Five Steps to ADULT Cardiac Arrest

ADULT Cardiac Arrest (absence of a Palpable pulse) could be a bummer, Not for our Students. 1.      Is a Defibrillator/AED available?       If so, Use It. Anytime a shockable rhythm is present, It Should Be Defibrillated. 2.      On a, b. or c.  Start CPR; a.       Immediately after the Defibrillation b.      If a non-shockable rhythm is encountered c.       Defibrillator/AED is not available or inoperable 3.      IV/IO Access; Give 200ml-500ml IV Bolus, as fast as you can get it in (60-90sec) Fluids should be given by High volume infuser or using a pressure Bag, using 0.9NS. Administration of fluids and Drugs should always be done during compressions. 4.      Administer 1mg/10ml Epinephrine every 3 minutes (the only clock you need to remember), better if done consecutively with Fluids. 5.      By the 3rd Defibrillation if you still have a shockable rhythm, consider Amiodarone before the 4th Defibrillation: May be repeated if shockable rhythm persists. a.        1st dose: 300mg/6ml IV Bolus b.      2nd dose: 150mg/3ml IV Bolus GOTO Step 2

ADULT Cardiac Arrest (absence of a Palpable pulse) could be a bummer, Not for our Students. 1.      Is a Defibrillator/AED available?       If so, Use It. Anytime a shockable rhythm is present, It Should Be Defibrillated. 2.      On a, b. or c.  Start CPR; a.       Immediately after the Defibrillation b.      If a non-shockable rhythm is encountered c.       Defibrillator/AED is not available or inoperable 3.      IV/IO Access; Give 200ml-500ml IV Bolus, as fast as you can get it in (60-90sec) Fluids should be given by High volume infuser or using a pressure Bag, using 0.9NS. Administration of fluids and Drugs should always be done during compressions. 4.      Administer 1mg/10ml Epinephrine every 3 minutes (the only clock you need to remember), better if done consecutively with Fluids. 5.      By the 3rd Defibrillation if you still have a shockable rhythm, consider Amiodarone before the 4th Defibrillation: May be repeated if shockable rhythm persists. a.        1st dose: 300mg/6ml IV Bolus b.      2nd dose: 150mg/3ml IV Bolus GOTO Step 2

Asystole - Prove It!

I can give a scientific view to Asystole. In Asystole your patient's heart is DEAD, Zero electrical activity.  So, Let's Prove It! There is a difference between discontinuity and a real Rhythm on the monitor. A Flat Line is usually never real, check LEADS. Asystole is defined as a cardiac arrest rhythm in which there is no discernible electrical activity on the ECG monitor. Asystole is sometimes referred to as a “flat line.” Confirmation that a “flat line” is truly asystole is an important step in the ACLS protocol. Put in a new Compressor  Switching out to a fresh Compressor gives you a baseline for the compressions. This will get you good compression's for at least the next minute. During Compression's (with new Compressor) check for Carotid & Femoral Pulses. Pulses don't have to be great but, THEY MUST BE PRESENT, or the compression's are useless to the patient. If you don't feel pulses, start fluids immediately, 200-500 ml NS, over 1 minute. Has anyone checked the Rectum?  It may sound funny, but it's not a Joke.  A diaper can hold 2 liters of blood and you would never know, unless you look.  If the patient isn't wearing a diaper, well then theres nothing in the way to help you see all that blood if  they are bleeding out. This doesn't change what your doing but, it may explain why your not going to be successful. Think a little; Bright Red Blood in the diaper or coming out the rectum;  A GI bleed is usually a slow process, and now your pushing on their chest.   Check the IV/IO line?   If the asystole is real, FLUIDS may be your only reversible cause at this point. Make sure the IV line is patent and flows freely.  If the line has infiltrated, then it's useless. An Intraosseous access line will not even flow without a pressure bag attached. Unless your pushing fluids manually, Use a pressure bag! Did the patient get what you intended to administer? If the fluids aren't getting to the patient, you won't be very successful with asystole. Epinephrine 1 Mg in 10 ml of every 3 minutes. Did you make a change in the patient with the above steps?​​​​​​ Anything is better that asystole.  What's on the cardiac monitor? Ventricular Fibrillation: Great Job, don't forget to defibrillate. PEA (Pulse Electrical Activity); Again, Great Job; Your patient MAY have a chance. PEA is the precursor to asystole. So, to get PEA after asystole, your going in the right direction. With PEA, give another Fluid Bolus 500 ml NS.l. If you still have asystole; well, you didn't make them any worse. Then GOTO Step 1 and do it again. Your getting closer to Proving the asystole may be real. After doing the above twice with the same results, you can conclude, it’s not you or your actions, but that the patient is REALLY in asystole. To this day, there isn't any proof of a single patient coming back from the dead.  Asystole isn't Asystole until you prove it. Discontinuity can give you Asystole, without a blood flow from the heart to the skin, continuity cannot be accomplished.  So the most important thing to do in asystole is give fluids.  That’s why the protocols tell you to give fluids, VOLUME is your friend in PEA and Asystole. If you don't feel a carotid pulse during CPR, your compressions are bad or your patient may have had an aneurysm that ruptured (carotid, aortic, ect).  (guess what, More Fluids Please) If you don't feel a Femoral pulse during CPR, your compressions are bad or your patient may have had a AAA rupture.  (guess what, More Fluids Please) If the IV/IO line isn't’t working, your patient didn't get any fluids.  So it’s important to check that your line is functional. In a cardiac arrest there’s only so much you can do to help your patient’s heart start. 1)    The most important thing to do is SHOCK a shockable rhythm any time you see it. a)    After that shock, CPR immediately. i)      Unless your patients heart was beating a second ago, it takes 30 seconds to a minute of compressions after the shock, to develop a circulation.  Checking for a pulse after the defibrillation is useless, theres no guarantee it will keep going unless you help it.  That's what compressions do after the shock, they help develop a circulation.  Otherwise, that heart may start and stop until its dead.  Help the heart develop a circulation. ii)     Your vascular system has to be functioning in order for a blood pressure to . 2)    Fluids, everyone in cardiac arrest should get fluids. a)    Fluids, in a cardiac arrest, are your friend. i)      You see asystole, you start CPR, now you see Ventricular Fibrillation (Vfib). All you did was create a connection to the patient. Your compressions got the blood flow needed to measure what was inside that patient’s chest the whole time. You just gave fluids and the asystole just became Vfib.  This is explained very easily.  A dead heart will not change back to anything but more dead, if you made asystole change, look back at what you just did, it was Fluids and CPR. Our biggest problem in CPR is chest compressions and fluids.  We do compressions as best we can, but if a human is involved, well then it can vary a little.  Look at the cardiac arrest stats on patients over 400 lbs.  You'll find witnessed cardiac arrest to have the best results on that category of patients.  Why, Once the blood leaves the chambers of the heart, your CPR may not be effective enough to get blood back to the heart.  Hence, best outcomes when the vascular system is still primed.  We do reach a point of non-functionality; this is a mechanical coefficient.  In other words, even if the compressor is twice the size of the patient, you still won’t be able to move enough blood to the heart.  This is due to the patient’s body not allowing recoil of the chest; adipose tissue (30+kg) absorbing the compression, resulting in much less force to the chest.  When you add the final factor, how high is that chest if their 400+lbs.  Even if everything we do is correct, the bariatric patient is a fragile one.  Once blood leaves that heart your fighting a head wind. Bedside defibrillator, as a minimum, for any bariatric patient that needs monitoring.  The amount of  time it takes to leave the room and get the equipment could be detrimental in trying to reverse even Ventricular Fifbrillation. Just a little of my input on asystole.  Hope it helps.

About GoACLS

GoACLS Training Center, offers certifications by American Heart Association ( AHA ). Chosen for their wide recognition within healthcare.GoACLS offers you the training you need in the comforts of your own office or at one of our training facilities. We will work within your schedule and time frame to accomplish all your certification needs. We offer a variety of courses including some that we have developed for the Healthcare industry.We offer certifications from the American Heart Association (AHA) and the American Safety and Health Institute (ASHI). Both were chosen for their wide recognition within healthcare. Our instructors work in the medical community. Most are hospital based and can bring a vast of knowledge and firsthand experience to the training seminars. With experience comes educator value. Our staff brings that value to our students.Throughout the year, we have some seasonal specials. Also, if you would like to setup your own group just give us a call. We will reply back to you with a special price (Promo Code) for your group to use when registering. Either sign then up as a group or let each student sign up on there own (using the Promo Code). We make it that simple.Corporate clients may contact us directly (888-503-3113) so that we may discuss your needs and expectations.Dental and medical private practices, we can train your staff using a blended Online and Onsite course. This allows your staff to complete the Online portion at home and then a few minutes onsite skills evaluation per person and their certified.

 

Excellent! - Great Class Room! - Gerry is extremely experienced and an exceptional instructor. I plan on definitely returning to Gerry for my next "Life Support" renewal. Special "Note" to the "Long Island People" - Don't worry! - The Glendale Location has plenty of parking for your "Giant Super Sized" SUV's & Pick Up Trucks :-) - Sorry, couldn't help myself! On another note, - Gerry - Thank you for keeping things "Real" - I enjoyed your course!Read Louis R.'s review of GoACLS Training Center on Yelp

Very knowledgeable instructor for ACLS. The instructor has a good attitude and came across like he cared about what he teaches.The learning environment was comfortable and stress free. Received my card the same day. Thank You. Read Elina K.'s review of GoACLS Training Center on Yelp

Can't get too excited about professionally mandated re-certification. That stated, my experience with GoACLS Training Center was only positive. Straightforward, informative, and stress free. I wholeheartedly endorse this business.Read Eli G.'s review of GoACLS Training Center on Yelp

Jerry is an amazing instructor! He is very knowledgeable and breaks the information down to you in a simple way you can understand. By the time the test comes it is a breeze!Read Diana A.'s review of GoACLS Training Center on Yelp

Which course do you need?

BLS Provider is CPR for healthcare workers.  The BLS course includes Adult, Child and Infant cpr and AED instruction. If you work in healthcare  and need to learn CPR, this will be the correct course. We offer BLS classes 3 times a week. Links to BLS class Schedules: Fridays Initial & Renewals from 9:00 AM - 1:00 PM Days - Initial & Renewals every Fridays ; https://goacls.com/bls-schedules-days  Evening -  Mondays & Wednesdays - Renewals Only from 5:00 PM - 7:00 PM  Evenings Renewals: https://goacls.com/bls-renewal-schedules-evenings  You must register before coming to class.   We do not accept Walk Ins during class.  Please register on our website before coming to class. Registrations stay open until class starts, so you can always register before class starts.    

The ACLS course, Advanced Cardiac Life Support is for anyone working in an area that can have cardiac emergencies. ACLS has many levels of care, all dictated by scope of practise. If you work in healthcare  and need ACLS training, you will be told by your employer.  Working in a Cardiac unit, ICU, CCU, ERD], this will be the correct course. We offer ACLS classes 7 times a week. Links to ACLS class Schedules: Monday, Tuesday, Wednesday, Thursday Saturday & Sunday. Initial & Renewals from 9:00 AM - 5:00 PM (usually done by 3PM) Days - Initial & Renewals ; https://goacls.com/bls-schedules-days  Evenings -  Tuesdays & Thursday - Renewals Only from 5:00 PM - 9:00 PM  Evenings Renewals:  https://goacls.com/acls-providers-update-evenings  You must register before coming to class.   We do not accept Walk Ins during class.  Please register on our website before coming to class. Registrations stay open until class starts, so you can always register before class starts.    

PALS Provider is a very specialized course.  Usually used in the Emergency departments, Pediatric departments and Pediatric Intensive Care  environments. Many new Grads get PALS to beef up their resume.  As one of our students, we keep an open door policy.  Any of our students can sit in (Audit) on any of our regular courses. We offer PALS 5 times a week. Wednesdays, Saturdays & Sundays : Initial & Renewals from 9:00 AM - 5:00 PM (usually done by 3 PM) Evening -  Tuesdays & Thursdays - Renewals Only from 5:00 PM - 9:00 PM (usually done by 8 PM)    You must register before coming to class.   We do not accept Walk Ins during class.  Please register on our website before coming to class. Registrations stay open until class starts, so you can always register before class starts.

If your card is expired or you have never taken the Initial course, then you must take the Initial course.

What Students say about us

 

Excellent! - Great Class Room! - Gerry is extremely experienced and an exceptional instructor. I plan on definitely returning to Gerry for my next "Life Support" renewal. Special "Note" to the "Long Island People" - Don't worry! - The Glendale Location has plenty of parking for your "Giant Super Sized" SUV's & Pick Up Trucks :-) - Sorry, couldn't help myself! On another note, - Gerry - Thank you for keeping things "Real" - I enjoyed your course!Read Louis R.'s review of GoACLS Training Center on Yelp

Very knowledgeable instructor for ACLS. The instructor has a good attitude and came across like he cared about what he teaches.The learning environment was comfortable and stress free. Received my card the same day. Thank You. Read Elina K.'s review of GoACLS Training Center on Yelp

Can't get too excited about professionally mandated re-certification. That stated, my experience with GoACLS Training Center was only positive. Straightforward, informative, and stress free. I wholeheartedly endorse this business.Read Eli G.'s review of GoACLS Training Center on Yelp

Jerry is an amazing instructor! He is very knowledgeable and breaks the information down to you in a simple way you can understand. By the time the test comes it is a breeze!Read Diana A.'s review of GoACLS Training Center on Yelp

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