Last updated: July 30, 2024
You would need a crash cart with meds. As long as you have the equipment to manage an airway to your skill level you are fine.
It is recommended that a patient within a hospital be defibrillated within 3 minutes.
According to our medical experts, intubation is not indicated in the post-cardiac arrest scenario unless the patient is unable to breathe spontaneously. This patient would have an intact gag reflex and therefore would be at risk of aspiration. Intubation is not indicated in this scenario and would not meet the requirements for most EMS intubation protocol.
“In recent years as the opioid crisis has grown Narcan has become available in IntraNasal spray in single dose applicators (4 mg). Most kits come with two doses so that it can be repeated once. There has been a big push to train all first responders and laypersons in their use.”
“This information is available on our website. Crash Cart Supply & Equipment Checklist”
It should read less than 90%.
I don’t have the pagination to be able to give her page numbers. You could try and search tube tamer though!
Stroke volume has decreased. Because of the increased heart rate there is less time for the left ventricle to fill during diastole and therefore less blood to pump (preload) with each contraction, resulting in hypotension.
Unfortunately, none of our courses cover trachea intubation. You can go to a children’s hospital for patient education.
PALS emphasizes resuscitation in children less than 8 years or pre-puberty. The approach to resuscitation is vastly different between adults and children. One small example: adults have primary ischemic arrests (usually ventricular fibrillation) Infants and children rarely do. They arrest secondary to another cause such as hypoxia or hypovolemia. The list of differences is indeed a large one.
There is no set time on restarting CPR. Once advanced life support is available, the interventions for the Hs and Ts will be considered. Each case is different, the team must consider the down time, and how long CPR has been in progress, the history of the patient, and events leading to cardiac arrest, and signs of return of circulation before making the decision to stop resuscitation attempts.
The AHA recommendation is that the patient comes off. Read more here.
There are no recommendations specific to clinics. Our generic recommendations would work as they would exceed, in all probability, State requirements. Those requirements are written by each State’s DOH.
Anaphylactic shock and the management associated in a non-hospital setting are not covered in our ACLS course. Our ACLS course is completed entirely online.
1.Unlicensed healthcare workers can perform the BLS portion taught in ACLS such as compressions and use of AED. For medication administration, it is required that you work under the scope of your license. Nurses and doctors, for example, can administer medication. CNAs cannot give medications, even if they have taken the course.
2.Morphine is one of the recommended interventions for chest pain. It is very efficient in helping relieve chest pain during a heart attack. The use of the mnemonic MONA helps remember the chest pain interventions: morphine, oxygen, nitroglycerin, and aspirin.
The answer depends on the policies of your institution. Some cardiac catheterization laboratories allow technologists to give medications, while others forbid it. Those decisions are made on an institutional basis.
AHA treats children at puberty (armpit hair in boys, breast development in girls) as adults. If age is known, it is age 14 for a child and up to 1 year for an infant.
It can be given two minutes after the Epi and the defibrillation that follows.
ACLS does not certify anyone to run a code. That is a facility policy. That said, any nurse has within their scope of practice the ability to administer acute care medications. However, a nurse generally requires an order to do so (standing written orders, verbal, or written order).
1/3 of the chest or 2 inches is the compression depth. 2.5 inches is the maximum.
There is no difference in response to hypothermia.
The medications in a crash cart are the decision of individual facilities or regulatory agencies, not AHA.
Passive ventilation is practiced by EMS. A nonrebreather with 100% oxygen is placed while doing high-performance compressions. The theory is that the patient is ventilated passively. In the 2019 recommendations, this did not hold up to science, so it is being removed although it remains an EMS practice.
For arrest team response, it is under 5 minutes. For use of an AED outside critical care, it is under 3 minutes.
It is pulmonary end-tidal CO₂.
tPA is recommended to be administered within 3 hours of symptom onset, or up to 4.5 hours of symptoms for some indications. Refer to the tPA administration guide.
Adenosine is used to treat regular narrow complex tachycardias and, in some cases, to differentiate regular wide complex tachycardias. The initial dose is 6 mg, followed by 12 mg if needed.
5-20 mcg/kg/min to achieve a systolic blood pressure greater than 90 or MAP greater than 65.
