The American Heart Association’s Advanced Cardiac Life Support (ACLS) is a specialized certification course and set of guidelines designed for healthcare professionals who manage serious cardiovascular emergencies, such as cardiac arrest, arrhythmias, stroke, and acute coronary syndromes. cpr.heart.org+2international.heart.org+2
Here’s a breakdown of what ACLS is, what it covers, who it’s for, and how the course works:
What is ACLS?
ACLS is an advanced set of protocols and algorithms that builds on Basic Life Support (BLS) skills (such as chest compressions, use of an AED, airway management) and adds additional diagnostic and therapeutic tools (e.g. ECG / cardiac rhythm interpretation, advanced airway techniques, IV/IO drug administration) in the care of cardiovascular emergencies. cpr.heart.org+2Wikipedia+2
It’s intended to enhance survival and neurological outcomes in patients with life-threatening cardiac conditions by applying a structured, evidence-based approach. international.heart.org+2Wikipedia+2
The ACLS algorithms address multiple components, including:
High-quality CPR (continuous compressions, minimizing interruptions)
Early defibrillation / electrical therapy
Airway management and ventilation
Recognition and treatment of arrhythmias (bradycardia, tachycardia, pulseless rhythms)
Use of medications (epinephrine, amiodarone, etc.)
Post-cardiac arrest care
Team dynamics, communication, and leadership in resuscitation settings international.heart.org+2cpr.heart.org+2
Who is it for?
ACLS is intended for healthcare professionals who may need to direct or participate in managing advanced cardiac emergencies. This includes:
Physicians, nurses, and paramedics
Personnel in emergency response, intensive/critical care, emergency medicine, and related units
Any provider whose job or credentialing requires an ACLS course (hospital privileging, certification boards, etc.) international.heart.org+1
There is also an “ACLS for Experienced Providers” track tailored for learners who already have strong familiarity with ECG interpretation, ACLS pharmacology, and resuscitation leadership. cpr.heart.org
Course Format & Requirements
ACLS courses are offered in various formats: traditional instructor-led classroom sessions, blended learning (online didactic modules + hands-on skills sessions), or hybrid approaches like HeartCode ACLS which allow flexibility in the online component followed by a skills check in person. shopcpr.heart.org+2cpr.heart.org+2
Trainees must perform hands-on skills (simulated or real equipment) and pass both skill testing (megacode / scenario practice) and written (cognitive) assessments. international.heart.org+1
Upon successful completion, participants receive a Provider Course Completion Card, which is generally valid for 2 years. international.heart.org+1
After the expiration, recertification is required by retaking an ACLS course or an equivalent refresher.
Advanced Cardiovascular Life Support skills focusing on high-quality CPR, team dynamics, and interventions for cardiac arrest, stroke, and other emergencies, reflecting the latest 2025 AHA guidelines through online work and hands-on simulation.
What it is:
An advanced course building on Basic Life Support (BLS) for experienced healthcare professionals.
A renewal/recertification for those with a current AHA ACLS card, typically valid for two years, to maintain certification.
Updated content reflecting the latest American Heart Association Guidelines (e.g., 2025 guidelines).
What it covers:
Recognition and early management of cardiac arrest, stroke, and other emergencies.
Airway management, pharmacology, and rhythm recognition.
Effective resuscitation team dynamics and leadership.
Acute coronary syndromes (ACS) and post-cardiac arrest care.
Course format:
Often uses a blended learning approach: online self-paced learning followed by a hands-on skills session.
Includes simulated patient cases and team-based scenarios for practical application.
Who should take it:
Healthcare professionals like physicians, nurses, paramedics, respiratory therapists, and others involved in critical care.
Advanced Cardiovascular Life Support (ACLS)
The American Heart Association’s ACLS course builds on the foundation of lifesaving BLS skills, emphasizing the importance of high-performance teams. The 2025 ACLS course reflects the new 2025 science and education from the American Heart Association Guidelines Update for CPR and Emergency Cardiovascular Care (ECC).
ACLS Advanced Cardiac Life Support Instructor Led Training - FAQ
As of October 22, 2025 Advanced Cardiovascular Life Support (ACLS) Provider Instructor-Led Training (ILT) Course
Q: What is the American Heart Association’s 2025 ACLS Provider Course?
