ALS Insights – Life Support Institute of Australia

Life Support Institute of Australia
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Free ANZCOR-aligned Advanced Life Support podcast for Australian nurses, paramedics and doctors. Each episode takes one resuscitation topic and explains the reasoning underneath it — not just what the algorithm says, but why it's shaped that way. Episodes cover high-quality CPR, how defibrillation actually stops the heart, the adrenaline paradox, why pulse checks during CPR mislead, the death of therapeutic hypothermia, and the single question that changes everything in pre-arrest care. Full transcripts at lifesupportinstitute.com.au/podcast

  1. 6d ago

    Not a Fire Hose: IV Fluids in Cardiac Arrest

    The line goes in, and it might feel helpful: run the fluids wide open — but for most cardiac arrests, that reflex doesn't hold up against the evidence. In this episode of ALS Insights, we break down intravenous and intraosseous fluid management during cardiac arrest resuscitation — what the access is actually for, what ANZCOR Guideline 11.5 says about routine fluid infusion, and why unindicated fluid administration carries real physiological risk with no corresponding benefit. Topics covered: Why IV/IO access exists primarily for drug delivery, not bulk volumeANZCOR Guideline 11.5 on routine fluid infusion in cardiac arrestFour risks of unindicated fluid: pulmonary oedema, dilutional coagulopathy, delayed drug delivery, and no mechanism of benefitHypovolaemia as one of the 4 Hs, and its link to PEA (pulseless electrical activity)ANZCOR trauma guidance on fluid bolus dosing in hypovolaemic arrestCrystalloid vs. blood product resuscitation in haemorrhagic shockThe PAMPer trial and prehospital plasma administrationThe PROPPR trial and balanced 1:1:1 transfusion ratiosPost-ROSC haemodynamic targets and MAP-guided fluid titrationBuilt for paramedics, registered nurses, nurse practitioners, and emergency physicians who want to understand the evidence behind the algorithm, not just the steps. ALS Insights is produced by Life Support Institute of Australia, provider of a fully online, ANZCOR-aligned Advanced Life Support course with 10 CPD hours, built for Australian nurses, paramedics, doctors and rural clinicians. Course info and full episode transcripts at lifesupportinstitute.com.au.

  2. Sep 30

    When the Device Won't Stop Shocking: ICD Firing During CPR

    Your patient has an implanted defibrillator, and mid-code, it starts firing. Is it working? Is it safe to keep your hands on the chest? And what do you actually do about it? In this episode, we break down what's really happening when an ICD fires during CPR — including a documented case where a device fired repeatedly on a rhythm that was actually asystole the whole time, because chest compressions can generate artifact these devices aren't built to filter out. We cover: Why the device firing tells you nothing reliable about the underlying rhythmWhether it's actually safe to keep touching the patient (yes — and here's why)The magnet trick: when it works, and when it doesn'tANZCOR's guidance on pad placement if you need to defibrillate externallyThe moment repeated shocks with no result should make you stop trusting the device and start hunting the 4 Hs and 4 TsWhatever the ICD is doing — firing, staying silent, firing on a loop — the algorithm doesn't change. This episode explains why, and what to actually do with the device itself. Read the full companion article at lifesupportinstitute.com.au ANZCOR-aligned. Part of the ALS Insights series from Life Support Institute of Australia.

  3. Sep 1

    Post-Arrest: Who Actually Needs the Cath Lab?

    Should every patient go to the cath lab after cardiac arrest? "Rush everyone" is the wrong answer — and this episode explains why. We walk through the post-ROSC coronary decision: considering ACS in every post-arrest patient, how the 12-lead ECG drives it, immediate angiography for ST-elevation, and what the COACT and TOMAHAWK trials showed for patients without ST-elevation — plus the high-risk features that still warrant urgent cath. ANZCOR-aligned reasoning for paramedics, nurses and doctors. Read the companion article (with references): https://lifesupportinstitute.com.au/blog/cath-lab-after-cardiac-arrest Full online ALS course (10 CPD hours): https://lifesupportinstitute.com.au

  4. Aug 1

    Haemodynamic Optimisation After ROSC- Are You Watching the Patient or Saving the Brain

    ROSC is not the finish line — it fires the starting gun on a second wave of injury that most clinicians never see coming.In this episode we dive deep into post-arrest haemodynamic management: why the post-arrest brain loses cerebral autoregulation entirely and becomes 100% dependent on systemic blood pressure, what MAP ≥65 mmHg means at the bedside, and how to approach post-arrest hypotension — from cautious fluid resuscitation through to vasopressor selection and why noradrenaline is the agent of choice.We also cover the complete post-arrest triad — haemodynamics, temperature control, and oxygen titration — and the evidence from the TTM and TTM2 trials that overturned two decades of therapeutic hypothermia. Plus we name the "handover gap": the dangerous window between the ED and ICU where blood pressure quietly drifts and secondary brain injury silently occurs.When the monitor finally shows a rhythm — are you just watching the patient, or are you actively saving the brain?Companion article:lifesupportinstitute.com.au/blog/haemodynamic-optimisation-post-arrestPost-Arrest State learning hub:lifesupportinstitute.com.au/post-arrest-stateOnline ALS Course (10 CPD hours, $299 AUD):lifesupportinstitute.com.au/online-als-course-australiaLife Support Institute of Australia — ANZCOR-aligned Advanced Life Support education for nurses, paramedics, doctors, and rural clinicians across Australia. Educational content only — not specific clinical advice.

