily practice.

1.  The role of the team leader; and

2.  The ability to use your quick reference cards.

The team leader is responsible for assigning tasks and overall direction of the team but can & should ask team members for help.

Using closed-loop communication to ensure the clarity of orders and speaking up if there’s any doubt about an order or action.

Use of your course’s approved text book and quick reference cards during the megacode and written exam.

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Two factors to cardiac arrest survivability that have been clearly shown to make the biggest difference is continuous, high-quality CPR and early defibrillation.

The most common dysrhythmia present during the first few minutes of cardiac arrest is ventricular fibrillation.

The chance of successful defibrillation decreases every minute that passes. 

How our chance of successfully defibrillating a patient into a perfusing rhythm significantly changes when good CPR is delivered vs when it isn't.

Why bystander CPR is important for out-of-hospital cardiac arrest (OHCA) outcomes. 

The role of the CPR coach.

Five tips to aid us in limiting CPR interruptions to less than 10 seconds so we can maintain a chest compression fraction (CCF) of 80% or more.

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Quantitative waveform capnography is used in ACLS as a way to confirm good CPR and placement of an endotracheal tube; identify return of spontaneous circulation; and during post-cardiac arrest care.

We can use waveform capnography with, and without, an advanced airway in place.

Monitoring end tidal CO2 during rescue breathing.

Use of capnography to objectively measure good CPR.

Capnography is a preferred method of confirming endotracheal tube (ETT) placement over x-ray during a code.

During CPR, a sudden increase in ETCO2 may indicate ROSC.

Quantitative waveform capnography use in the post-cardiac arrest algorithm.

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Patients with a narrow complex tachycardia with a rate over 150 BPM are in SVT.

Unstable patients in SVT, or V-Tach with a pulse, should be cardioverted with a synchronized shock.

Assessment & treatment of stable tachycardic patients.

Commonly used vagal techniques.

A less common technique to stimulate the vagus nerve is the dive reflex.

Indications and use of Adenosine for stable patients in SVT refractory to vagal maneuvers.

Possible treatments for patients found to be in A-Fib or A-Flutter with RVR after administration of Adenosine.

Carotid sinus massage.

Additional medical podcasts that have episodes on tachycardia can be found on the pod resources page at passacls.com.

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Remembering all the different energy setting needed for synchronized cardioversion and defibrillation used to be confusing for a lot of people.

Defibrillators can be broken down into three basic categories:

1.  Automated External Defibrillator (AED);

2.  Biphasic defibrillators; and

3.  Monophasic defibrillators.

Use of an AED to rapidly deliver a shock.

Advantages & use of Biphasic defibrillators.

For monophasic defibrillators, use 360J to defibrillate V-Fib or pulseless V-Tach.

AEDs must not be used on patients with a pulse.

Cardioversion of patients in unstable SVT or V-Tach with a pulse using biphasic vs monophasic monitor/defibrillators.

Team safety when performing synchronized cardioversion.

Energy needed to cardiovert unstable patients with a narrow vs wide complex tachycardia.

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Patients with a heart rate less than 60 are bradycardic. Some people can have a resting heart rate in the 40s without any compromise.  For others, a heart rate of 50 or less could signify the need for immediate intervention and warrants additional assessment.

Signs & symptoms that indicate a bradycardic patient is unstable.

Monitoring oxygen saturation with pulse oximetry and indications for administration of oxygen.

Calcium channel blockers and beta blocker medication as treatable causes of bradycardia.

The indications and dosage of Atropine.

Precautions for Atropine use in patients with second or third degree AV blocks.

The use of transcutaneous pacing (TCP) for unstable bradycardic patients refractory to Atropine.

The use and dosing of Dopamine and Epinephrine drips.

For additional information about causes and treatment of bradycardia, check out the pod resources page at PassACLS.com.

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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.

Recently published studies on TTM and ACLS’s current standard.

Monitoring the patient’s core temperature during TTM.

Patients can undergo EEG, CT, MRI, & PCI while receiving TTM.

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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!