A: The Association’s ACLS Provider Course has been updated to reϐlect new science in the 2025 American Heart Association Guidelines for CPR and ECC and the 2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients With Acute Coronary Syndromes. ACLS teaches the importance of preventing cardiac arrest, highperformance teams, continuous high-quality CPR, systems of care, recognition and intervention of cardiopulmonary arrest, post-cardiac arrest care, acute dysrhythmias, stroke, and acute coronary syndromes (ACS). The goal of the ACLS Provider Course is to improve outcomes for adult cardiac arrest, stroke and other cardiopulmonary emergencies through early recognition and time- sensitive interventions by high-performance teams.
Q: What speciϐically is taught in the new ACLS Course?
A: In the 2025 ACLS Provider Course, students will learn and practice
• Systematic approach (assessment)
• High-quality BLS
• Airway management
• Rhythm recognition
• Deϐibrillation
• Intravenous (IV)/intraosseous (IO) access (information only)
• Use of medications
• Cardioversion
• Transcutaneous pacing
• High-performance teams
Q: What are the key differences between the 2020 Guidelines and 2025 Guidelines versions of the ACLS Provider Course?
A: The 2025 ACLS Course includes the following updates:
Course Videos
• Course videos have been fully updated, except for the Coping with Death course video, that includes a new look, updated graphics, and updated animations.
Instructor Manual
• The Instructor Manual (IM) has been updated with new illustrations, updated checklists, and includes an emphasis on objective testing. With a focus on measuring and reporting chest compression fraction (CCF), checklists now include space to record team CCF. Provider Manual Updates
• The Provider Manual (PM) has been updated with new science and new illustrations. Please refer to the 2025 ACLS Science Summary Table for speciϐic science changes.
Q: What is the format for the ACLS Provider ILT Course?
A: In the new ACLS Provider ILT Course, video prework can be completed before the course depending on the agenda chosen by the Training Center (TC) so that students are more prepared for the course..
Video prework includes the eight video lessons, each followed by interactive questions to check for learning..
The course is structured as follows:
• Core concepts are presented through case-based scenarios around a manikin as a team during class.
• The CPR Coach and Instructor coaches students by using a required feedback device as they practice CPR and ventilation skills.
• The Instructor monitors as each student/team demonstrates skills proϐiciency as outlined in the learning station checklists and the skills testing checklists.
• Students take the ACLS Provider Course Exam to conϐirm their understanding of core concepts. The TC may choose for students to complete online video lessons (prework) before coming to class, or may choose to conduct a regular ACLS course, where all video lessons are conducted in class as interactive discussions with students. The course is designed to give students the opportunity to practice and demonstrate proϐiciency in the following skills used in resuscitation:
• Systematic approach (assessment)
• High-quality BLS
• Airway management
• Rhythm recognition
• Deϐibrillation
• Intravenous (IV)/intraosseous (IO) access (information only)
• Use of medications
• Cardioversion
• Transcutaneous pacing
• High-performance teams
Q: Is there an ACLS Update Course?
A: Yes. ACLS Target Audience
Q: Who is the intended audience for the ACLS Course?
A: The ACLS Course is designed for healthcare professionals who either direct or participate in the management of cardiac arrest, stroke or other cardiopulmonary emergencies. This includes personnel in emergency response, emergency medicine, intensive care/critical care units and surgery such as physicians, nurses, and paramedics, as well as others who need an ACLS course completion card for job or other requirements.
Q: What are the prerequisites for taking the ACLS Course?
A: Providers who take the ACLS Course must be proϐicient in the following:
• Performing high-quality BLS skills according to the current American Heart Association Guidelines for CPR and ECC
• Reading and interpreting electrocardiograms (ECGs)
• Understanding ACLS pharmacology
• Providing bag-mask ventilation
Q: What resources are available to help prepare students for the ACLS Course?
A: The following ACLS resources are available to students at eLearning.heart.org: • Mandatory Precourse Self-Assessment
• Precourse Preparation Checklist
• Prework (Video lessons)
• ACLS Supplementary Information
• IO Video
• Coping With Death Video Precourse Self-Assessment
Q: What is the ACLS Precourse Self-Assessment?
