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 side of the Adult Cardiac Arrest algorithm.

When to give the first dose of epi and its frequency for patients in V-Fib or pulseless V-Tach following the left side of the Adult Cardiac Arrest algorithm.

Example chronology of events for a scenario where a patient is found unresponsive with only gasping/agonal breathing.

Administration of epi via the IO or endotracheal route in the absence of an IV.

The maximum cumulative dose of epinephrine that can be administered to patients in cardiac arrest.

When do we stop administering epinephrine.

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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 & Treatment of hypoxia using a pulse oximeter.

Some seizures, electrolyte imbalance, sepsis, brain tumors, and Bell’s Palsy can also mimic a stroke.

Prehospital providers should transport suspected stroke patients to a stroke center following their local protocols.

Hospital providers should active their stroke team to ensure rapid assessment and treatment.

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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 resuscitation efforts.

In the absence of an IV or IO, some medications may be given down the endotracheal tube.

The disadvantages of medication administration via ETT.

Review of the medications that can be given down the tube and how they should be given.

Medications should not be given down the tube when anything other than an endotracheal tube is used as an advanced airway.

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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 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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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!