Pass ACLS Tip of the Day Paul Taylor

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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The chain of survival for ACLS is the same as was learned in your BLS class.
The beginning steps of the Cardiac Emergency and Stroke chain of survival.
ACLS's timed goals for first medical contact to PCI for STEMI and door-to-needle for ischemic stroke.
Characteristics of areas that have significantly better stroke and out-of-hospital cardiac arrest outcomes.
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Heart muscle contraction and repolarization is dependent on Sodium, Calcium, Magnesium, and Potassium ions crossing cellular membranes.
When a patient’s potassium levels get too low or too high, hypokalemia or hyperkalemia results respectively.
Two things that may lead us to suspect hypo or hyperkalemia.
Medical conditions & medications that can cause potassium imbalance.
ECG changes seen in hypo and hyperkalemia.
Critical lab values that would indicate a need for treatment.
Emergent, ACLS interventions for hypokalemia and hyperkalemia.
Additional information on causes of hypo and hyperkalemia can be found on Ninja Nerd podcast.  Check out the pod resources page at passacls.com.
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When treating patients having an MI or stroke, more minutes equals more dead 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. 
Review the first four steps in the Stroke Chain of Survival.
Time criteria for the administration of tPA or EVT of LVO strokes.
Stroke benchmarks for door to:
assessment;completing a non-contrast CT; andadministration of tPA (door-to-needle).
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.
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Adenosine is the first IV medication given to stable patients with sustained supraventricular tachycardia (SVT) refractory to vagal maneuvers.
Symptoms indicating a stable vs unstable patient.
Common causes of tachycardia.
Cardiac effects of Adenosine.
Indications for use in the ACLS Tachycardia algorithm.
Considerations and contraindications.
Adenosine as a diagnostic for patients in A-Fib or A-Flutter with RVR.
Dosing and administration.
Other podcasts that cover common ACLS antiarrhythmics in more detail and another covering Brugata Criteria used to differentiate V-Tach from SVT with an aberrancy can be found on the Pod Resources page at passacls.com.
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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 is to ask a series of questions such as:
What's the rate (150); Is the rhythm regular or irregular;What's the shape, width, and frequency of P waves and QRS complexes; andWhat's the P-R interval and is it constant?
ECG characteristics of a second-degree Mobitz type I (Wenckebach).
Identification of unstable bradycardia and its treatment with Atropine.
ECG characteristics of a second-degree Mobitz type II.
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.
Connect with me:
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Good luck with your ACLS class!
The Curious Clinicians: History of Doctor Wenckebach & Mobitz
Practice ECGs with rationale at Dialed Medics