A: The Precourse Self-Assessment is an online tool that evaluates a student’s knowledge in three sections: rhythm recognition, pharmacology, and practical application. Students complete the assessment before the course to help evaluate their proϐiciency and determine the need for additional review and practice before the course. All students must complete the Precourse Self-Assessment and achieve a score of at least 70% before taking the ACLS Course. Students must print their successful scoring report and Course Completion Certiϐicate and bring it with them to class.
Q: Why is the ACLS Precourse Self-Assessment required?
A: Students need to make sure they are prepared for the ACLS Provider Course to minimize the risk of failing the course. Market research indicates a signiϐicantly favorable response from Instructors on making the Precourse Self-Assessment mandatory. The need for the mandatory Precourse Self-Assessment has increased due to more non-traditional students taking ACLS. Course Materials
Q: What materials are available for the ACLS Provider Instructor-led Course?
A: Materials for the Association’s ACLS Provider Instructor-led training course are currently available through ShopCPR.Heart.org. Materials include:
Student Materials:
25-1106 ACLS Provider Manual
25-1120 ACLS Reference Card Set (Set of 3)
25-3100 ACLS Provider Manual eBook
25-3109 ACLS Digital Reference Cards (Set of 3)
Instructor Materials:
25-1109 ACLS Provider Course Videos:
DVD 25-1154 ACLS Provider Course Videos:
USB 25-1413 ACLS Provider Course Videos:
Digital & Streaming 25-1107 ACLS Instructor Manual
25-3101 ACLS Instructor Manual eBook
25-1138 ACLS Instructor Package:
Digital & Streaming Videos
25-1108 ACLS Instructor Package:
DVD Videos 25-1155 ACLS Instructor Package:
USB Videos Cards 25-3000
ACLS Provider eCard 25-3015
ACLS Instructor eCard Supplemental 25-1111
ACLS Posters (Set of 10) 25-1110
ACLS Emergency Crash Cart Cards (Set of 4)
25-1112 Suspected Stroke and EMS Acute Stroke Routing Algorithm Card (Pack of 25)
Course Length
Q: How long is the ACLS Course?
A: Approximate times for each version of the ACLS Provider Course with breaks are listed below:
• ACLS Course with Video Prework: 13.25 – 14.25 hours with breaks
• ACLS Update Course with Video Prework: 8.25 – 9.25 hours with breaks
• ACLS Course: 15.50 – 16.50 hours with breaks
• ACLS Update Course: 8.50 – 9.50 hours with breaks
• HeartCode® ACLS Instructor-Led Hands-On Skills Session: 6.75 – 7.75 hours with breaks Teaching the New ACLS Provider Instructor-led Course
Q: Who can teach the new ACLS Provider ILT Course?
A: The new ACLS Course may be taught by Association ACLS Instructors who have completed their 2025 Guidelines Instructor Update for ACLS and have received and reviewed their new ACLS Course Instructor materials.
Q: What resources are available to help Instructors understand the new ACLS Course and materials?
A: The Association developed the ACLS Product & Course Orientation (P&CO) to help ACLS Instructors understand the new, 2025 ACLS course design and teaching strategies, and to quickly get up to speed on the latest and most important updates to the ACLS Course materials. This orientation is available free of charge to Instructors through eLearning.Heart.org (requires login with Association Atlas credentials).
The P&CO provides ACLS Instructors with:
• Information about new course materials, course curriculum updates, and how the changes impact the way you will teach the ACLS Course
• Details, clariϐication, and direction on various course formats
• Speciϐics about new ACLS course materials
• Steps to incorporate new updates into various course settings While all ACLS Instructors are strongly encouraged to complete the P&CO before teaching the new course, it is not required. Viewing the P&CO is most helpful if Instructors have new course materials in hand while viewing.
Q: Does the 2025 ACLS Provider Course include an option for students to earn a BLS Provider Card during an ACLS class?
A: Yes. The Association does offer an ofϐicial agenda for Instructors to add BLS skills testing and an exam to provide both a BLS Provider eCard and an ACLS Provider eCard upon successful completion of the ACLS course.
If a BLS Provider card is to be issued, a BLS Instructor must be present to complete the infant CPR skills tests as well as the exam. Renewal of BLS skills during an ACLS class should be a preplanned option, with registration for the BLS portion to allow for both the students and the Instructor to prepare. Finally, during an ACLS course, if a BLS card is also being issued, it must come from the same Training Center that is issuing the ACLS card. 2025 ACLS Exam
Q: Are students allowed to access resources when taking the ACLS Provider Course Exam?
