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I'm Paul from PassACLS.com and I'm here to help you pass ACLS. Like an audio flash card, this podcast is intended to aid any medical professional preparing for an Advanced Cardiovascular Life Support (ACLS) class. Each one-to-nine minute episode covers one of the skills needed to recognize a stroke or cardiac emergency and work as a high performing team to deliver safe, quality patient care. Listening to a tip a day for 14-30 days prior to your ACLS class will help cement the core concepts t ...
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Each month, EMedHome.com presents EMCast, the 90-minute podcast hosted by Dr. Amal Mattu, the premier educator in Emergency Medicine. Subscribe to EMedHome.com for an array of clinical content that will impact every shift.
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I'm a board certified Emergency Medicine physician and would like to share my expertise to help connect healthcare with the real world. One focus I have is the constant fight against misinformation. Join me for quick hitting and trending topics in healthcare to get the real story. A true inside look into healthcare. This podcast, social media content, and website contains the opinions of Dr. John Parente. It does not represent the opinions or interests of any corporations or hospitals for wh ...
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Dr. Carisa Hines is the founder of Freeman Moore Medical Consultants, a full spectrum disability consultation practice. She is a native of Norfolk, Virginia, and is a proud graduate of Booker T Washington HS. Dr. Hines completed her undergraduate degree in Biological Chemistry at the University if Virginia. She graduated from Meharry Medical College, and subsequently completed her residency at Atlanta Medical Center in Internal Medicine. Since completing residency, she has worked in Emergenc ...
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State of the art information on natural medicine and the expressive arts for the best healthcare possible to build your immune system, and heal from lingering trauma! Most of the first 30 episodes explored the basis for Dr Heather's new book, Surviving A Viral Pandemic Through the Lens of a Naturopathic Medical Doctor. We also have started to venture into her upcoming book, Transforming Trauma, a drugless and creative path to healing PTSD. Dr Heather speaks with top people in the field - doc ...
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Contributor: Aaron Lessen MD Educational Pearls: A recent study assessed EMS treatment of high blood pressure in the field 2404 patients randomized to prehospital treatment (1205) vs. usual care (1199) Included patients with prehospital BP greater than 150 mm Hg The treatment arm’s BP goal was 130-140 mm Hg The primary efficacy outcome was function…
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Send us a Text Message. Ever wonder if the medical scenes in movies are realistic? Is it possible to jump start someone's heart by stabbing them in the chest with a big needle full of adrenalin? Is it possible to treat a collapsed lung by putting a giant needle in the chest with a valve? If someone collapses and loses their pulse should you punch t…
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For patients exhibiting symptoms consistent with myocardial ischemia, Aspirin is the first medications we should consider along with morphine, oxygen, and nitroglycerine; if indicated & safe. Aspirin's mechanism of action & benefits for Acute Coronary Syndrome (ACS) patients. Contraindications and considerations for aspirin’s use. The dose and rout…
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To pass ACLS, you will need to be able to identify common rhythms on a monitor during your mega code and ECG strips on your written exam. If you don't normally monitor patients as part of your job, I suggest two things: 1. Find a system for ECG interpretation that works well for you; and 2. Practice reading ECGs every day for a few weeks before you…
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In the Adult Cardiac Arrest algorithm, we should administer an antiarrhythmic medication to patients in V-Fib or pulseless ventricular tachycardia approximately two minutes after the first dose of epinephrine. The two first-line ACLS antiarrhythmics that are generally used are Amiodarone and Lidocaine. Review of Lidocaine dosing and administration …
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The tongue is the most common airway obstruction in an unconscious patient. For patients with a decreased level of consciousness that can't control their airway, yet have an intact gag reflex, the nasopharyngeal airway (NPA) should be used as an alternative to the oropharyngeal airway (OPA). Examples of when a NPA should be considered. Contraindica…
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When blood, or other fluids, accumulate in the sac around the heart it’s called a cardiac tamponade or pericardial tamponade. The effects of tamponade on the electrical system and chambers of the heart. Cardiac tamponade can be acute or chronic and caused by traumatic, iatrogenic, or pathological etiologies. Common traumatic events, medical procedu…
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Two things have changed in recent years to aid students that don't use ACLS in their daily practice. The role of the team leader; and The ability to use your quick reference cards. The team leader is responsible for assigning tasks and overall direction of the team but can & should ask team members for help. Using closed-loop communication to ensur…
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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. …
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Contributor: Taylor Lynch MD Educational Pearls: Overview: Sympathomimetic drugs mimic the fight or flight response, affecting monoamines such as dopamine, norepinephrine, and epinephrine Limited therapeutic use, often abused. Types: Amphetamines: Methamphetamine, Adderall, Ritalin, Vyvanse MDMA (Ecstasy) Cocaine (Both hydrochloride salt & free bas…
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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…
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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. Indication…
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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 sho…
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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 saturat…
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Contributor: Travis Barlock MD Educational Pearls: Wide-complex tachycardia is defined as a heart rate > 100 BPM with a QRS width > 120 milliseconds Wide-complex tachycardia of supraventricular origin is known as SVT with aberrancy Aberrancy is due to bundle branch blocks Mostly benign Treated with adenosine or diltiazem Wide-complex tachycardia of…
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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 …
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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 arres…
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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 ca…
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Contributor: Aaron Lessen MD Educational Pearls: The case: A gentleman came in from a nursing home with symptoms concerning for sepsis. He was hypotensive, hypoxic, febrile, and mentally altered. His past medical history included previous strokes which had left him with deficits for which he required a feeding tube. Initial workup included some poi…
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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 …
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This episode talks about grieving and how and why an approach using both naturopathic medicine and the expressive arts can keep you balanced and sane, literally in this difficult but precious time. Grieving the loss of a loved one is not easy work. This is why it's so important to do whatever you can on your own to balance your body and mind in eve…
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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. Aden…
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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 (<60, 60-100, 101-149, or >150); Is the rhythm regular or irregular; What's the shape, width,…
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Contributor: Aaron Lessem MD Educational Pearls: Oseltamivir (Tamiflu) is an antiviral medication used commonly to treat influenza Trials show that the medication reduces the duration of illness by less than 1 day (~16 hours in one systematic review) Benefit only occurs if taken within 48 hours of symptom onset Must be taken for 5 days A 2024 meta-…
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When treating patients with Acute Coronary Syndrome (ACS), MONA is an acronym sometimes used to help us remember the initial interventions. The O in MONA is Oxygen. When we should administer oxygen to ACS patients. When O2 administration is unnecessary based on an accurate pulse ox. Monitoring patient's oxygen saturation (SaO2) using a pulse oximet…
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Along with early defibrillation, high quality CPR with minimal interruptions is one of the two factors that has been shown to improve cardiac arrest outcomes. How do we know if high quality, effective CPR is being performed? Objective measures of high-quality CPR include: Compression rate; Compression depth & recoil; ETCO2; and Chest Compression Fr…
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When we should consider using the bradycardia algorithm. The signs & symptoms of unstable bradycardia. Atropine's dose and maximum. The use of atropine when a patient is in a second degree type II or third degree heart block. ECG changes that indicate subsequent doses of atropine are likely to be ineffective. The dose of Dopamine. The use of Dopami…
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The tongue is the most common airway obstruction in an unconscious patient. Insertion an oropharyngeal airway helps keep the patient’s tongue from falling to the back of the pharynx, causing an airway obstruction. The oropharyngeal airway is sometimes called an OPA or simply an oral airway. Indications for using an oral airway. Contraindication for…
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Hypoxia is a state of low oxygen levels in the blood. Determining hypoxia using a pulse oximeter or arterial blood gasses (ABGs). A goal of ACLS is to recognize signs of hypoxia and provide timely treatment to prevent an arrest. Examples of some things that might lead us to think of hypoxia as a cause of cardiac arrest. Why we should not rely on pu…
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Contributor: Aaron Lessen MD Educational Pearls: Epinephrine is essential in the treatment of anaphylaxis, but is epinephrine dangerous from a cardiovascular perspective? A 2024 study in the Journal of the American College of Emergency Physicians Open sought to answer this question. Methods: Retrospective observational study at a Tennessee quaterna…
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ECG characteristics of supraventricular tachycardia (SVT) vs. sinus tachycardia. Signs & symptoms that indicate a patient is unstable. Delivery of a synchronized shock for the treatment of unstable SVT using a biphasic vs monophasic defibrillator. Consideration for team safety while performing synchronized cardioversion. Actions to take immediately…
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This episode completes the tragic story of Avi's passing by hospital error. This is Part 2. Although the cause of his original problem was TDap vaccine we did get him well after two heart attacks and a stroke. There was nothing wrong with his brain and his heart and body were healing after we initially got him well with homeopathy and botanicals an…
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When working to resuscitate a patient in sudden cardiac arrest, Epinephrine is the first IV medication we administer. When we give the first dose of epinephrine depends on whether the patient is in a shockable or non-shockable rhythm. When to give the first dose of epinephrine and its frequency for patients in asystole or PEA following the right si…
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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 &…
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Most ACLS medications are given IV push. But, what happens if we can't get an IV? Why IO is better than ETT as an alternative route. The locations we should place an IO when running a code and a location we should avoid. The ACLS medications that can be given intraosseous. Where you can find more information about intraosseous access during resusci…
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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 sus…
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Contributor: Aaron Lessen MD Educational Pearls: Opioid overdoses that are reversed with naloxone (Narcan), a mu-opioid antagonist, can precipitate acute withdrawal in some patients Treatment of opioid use disorder with buprenorphine can also precipitate withdrawal Opioid withdrawal symptoms include nausea, vomiting, diarrhea, and agitation Bupreno…
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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 …
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Each month, EMedHome.com presents EMCast, the 90-minute podcast hosted by Dr. Amal Mattu, the premier educator in Emergency Medicine. Subscribe to EMedHome.com for an array of clinical content that will impact every shift. This month's EMCast covers: (1) Risk Management (2) Cervical Artery Dissection (3) Hypoglycemia (4) Geriatric Psychiatric Emerg…
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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…
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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 rat…
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Contributor: Travis Barlock MD Educational Pearls: How do you differentiate between compensated and decompensated cirrhosis? Use the acronym VIBE to look for signs of being decompensated. V-Volume Cirrhosis can cause volume overload through a variety of mechanisms such as by increasing pressure in the portal vein system and the decreased production…
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