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 at least 80%.

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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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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.

Connect with me:

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Give Back & Help Others:

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!