A: The Association has an open-resource policy for exams. Open resource means that students may use resources as a reference while completing the exam. Resources could include the provider manual, either in printed form or as an eBook on personal devices, any notes the student took during the provider course, the 2025 Handbook of ECC for Health Care Professionals, etc. Open resource does not mean open discussion with other students or the Instructor. Students may not interact with each other during the exam. Continuing Education (CE) Information
Q: Does the ACLS Provider ILT Course offer continuing education (CE)?
ACLS or ACLS for Experienced Providers
For healthcare professionals who either direct or participate in the management of cardiac arrest, stroke, or other cardiopulmonary emergencies. This includes personnel in emergency response, emergency medicine, critical care/intensive care, and surgery such as Physicians, Nurses, and Paramedics, as well as others who need an ACLS course completion card for a job or other requirement.
What does this course teach?
Systematic approach (assessment)
High-quality BLS
Airway management
Rhythm recognition
Defibrillation
Intravenous (IV)/intraosseous (IO) access (information only)
Use of medications
Cardioversion
Transcutaneous pacing
High-performance teams
Advanced Cardiovascular Life Support (ACLS) Course Options
Advanced Cardiovascular Life Support (ACLS) Course Options
ACLS for Experienced Providers:
For those who are proficient in performing BLS and ACLS skills, reading and interpreting ECGs, understanding ACLS pharmacology; and who regularly lead or participate in emergency assessment and treatment of prearrest, arrest, or post-arrest patients.
What does this course teach?
Cardiovascular Emergencies
Respiratory and Metabolic Emergencies
Toxicology Emergencies
Post-Cardiac Arrest Care
Learn more about the ACLS for Experienced Providers course
New 2025 Guidelines for ACLS
Foreign-Body Airway Obstruction: Adults, Children and Infants
New 2025: For adults with severe foreign-body airway obstruction (FBAO), repeated
cycles of back blows followed by 5 abdominal thrusts should be performed until the
object is expelled or the person becomes unresponsive.
AED Pad Placement
Anterolateral (High right, low left) or Anteroposterior (AP) Placement - 2 options
1). Center of the chest and center of the back
2) Place one on the upper left chest above the nipple and the other on the left side of
the back near the spine.
It is reasonable to adjust the position of a patient's bra instead of removing it when
placing pads.
Rigid cervical collars are no longer recommended for neck or spinal injuries as the can make it more difficult to maintain a patent airway. Mouth-to-nose ventilation may be necessary if ventilation through the person’s mouth is impossible because of trauma, positioning, or difficulty obtaining a seal.
A case series suggests that mouth-to-nose ventilation in adults is feasible, safe, and effective. After identifying an adult in cardiac arrest, a lone responder should activate the emergency response system first, then immediately begin CPR. In adult cardiac arrest, rescuers should perform chest compressions with the patient’s torso at approximately the level of the rescuer’s knees.
CPR for adult cardiac arrest patients with obesity should be provided by using the same techniques as for the average weight patient.
Higher first-shock energy settings (≥200 J) are preferable to lower settings for cardioversion of atrial fibrillation and atrial flutter. Updated termination of resuscitation (TOR) guidelines emphasize rule application based on emergency medical services (EMS) scope of practice (basic life support [BLS], ALS, or universal TOR rule [UTOR]), and that end-tidal carbon dioxide (ETCO2) should not be used in isolation to end resuscitative efforts.
Administration of intra-arrest medications via an in-place endotracheal tube) have been removed.
Use of point of care ultrasonography (POCUS) by experienced professionals during cardiac arrest may be considered to diagnose reversible causes if it can be done without interrupting resuscitative efforts (ie, CPR). Polymorphic ventricular tachycardia is always unstable and should be treated immediately with defibrillation, because delays in shock delivery worsen outcomes.
Intravenous (IV) access remains the first-line choice for drug administration during cardiac arrest; however, intraosseous (IO) access is a reasonable alternative if IV access is not feasible or delayed.
Post Cardiac Arrest Care - Maintain MAP >65 and target SPO2 90%-98%. Maintain 100% FIO2 until reliable SPO2 can be measured.