The metabolic rate in cardiac arrest is greatly decreased (30% cardiac output at most), so oxygen needs are much lower. This is the concept behind “hands-only CPR” for laypersons.
PALS emphasizes resuscitation in children less than 8 years or pre-puberty. The approach to resuscitation is vastly different between adults and children. One small example: adults have primary ischemic arrests (usually ventricular fibrillation), while infants and children rarely do. They arrest secondary to another cause such as hypoxia or hypovolemia. The list of differences is indeed a large one.
Pediatrics ends at puberty. Medications that are always weight-dosed would be adjusted by the smaller bodyweight, for example, dopamine at 2–10 mcg/kg/min. For the most part, adult doses apply to smaller adults.
It depends upon the standing orders within your hospital.
PALS certification is simply a recognition of completion of a continuing education course. The AHA offers treatment recommendations based on current science. However, it is up to the licensed provider to practice medicine according to what they determine to be best for their practice. There is no administration that enforces adherence to PALS algorithms.
Pediatric care is defined as ending at puberty. However, pediatric hospitals may use the definition of the “end of the 18th year.” PALS is aimed at infants (under one) and children (up to puberty or age 8). After that, adult CPR protocols apply.
There is no requirement that anyone must be ACLS certified. Most regulatory agencies, however, require training in resuscitation for anyone administering or monitoring patients receiving anesthesia or sedation. Many facilities use ACLS or PALS to meet this requirement, but it is not mandatory.
ACLS and PALS certifications are valid worldwide. However, EMT certification may not be. You will need to complete whatever is required by your new state.
PEA should not be treated with defibrillation (AED). The treatment for PEA is to find the cause (usually hypovolemia or hypoxia) and address it.
Yes, PEA can result from ventricular fibrillation or ventricular tachycardia. However, the treatment for PEA remains the same: CPR, epinephrine, and addressing reversible causes.
Yes. The NIHSS stroke scale needs to be completed before presenting the patient to the neurologist. However, the CT is the number one priority, and nothing but life threats should delay it.
It means if the CT scanner is available, perform the scan as soon as possible. You want the CT done early to make a diagnosis.
Yes, each room where procedures are performed needs a crash cart. Having one crash cart at a satellite office will not be sufficient.
Atropine remains the first-line drug for acute symptomatic bradycardia. However, it is not recommended in Mobitz II or 3rd-degree heart block if it’s likely to be a bundle of His or more distal conduction system block.
The monitor must be set for synchronization, using the R wave to time the shock. After cardioversion, immediately turn off synchronization mode to switch to defibrillation mode if needed. The defibrillation dose is generally double that of synchronized cardioversion. Check your manufacturer’s guidelines, but typically it’s between 150 joules and 200 joules for the first defibrillation.
Yes, aspirin remains an important adjunct therapy to any reperfusion strategy used in infarction as well as the treatment of unstable angina for infarction prevention.
1 mm is the threshold for clinical significance. The ST segment begins at the end of the QRS complex and ends at the start of the T wave. Any deviation of 1 mm (one small square) above or below baseline is considered significant.
The responsibility of the organization is to determine if it can provide the level of care required by the patient. If the organization has a cardiac or intensive care unit that can provide ongoing care, then it is appropriate to keep the patient. Otherwise, the organization must find an accepting facility that can provide the required care. In your example, if a patient needs a pacemaker and your facility cannot provide it, they must be transferred to a facility that can.
We cannot provide medical advice. Please consult a specialist or your healthcare provider for more details regarding your condition.
All the updated algorithms can be found on our site. You can view them here.
You are right to remain concerned. I would recommend asking the Zoll representative to explain why the unit is failing its self-checks and to ensure that it is fully operational. You could also document these issues as there could be liability concerns if the unit fails during patient use.
We are in the process of updating our exam. The data for lidocaine recently changed, and our exam will be updated accordingly.
You can find them on our ACLS algorithms page.
Sodium bicarbonate is no longer mentioned in resuscitation guidelines as of 2010. Beta-blockers should be initiated after stabilization, typically post-reperfusion therapy. Nitroglycerin is not administered during hypotension and should be avoided in cases of right ventricular infarction or when taking erectile dysfunction medications.
