The chain of survival for a cardiac emergency and stroke start the same:

1. preparedness & recognition of an emergency;

2. activation of EMS;

3. delivery of Advanced Life Support; and

4. transporting to the most appropriate facility.

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 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.

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Performing good CPR and delivering a shock as soon as possible to a patient in Ventricular Fibrillation or pulseless V-Tach are the two most critical interventions that have been shown to increase survival from sudden cardiac arrest.

Studies have demonstrated significantly better out-of-hospital cardiac arrest survival outcomes in communities with robust public CPR training and public access/first responder AEDs.

The general use of AED including:

• indications for use;
• attaching the AED pads;
• following verbal prompts; and safely administering a shock.

Following the Adult Cardiac Arrest algorithm while using an AED.

Contraindications to AED use.

General safety considerations to remember.

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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.

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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) with a tempo of 100 to 120 beats per minute to help the person doing chest compressions maintain an adequate rate.

Characteristics of good songs that will help us.

Advantages & disadvantages of using a song during CPR.

Selected songs from various genres and time periods from AHA's "Don’t Drop The Beat" playlist on Spotify. https://open.spotify.com/playlist/2mU2FNAhSOtQwW0hBgQMaK

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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 format.

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Although magnesium can be used in the treatment of other medical conditions such as eclampsia, asthma, & digitalis toxicity; for ACLS, magnesium is primarily used to treat Torsades de Pointes.

Identification of Torsades on the ECG.

Administration of a magnesium infusion for stable patients vs slow IV push for 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.

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Listen to Pass ACLS tips and other medical podcasts at ConveyMed.io

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.

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.

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

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

Why Morphine is helpful for patients with ACS.

Contraindications and considerations for the safe administration of Morphine.

Morphine as an alternative to nitro for patients with chest pain that take PDE inhibitors.

Common dosing & administration of Morphine.

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

Possible side effects of Morphine administration.

Narcan as an antidote to Morphine if needed.

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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!