Unstable Tachycardia is now defined as SBP below 80 and should be synchronized cardioverted.
Stable Tachycardia Cardiovert / Adenosine 6 mg, 12 mg then start a Procainamide OR
Amiodarone drip.
(For synchronized cardioversion of atrial flutter in adults, an initial energy setting of
200 J may be reasonable and incremented in the event of shock failure, depending
on the biphasic defibrillator used.)
Review New Adult and Pediatric Ventricular Assist Device Algorithm
Therapeutic Hypothermia has been extended to a minimum of 36 hours.
Adults and Children with Life Threatening Asthma Exacerbations refractory to
standard therapy may benefit from EMCO.
Hyperthermia: Adults and children with life-threatening hyperthermia from
environmental causes, cocaine poisoning, or sympathomimetic poisoning should be
rapidly cooled, ideally at a rate of at least 0.15 °C/min (0.27 °F/min). This is best
achieved with immersion in ice water.
It is recommended that health care professionals first attempt establishing IV access
for drug administration in adult patients in cardiac arrest. Intraosseous (IO) access is
reasonable if initial attempts at IV access are unsuccessful or not feasible for adult
patients in cardiac arrest.
This concludes the NEW 2020 Changes for ACLS
When Performing CPR
Always begin with chest compressions, not breaths. Give 30 compressions and 2
breaths.
5 cycles of 30 compressions and 2 breaths = 2 minutes.
Check for a pulse every 2 minutes, and switch providers every 2 minutes so that the
person giving compressions does not get too tired. High quality compressions must
be given.
For adults, compress at least 2 inches or 5 cm. Do not compress more than 2.4 inches
or 6 CM. Always let the chest completely recoil between compressions. Provide 100 to
120 compressions per minute.
Don't spend more than 5 - 10 seconds assessing the patient, and checking for a pulse,
or switching compressors.
If you are unsure if they have a pulse, begin chest compressions. Keep interruptions
in chest compressions to 10 seconds or less.
WAVEFORM CAPNOGRAPHY
Waveform capnography is written as PETCO2 (Partial End Tidal Carbon Dioxide)
Waveform capnography is used to measure CPR quality and determine ROSC (Return
of Spontaneous Circulation).
Think of ROSC as "Return of Life". If CPR is being done, and the patient's heart starts
beating again on it's own, the patient has achieved ROCS, or return of life.
Waveform capnography is the MOST reliable indicator of ETT placement. If the
person doing the intubation happens to get the ETT into the esophagus vs the
trachea, there would be no waveform capnography reading.
A PETCO2 of less than 10 indicates ineffective chest compressions. Treatment should
focus on improving the quality of chest compressions. A PETCO2 greater than 10
indicates effective chest compressions . Normal PETCO2 is 35-40mmHg.
Don't get the waveform capnography confused with the colormetric device. A
colormetric device only changes color and indicates the detection of CO2 in the tube.
RESCUE BREATHING
When providing breaths, if doing compressions give 30 compressions and 2 breaths.
Each breath should be given over 1 second, and only until you see the chest rise.
Giving a bigger breath will only fill the stomach with air which will crush the
diaphragm, chest, lungs, and crush the heart making it difficult to resuscitate your
patient and decreasing cardiac output.
If your patient has a pulse and simply cannot breath, provide rescue breaths at a rate
of 1 breath every 6 seconds. This gives you 10 breaths/min
If your patient is intubated (has an advanced airway), provide 1 breath every 6 seconds
= 10/min. When an advanced airway is in place, compressions should not be paused
to give breaths.
If your patient has agonal gasps, this is NOT normal breathing and is a sign of cardiac
arrest. Start CPR.
GUIDELINES FOR SYNCHRONIZED CARDIOVERSION AND DEFIBRILLATION
The only difference between defibrillation and cardioversion is: One is synchronized,
and one is not.
Synchronized cardioversion is a LOW ENERGY SHOCK that uses a sensor to deliver
electricity that is synchronized with the peak of the QRS complex (the highest point
of the R-wave).
If the patient has a pulse, you must push the synchronize button on your defibrillator,
before you deliver the shock. This will ensure that the shock lands on the R-wave of
the heart beat.
