Pass ACLS Tip of the Day

A brief review of some easily identifiable & treatable medical conditions that can mimic a stroke.

If a person suddenly develops symptoms such as weakness, slurred or garbled speech, loss of balance, or a massive & severe headache; it’s possible they could be having a stroke.

The Cincinnati Prehospital Stroke Scale.

There are several conditions that can mimic a stroke.

Identification & Treatment of hypoglycemia or hyperglycemia.

Identification & Treatment of hypoxia.

Some seizures, electrolyte imbalance, sepsis, brain tumors, and Bell’s Palsy can also mimic a stroke.

Prehospital providers should transport suspected stroke patients to a stroke center following their local protocols.

Hospital providers should active their stroke team to ensure rapid assessment and treatment.

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

Safe Meds VIP: Learn about medication safety and download a free drug discount card to money on your prescription medications. https://safemeds.vip/

The pros and cons of ACLS medication administration via the intraosseous (IO) vs endotracheal tube (ETT) route when IV access can’t be established.

The locations we should place an IO when running a code.

The ACLS medications that can be given intraosseous.

Where you can find more information about intraosseous access during resuscitation efforts.

In the absence of an IV or IO, some medications may be given down the endotracheal tube.

The disadvantages of medication administration via ETT.

Review of the ACLS medications that can be given down the tube and how they should be given.

2025 ACLS guidelines regarding medication administration via the ET tube.

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

Safe Meds VIP: Learn about medication safety and download a free drug discount card to money on your prescription medications. https://safemeds.vip/

Prehospital EMS capabilities and why paramedic-staffed ALS ambulances make a difference in the early identification & treatment of STEMI and stroke.

The chain of survival for a cardiac emergency and stroke.

ALS ambulances are staffed with paramedics who have training in ACLS skills.

Why EMS Destination Protocols for suspected stroke and STEMI make a difference.

ACLS’s timed benchmarks for:

• point of first medical contact to PCI for ST elevation MI;
• door to tPA or Tenecteplase for ischemic stroke; and
• onset of symptoms to EVT for LVO strokes.

Why EMS should bypass a close hospital to transport a STEMI or suspected stroke patient to a hospital capable of 24/7 PCI or a certified stroke center.

Check out the Pod Resource page at passacls.com for links to the "EMS On Air" podcast for links to episodes that look at EMS's role in stroke outcomes in the rural vs urban area.

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

Safe Meds VIP: Learn about medication safety and download a free drug discount card to money on your prescription medications. https://safemeds.vip/

Review the use of an AED including: indications & contraindications; connecting the device; administering a shock; and general safety considerations.

Why we should use an AED.

The general instructions for safe use of AED.

Following the Adult Cardiac Arrest algorithm while using an AED.

Contraindications to AED use.

General safety considerations to remember.

When we should discontinue resuscitation efforts and call the code.

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

Safe Meds VIP: Learn about medication safety and download a free drug discount card to money on your prescription medications. https://safemeds.vip/

Review the Asystole/PEA side of the Cardiac Arrest algorithm including: epinephrine administration, advanced airways, causes of PEA, and when to call the code.

For apneic patients without a carotid pulse or patients with only gasping/agonal respirations, we will follow the Adult Cardiac Arrest algorithm.

For pulseless patients that the AED doesn't advise a shock, the patient's ECG shows asystole, or a non-perfusing organized rhythm (PEA), we will follow the right side of the Adult Cardiac Arrest algorithm.

Initial steps are aimed at delivery of high-quality CPR to keep the brain and vital organs alive.

Epinephrine administration.

Placement of an advanced airway.

Considering possible reversible H & T causes of cardiac arrest including three common causes of PEA and their emergent interventions.

When we should discontinue resuscitation efforts and call the code.

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

Safe Meds VIP: Learn about medication safety and download a free drug discount card to money on your prescription medications. https://safemeds.vip/

Many CPR classes use songs like "Stayin Alive" to help compressors maintain an adequate rate. Advantages, disadvantages, and a selection of CPR songs from the American Heart Association’s play list.

Providing good, high-quality CPR with minimal interruptions and early defibrillation are two key interventions shown to improved cardiac arrest outcomes.

A training tool used in many CPR and ACLS classes is to use a song (or a song list) to help the person doing chest compressions maintain a rate of 100-120 per minute.

Characteristics of songs that will help us perform good CPR.

Advantages & disadvantages of using a song during CPR.

Considerations if playing a song during a code.

Selected songs from various genres and time periods from AHA's "Don’t Drop The Beat" playlist on Spotify.

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

Safe Meds VIP: Learn about medication safety and download a free drug discount card to money on your prescription medications. https://safemeds.vip/

AHA’s Don’t Drop the Beat Playlist: Opens in Spotify. https://open.spotify.com/playlist/2mU2FNAhSOtQwW0hBgQMaK

Obtaining a medical history guides clinical decisions so we can provide the safest evidence-based care possible. The SAMPLE-PQRST format is explained.

A patient’s medical history will help us identify things that may be causing (or contributing) to their current condition as well as guide our decisions so we provide the safest evidence-based care possible.

Examples of information obtained in a medical history that will impact the treatment we provide.

There are several mnemonics and memory aids that people use to guide their history taking.

Review the SAMPLE-PQRST medical history mnemonic.

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

Safe Meds VIP: Learn about medication safety and download a free drug discount card to money on your prescription medications. https://safemeds.vip/

The indications and administration of ACLS antiarrhythmics Magnesium & Procainamide for treating Torsades de Pointes and stable tachycardias.

Identification of Torsades on the ECG.

Administration of a magnesium for stable patients with Torsades vs patients in cardiac arrest.

Procainamide use for stable patients with a monomorphic wide-complex tachycardia.

Procainamide dosing and when to stop the infusion.

Tip for determining whether magnesium or Procainamide should be used when treating stable patients with V-Tach.

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

Safe Meds VIP: Learn about medication safety and download a free drug discount card to money on your prescription medications. https://safemeds.vip/

Review of hypovolemia as a H&T reversable cause of cardiac arrest including: causes, signs & symptoms, and treatment.

When a patient loses excessive amounts of fluids, we say that they are in a state of hypovolemia.

The most obvious cause of hypovolemia is from bleeding.

Common conditions other than bleeding that can cause hypovolemia.

Bleeding can be internal or external and caused by trauma, pathology, or iatrogenic.

Classic signs & symptoms of hypovolemic shock.

Volume replacement with crystalloids vs blood.

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

Safe Meds VIP: Learn about medication safety and download a free drug discount card to money on your prescription medications. https://safemeds.vip/

Review the mechanism of action and safe administration of Morphine or Fentanyl for patients with myocardial ischemia in ACLS’s Acute Coronary Syndrome (ACS) algorithm.

MONA is the acronym sometimes used to help us remember the interventions to consider for patients with Acute Coronary Syndrome.

Morphine and Fentanyl's use in the Acute Coronary Syndrome (ACS) algorithm.

Why Morphine or Fentanyl is helpful for patients with ACS.

Contraindications and considerations for their safe administration.

Common dosing & administration.

Monitoring of the patient's level of consciousness, pain, blood pressure, and respirations after administration.

Possible side effects.

Narcan as an antidote to Morphine or Fentanyl if needed.

Links:

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

Buy Me a Coffee: To support the show. https://buymeacoffee.com/paultaylor

Safe Meds VIP: Learn about medication safety and download a free drug discount card to save money on your prescription medications. https://safemeds.vip/

Thanks for listening. Good luck with your class!