ACLS CERTIFICATION - IMPORTANT TIPS TO PASS THE ACLS CERTIFICATION LIKE A BOSS QUICK GUIDE

so today we're gonna talk about a video that's been very very long requested it is the ACLS how to pass it like a boss so stay tuned [Music] so I want to preface this video by saying we're gonna kind of go over a little bit of your BLS as well as your ACLs I'm not gonna make a separate video for BLS just simply because of the fact that a lot of the information that's covered in your BLS is also really covered in your ACLs um so I'm kind of combining those together so if you listen to the course I'm gonna touch on key points I'm not gonna go into a full depth conversation regarding ACLs mpls I'm really gonna cover what's important for you to know for your Mecca code as well as what you need to know for your tests so to begin with we're gonna start off with our basic life support information so what is the first thing that you're gonna do in regards to your ACLs as well as your BLS you're gonna check for responsiveness of the patient you're gonna attack the patient hey are you okay if they don't answer you you're gonna shout for help you want to immediately activate the emergency response system let that person know this activating it or if there's someone else there please find me an AED or defibrillator some people know them a little bit differently some people don't know what an AED is step three you want to check for breathing and pulse if there is no pulse and no breathing you're gonna begin CPR immediately but the one top key thing that you need to know and what will probably be on your test as well as your megacode is you want to check for breathing and pulse no more than 10 seconds 10 seconds at the max start CPR if a pulse is present you can start rescue breathing if somebody's kind of just gasping for air not agonal gas but just kind of unconscious but they have a pulse you wanted to start rescue breaths make sure that oxygenation is getting to the brain when you're doing compressions the main number one thing red red you see it in red is you need to do a hundred to a hundred and twenty chest compressions per minute that is ACLS guidelines as well as BLS guidelines respirations one every five to six seconds you do not want to do more than that because you can't actually hyperventilate the so when you begin your mega code you're gonna fall a very detailed plan of how you're going to assess and treat these patients so you're always gonna start out with your basic BLS which we just covered then you're gonna move on to your primary survey which actually has a very good mnemonic it's a b c d e your airway your breathing your circulation your disability in your exposure all of which we'll cover don't worry and then you've got your secondary survey we're gonna cover that at the end of the primary survey so to begin we're gonna start with her a our airway you're gonna maintain a airway patency and unconscious patients whether that is putting in an advanced airway whether it is bagging until you can get an advanced airway we need to make sure that the airway is paint we need to confirm that our CPR our ventilations are adequate so what does that mean we're making sure that we're pushing 100 to 120 compressions per minute and that we're giving one breath every five to six seconds something very big you need to know when you're doing your megacode is you want to secure the device you want to make sure that once a airway is placed that that device is secured on that patient so that it is not moving those are very important things that you need to know for your megacode you want to monitor the airway placement how do you do that it continuous quantitative wave form capnography so there's a couple different things that that is achieved by there's a little device that actually sits on the bag that'll change colors if there is positive co2 moving in and out of the patient there is also a machine that you can hook the patient up to that'll actually give you information regarding their capnography where they at are at in their carbon-dioxide their co2 usually between 35 to 45 is what is achievable in regards to a stable patient however if your patient is not stable or they've been in cardiac arrest for a period of time obviously those numbers are gonna be a little bit different so moving on in our primary sir we're gonna go on two breathing you're gonna give supplemental oxygen is needed really a hundred percent oxygenation for those that are in arrest and you want to titrate the oxygen for staple patients so the patient is stable they have a pulse they're breathing but their oxygenation is a little bit low obviously you want to give them oxygen and just titrate it until you reach what you need to reach usually equal to or greater than 94% oxygenation you want to avoid that excessive ventilation that we talked about earlier because that's no good to anybody and then another important thing that you need to know that's very important is agonal gas are not considered normal breathing it's actually one of the first signs of cardiac arrest so if somebody is having agonal gas then you need to start CPR immediately do not wait so for your circulation we're gonna continuously monitor CPR quality during this time you want to make sure that we're minimizing interruptions and checking for the pulse no more than 10 seconds 10 seconds seems to be a big number that is on ACLs and that is a good thing to know so make sure that you're minimizing those interruptions and that you're checking for that pulse no more than 10 seconds if the person who is performing the CPR is not providing effective chest compressions it is okay to give positive constructive criticism or feedback to that person hey and notice that you're slowing down a little bit you know do you need a break you need to switch out or can you keep up it's just that way we're treating the patient effectively while also maintaining a good team dynamic which we'll talk about a little bit later we want to make sure that we're attaching that monitor defibrillator AED because we want to know what's going on is our chest compressions effective do they have a heart rhythm do they have a heart rate potentially so those are things that we need to monitor the first thing when you are in the field and this is important because this will come back to you is you want to make sure that when you have the AED present these the very first thing you do before you attempt touch pads before anything else is turning it on trust me you need to know this this is very important as soon as you get it before anything else you turn it on then you follow the prompts the ad will prompt you on what to do once it is our nation you