If you do not synchronize the shock on someone with a pulse, the shock could hit the
heartbeat on the T-wave and cause the patient to go into ventricular fibrillation. This
will be bad. Very, very bad.
So just remember, you can’t synchronize dead. If the patient has a pulse, you must
synchronize the shock.
HOW MANY JOULES DO YOU USE?
Start with 200 Joules
If the initial shock fails, always increase the dose in a stepwise fashion.
THERAPEUTIC HYPOTHERMIA
Used only when your patient remains unresponsive following cardiac arrest,
especially those who presented with an initial rhythm of v-fib.
These patients are cooled to 32-34 degrees celsius for at least-36 hours.
If your patient wakes up and follow commands, do not start hypothermia protocol.
Therapeutic Hypothermia can be combined with PCI (Percutaneous Coronary
Intervention) or "heart cath" or "angiogram". Therapeutic hypothermia can be started
after return of ROSC and then can be continued in the Catheterization Lab.
CHEST PAIN
Any patient having chest pain should have an EKG first. You must know if they are
having a STEMI.
STEMI (ST segment elevation) must go to the cath lab for an angiogram or they will
die. The heart muscle is not perfusing. Just remember, if the ST segment is elevated
and pointing toward heaven, your patient is GOING TO HEAVEN without immediate
intervention.
NSTEMI (ST depression) usually are able to go home on blood thinners. Having a
depressed ST is not as life threatening as "going to heaven".
The only exception to the EKG first, is a patient where the chest pain is caused by
their increased heart rate.
If they are in an unstable tachycardia WITH A PULSE, synchronized cardioversion
should be the first treatment.
So, if an ambulance is bringing you a STEMI patient, and your facility does not have
the capabilities to do a heart cath, or angiogram, these patients need to be diverted
to a specialty cardiac hospital even if it’s an hour away. If you accept the patient, you
then have to get admit orders, have consents signed, do the whole medication
7
reconciliation, then get transfer orders, find an accepting doctor and transfer the
patient anyway.
Door to balloon inflation time should be 90 minutes or less. The patient would be
better off getting closer to a hospital that specializes in handling an acute heart
attack, or M.I. (Myocardial Infarction or "heart muscle damage/death", and has a
catheterization lab.
Suspected Stroke
Assess Facial droop, arm drift, slurred speech and get the time the symptoms first
started. This is super important! Get the time.
Some facilities call this a "FAST" or Cincinnati Stroke Scale If the CT scan is negative
and there is no sign of hemorrhage, Fibrinolytics should be started as soon as
possible.
The THIRD thing you need to do is get that CT SCAN. The CT scan should be done
within 25 minutes of the patients arrival in the ED. You need to know if they are
having an ischemic stroke or a hemorrhagic stroke. If they are bleeding, they will not
get the fibrinolytics. Once the CT is done, there is no sign of bleeding and no
contraindications, administer the fibrinolytics as soon as possible.
The American Heart Association defines PEA as sinus rhythm without a pulse. During
a CODE situation, you should check a pulse EVERY 2 MINUTES. If the monitor shows
sinus rhythm or sinus bradycardia and there is no pulse, your patient is dead !
Continue chest compressions and administer 1 mg of Epinephrine. Reassess the
rhythm and the pulse EVERY 2 MINUTES and follow the cardiac arrest algorithm.
Atropine is the first line treatment for any bradycardia regardless of the type, if
Atropine is ineffective a dopamine drip should be started at 2-20 mcg/kg/min. A good
place to start is at 5mcg/kg/min. Titrate to desired heart rate. If the heart rate does not
increase, increase the dopamine drip rate. If the heart rate is too fast, decrease the
dopamine drip rate. Run the dopamine until external pacing begins.
HOW TO PERFORM EXTERNAL PACING
STEP 1: Turn on defibrillator and set to PACER mode.
STEP 2: Place defib pads on your patient AND the 3 leads: red, white and black.
STEP 3: Get a doctor's order to pre-medicate your patient. Pacing is VERY PAINFUL !
STEP 4: Begin pacing. PRESS THE START BUTTON ! Your pacer should have default
settings of a heart rate between 60-70 and a millivolt setting anywhere between 5
and 30.
STEP 5: If your patient's heart rate does not increase, increase the millivolts by 5 every
couple of heart beats until your patient is 100% paced.