The AHA does not specifically address heart transplant patients. In post-transplant settings, bradycardia may be treated with beta-agonists like epinephrine or Isuprel. Pacing is also an option, either transvenous or transcutaneous, depending on the situation. Most bradycardias in this population are rare and may be due to parasympathetic denervation.
That is correct. If there are no non-survivable conditions (such as brain herniation), you should wait 72 hours after the return to normal body temperature in TTM-treated patients or 72 hours post-cardiac arrest in non-TTM-treated patients to make any neurological prognostications.
Sodium bicarbonate was eliminated from resuscitation guidelines in 2010. Beta-blockers should be initiated post-stabilization and after reperfusion therapy. Defibrillator pads should be placed on the chest with the heart between the pads.
The AHA does not provide specific guidelines for heart transplant patients. In general, bradycardia in these patients is rare, but it can be managed with epinephrine or Isuprel. Pacing can also be used if needed. Immediate post-op bradycardia is often caused by sympathetic denervation or myocardial damage from biopsy.
ACLS and PALS certifications are recognized globally. However, your EMT certification may require additional requirements in a new state or country.
PEA is not treated with defibrillation. The treatment involves identifying and correcting the underlying cause (commonly hypovolemia or hypoxia) while performing CPR and administering epinephrine.
Yes, pulseless ventricular tachycardia (pVT) can evolve into PEA after defibrillation. The treatment for PEA remains CPR, epinephrine, and addressing reversible causes.
The NIHSS stroke scale should be completed before presenting the patient to a neurologist. The CT scan, however, is the priority and should not be delayed unless there are life-threatening conditions. If the CT shows a bleed, the treatment approach changes.
This means that if the CT scanner is available, the scan should be performed immediately, and other tests (such as an ECG) can be completed afterward. The CT scan is the top priority for diagnosing a stroke.
Yes, each location where procedures are performed should have its own crash cart. Sharing a crash cart between multiple locations could delay treatment in an emergency.
Atropine remains the first-line drug for symptomatic bradycardia. However, it is not reliable in Mobitz II or third-degree heart block, and pacing or drugs like dopamine and epinephrine should be considered.
Synchronized cardioversion uses the R wave of the QRS complex to time the shock delivery. The defibrillator must be set to synchronization mode, and the energy levels are typically half of the defibrillation dose.
Yes, aspirin is recommended for all patients with suspected STEMI as part of the reperfusion strategy, as well as for unstable angina.
ST elevation or depression of 1 mm or more is clinically significant. The ST segment begins at the end of the QRS complex and ends at the beginning of the T wave.
The organization is responsible for ensuring that it can provide appropriate care. If higher-level care is needed or a procedure is not available on-site, the patient should be transferred to an appropriate facility.
We cannot provide medical advice on this matter. Please consult your healthcare provider for more specific information regarding your situation.
Updated ACLS algorithms can be found on our ACLS algorithms page.
Yes, if the device is consistently failing its automated self-checks, you should follow up with the manufacturer and ensure it is safe to use. It’s important to document these issues as well.
We are in the process of updating our exam. The guidelines and recommendations for some drugs, such as lidocaine, have recently changed.
Sodium bicarbonate was removed from the resuscitation guidelines in 2010 and is no longer used for this purpose.
Treatment can include epinephrine or Isuprel for severe bradycardia. Pacing (transvenous or transcutaneous) may also be necessary in some cases. The most common cause of bradycardia in transplant patients is parasympathetic denervation.
AHA treats children at puberty (armpit hair in boys, breast development in girls) as adults. If age is known, it is age 14 for a child and up to 1 year for an infant.
The medications in a crash cart are the decision of individual facilities or regulatory agencies, not AHA.
You do not have to have a license, however, you must be functioning in an environment that utilizes the skills taught in ACLS.
The certification period lasts for 2 years.
Write us any time with your questions about learning ACLS at support@ACLS.netEmail.
Written by Judy Haluka, a cardiovascular invasive specialist and paramedic since the 1990s. She is certified as an instructor through the American Heart Association, the Health and Safety Institute, and the National Association of Emergency Medical Technicians.
More by this author:
Reviewed by Jessica Munoz DPN, RN, CEN, providing nurse training at Yale New Haven Health-Bridgeport Hospital since 2022. Previously in healthcare and education at Griffin Hospital, St. Vincent's College of Nursing and Sacred Heart University Medical Center.
More by this author: