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 pulse ox to give accurate readings during CPR.

Delivering ventilations with near 100% oxygen concentration using a BVM attached to supplemental O2 and a reservoir.

Using end tidal waveform capnography to assess the quality of CPR.

Changes to ventilation rates, tidal volume, and O2 concentration affects a patient's oxygen, carbon dioxide, and pH.

The danger of excessive ventilation of a patient in cardiac arrest.

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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 if an unstable patient we’ve cardioverted goes into a pulseless rhythm.

Management of stable patients in SVT.

For more FOAMed on narrow complex tachycardias, check out the pod resource page at passacls.com.

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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 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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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.

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