NOTE: You must have defib pads AND the 3 leads connected to your patient. BOTH of
these must be connected to the defibrillator. The 3 leads (red, white and black) sense
what your patient's heart rate is. So if your patient's heart rate is 40 and your pacer is
set to a heart rate of 60, the pacer will shock them 20 times per minute for a total of
60/bpm. If your patient's heart rate gets up to 61 nothing will happen. If their heart
rate drops to 59 they get shocked once per minute. If it drops to 58 they get shocked
twice per minute and so on. Without the red, white and black lead, your pacemaker
will not know what to do. (If you can remember: White on the right, and smoke
above the fire")
Provide a fluid bolus of 1-2 liters if the patient remains hypotensive after ROSC.
If you are going to induce therapeutic hypothermia, use COLD saline for the bolus.
The minimum systolic BP to achieve is 90mmHg.
Providing quality chest compressions immediately before a defibrillation attempt
and giving drugs during compressions will improve successful conversion of V-Fib
and the return of ROSC.
The American Heart Association says that it is acceptable to stop resuscitation efforts
if the patient has not had a pulse for 15 consecutive minutes. Except in special cases
of drowning or hypothermia.
Always be aware of safety hazards. Don’t ever cut adult pads in half or shock a
patient if there is oxygen blowing across their chest. The oxygen combined with the
electric spark could cause a small explosion or ball of fire that injures everyone in the
room.
Always provide chest compressions while the defibrillator is charging. The time it
takes to analyze is several seconds, you want to make the hands-off period of time as
short as possible. Some defibrillators can take up to 45 seconds to charge.
Always make sure you have a 6 second rhythm strip if you are going to be counting
the QRSs by 10 to get your heart rate. If you have a 12 second strip and do this you are
likely to end up with a heart rate of 80 when it’s actually only 40. The treatment is
significantly different.
WHAT'S THE DIFFERENCE BETWEEN DEFIBRILLATING AND CARDIOVERSION?
There are 2 types of shocks. One is synchronized and one is not.
A synchronized shock is called cardioversion. A blind shock is defibrillation.
If I blindly charge the defibrillator and shock them, if the shock happens to land on
the last part of the heartbeat called the "T-wave" this will change their rhythm to
V-Fib. This would be bad !
But if I "Synchronize" the shock by pushing the "synch" button on the defibrillator, a
small dot or line will appear above every "R-wave" (which is the tallest portion of the
heartbeat). Then when I push the shock button, the machine will automatically
synchronize the shock so that it lands on the "R" wave
Now, do you see how you can't synchronize dead? You can't synchronize a shock to
land on a particular part of a heartbeat if there is no heartbeat.
MORE AWESOME TIPS:
Always allow the chest to completely recoil when doing compressions. Say there was
a small fire, and you had a water bottle full of water. Would it make sense to squeeze
tiny amounts out really really fast? Or, would it make more sense to give the bottle a
good squeeze and force out as much water as you can at one time, and repeat?
When you compress the chest, it squeezes a small amount of blood out. By letting
the chest completely recoil with each compression, more blood is squeezed out with
every compression.
The only rhythm you will ever shock is V-Fib and pulseless V-Tach (Because you can't
synchronize DEAD)
The biggest misconception people have is that when you shock someone, you jump
start the heart just like you would jump start a car. This is not true. When the heart is
in Ventricular Fibrillation or Pulseless
Ventricular Tachycardia the heart is quivering. The heart is getting told to contract
too fast, from too many different cells that it can't possibly keep up and just begins to
vibrate. For example: My computer gets a virus. The first thing I want to do is pull the
cord from the wall and stop the virus. I don't want to start opening other programs
and get them running too. The same goes for V-Fib and Pulseless V-Tach.
13
The shock stops the heart completely, giving it a chance to start over and hopefully
produce a normal organized rhythm. So if defibrillating actually stops the heart, do
you see why shocking someone in asystole doesn't make any sense? Why shock
someone to stop the heart, when their heart is already stopped.
So remember V-Fib = DEFIB.
For every heart rhythm
Pulse or not - no pulse, start CPR
If they have a pulse, is it too fast or too slow
Is it Vfib or Pulseless Vtach - they need a shock
First In Last Out Medical Response at 3322 Coors Blvd NW Suite 4 Albuquerque, New Mexico 87120