  5. Jul 9

    Stable or Unstable? The One Question That Changes Everything in Pre-Arrest Care

    In pre-arrest arrhythmia management, one clinical question sits above all others — and your answer to it determines whether you have time to think or need to act right now. In this episode we break down the haemodynamic stability assessment: what "unstable" actually means in an ALS algorithm (it's narrower than most clinicians assume), the four adverse features that define it, and why getting this distinction right stops you from either under-treating a deteriorating patient or over-treating a stable one who just needs time and a 12-lead. We also cover the "symptomatic vs unstable" trap — one of the most common sources of clinical confusion in pre-arrest arrhythmia management — and walk through how the ABCD assessment anchors every decision that follows. This episode pairs with our blog article Defining Haemodynamic Stability: The Critical Decision Point in Australian Cardiac Care at lifesupportinstitute.com.au/blog/stable-vs-unstable

  6. Jun 10

    One Cent Miracles

    One Cent Miracles: How Aspirin Matched the Power of Clot Busters In emergency medicine, some of the most powerful interventions don’t come from expensive drugs or high-tech equipment — they come from a simple pill that costs cents. In this episode we dive into the landmark ISIS-2 trial that changed cardiology forever. Aspirin alone reduced mortality by 23% — nearly matching the powerful clot-buster streptokinase. When used together, they delivered a remarkable 42% reduction in deaths. We break down: How aspirin stops platelets from clumping and worsening a heart attackWhy it remains a Grade A recommendation in ANZCOR and ARC guidelinesThe correct 300mg dose and why it should be chewedWhen not to give aspirinA powerful reminder that great medicine isn’t always complicated — it’s about doing the simple things right, at the right time. Essential listening for paramedics, emergency nurses, and doctors.

  7. May 31

    The Fallacy of pulse checks with CPR

    Why You Should Stop Using Pulse Checks to Gauge CPR Quality In the middle of a cardiac arrest, it’s tempting to reach for a pulse to see if your compressions are working. But what if that reassuring pulse you feel isn’t what you think it is? In this episode, we explore why manual pulse checks during CPR are often unreliable. Evidence shows they can be misleading in up to 50% of cases, frequently detecting retrograde venous pulsations rather than true arterial flow. This false confidence can lead teams to unintentionally ease off on compression quality when it matters most. We break down: Why ANZCOR no longer recommends pulse checks as a measure of CPR qualityThe superiority of waveform capnography (ETCO2) for monitoring resuscitation effectivenessHow a sudden rise in ETCO2 is one of the best early signs of ROSCPractical team strategies to maintain high-quality CPR without unnecessary interruptionsIf you’ve ever paused or adjusted compressions based on a pulse check, this episode will change how you approach resuscitation forever. Listen now for clear, ANZCOR-aligned insights you can apply on your very next shift. #CPR #PulseCheck #ETCO2 #Capnography #ALS #Resuscitation #ANZCOR #FOAMed #AdvancedLifeSupport

  8. May 15

    The Adrenaline Paradox

    Adrenaline (epinephrine) is a key drug in ANZCOR-aligned ALS for cardiac arrest — but what's really happening? Its alpha-adrenergic effects cause vasoconstriction, boosting coronary and cerebral perfusion to improve ROSC chances. The beta-adrenergic side ramps up heart rate and contractility... which can spike myocardial oxygen demand and contribute to poorer neurological outcomes in survivors. We cover the basics: standard 1 mg dosing, timing in shockable rhythms, and why evidence shows ROSC gains but often no long-term neuro benefit — or even risks. Quick, practical insights for paramedics, nurses, and doctors.

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Free ANZCOR-aligned Advanced Life Support podcast for Australian nurses, paramedics and doctors. Each episode takes one resuscitation topic and explains the reasoning underneath it — not just what the algorithm says, but why it's shaped that way. Episodes cover high-quality CPR, how defibrillation actually stops the heart, the adrenaline paradox, why pulse checks during CPR mislead, the death of therapeutic hypothermia, and the single question that changes everything in pre-arrest care. Full transcripts at lifesupportinstitute.com.au/podcast

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