want to obtain that IV and IO you need to start that immediately that way we can start getting those medications onboard and start getting some fluid pumped into these patients like I said give the appropriate medications based on what the patient is presenting with we want to administer those IV I hope fluids start getting some more of that vasculature moving and then we want to check their blood glucose blood glucose a lot of times when people are unconscious is because you know their blood sugar is low and those are things that you have to remedy to fix what is going the underlying problem you also want to check their temperature I can't tell you how many people in megacode don't check temperature and it's one of the main things that they tell you to check so if anything that you're running from this course what you're doing you're megacode is you want to check that temperature and lastly you want to check the capillary refill you want to make sure that they're profusing appropriately no more than three seconds and another thing as well is burning blood pressure blood pressures should always be at a minimum of 90 degrees I'm sorry 90 millimeters of mercury that is the standard in regards to post resuscitation efforts as well as you know during resuscitation so make sure that is a big key thing that will most likely be on your test weight you want to make sure that blood pressure is a minimum of 90 systolic so moving on into the D part of our ABCDE so we've got disability what exactly does that mean we're checking for neurological status we're making sure that we look at those pupils we're making sure that they're dilated or they're fixed we need to know those things those things ultimately tell us how the brain is profusing any loss of consciousness those are kind of things I know it sounds silly that you're talking about it now the patient's unconscious you pretty much figure that out during your BLS however when you're doing mega could they want to hear that from you I'm a poo is also another thing they want to know what the a poo is so what does that mean it a vpu so they all stand for something different a is the patient alert away with it you know you wouldn't be doing chest compressions then would you be is the patient responding to verbal stimuli can you talk to them and then they answer back to you you know having to be prompt by that verbal stimuli is the patient only responds responsive to painful stimuli do you have to you know chest rub them or chest Earl rub them to make sure that they are awake and that they can answer you that would be the P they're only responsive to the painful stimuli and then lastly of course you is a patient completely unresponsive unconscious you know you're doing CPR most of most of your cardiac patients are obviously you're gonna fall under the U so those are also very important things to know when you're doing your megacode so lastly in the ABCDE we're gonna talk about e that is your exposure so you want to remove those clothing you want to assess for obvious signs of trauma is there bleeding are there any markings do they have a medical alert bracelet you really want to take a good look at that patient to see what potentially is causing them to be in cardiac arrest so now we're coming into our secondary survey this is where we start to kind of pick up the pieces and figure out what's going on and what's really great is they have a very good mnemonic again a sample sample stands for signs and symptoms what was going on when this happened what were the signs and symptoms that led up to this allergies are they allergic to any medications medications have they taken any medications before they came in did they take any extra doses of something did they miss a dose and then potentially overdose we need to know those things past medical history you know sometimes you're going to have a patient it's completely healthy and it just happens - and they have nothing but a lot of times you're gonna have patients that have a core morbidities of everything and those are things you need to notice that you can treat the patient appropriately their last meals and liquids consumed that's very good to know in case there's any surgery or anything else that needs to take place and that events what led up to this what happened talk to me about it I know it sounds silly that we're not getting that information initially when we have the person that's in cardiac arrest are needing advanced life support however this is really where you want to get the details and figure out what's going on and the last part of our secondary survey is we want to treat what is actually causing the problem so we're gonna go back to our HSN our T's being hypovolemia hypoxia hydrogen ions hypo or hyper kami mia hypothermia tension pneumothorax tamponade toxins and a thrombosis advisor at the coronary or pulmonary kind we want to eliminate what is not causing the problem so that we can get to what is and treat it effectively so starting off with rhythms that you need to know one of the very important rhythms that you need to know is ventricular fibrillation or pulseless ventricular tachycardia this is something that usually shows up on megacode and it's a good thing to know that way you're prepared so is ventricular fibrillation or pulseless v-tach something that is important in shockable yes it is a shockable rhythm yes it is important how do we treat it outside of CPR we start by medications the first medication that we give is epinephrine one milligram every three to five minutes second-line medication is your amiodarone IV or you can also get that dose io that is 300 milligram bolus to begin with and then a hundred and fifty milligrams each consecutive dose make sure that you are well aware of how this kind of plays out so you're doing two minutes of CPR and then we're checking for a pulse we're looking at the monitor we're seeing if the monitor is giving us a shockable rhythm we shock and we continue CPR immediately then we start giving you medications it could be a little bit different in regards to where you are from regarding your facility but for ACLs purposes just make sure that you understand how that train of events occurs and then how you need to treat based on the rhythm so moving on to another rhythm is a Cicely or pulseless electrical activity what does that mean pulseless electrical activity means that the patient has no pulse however the monitor is still showing that the patient does have a whole or some kind of organized rhythm so in this situation what do we do is it a shockable rhythm now we don't shock these rhythm because again there is no rhythm what is our first line medication treatment usually epinephrine one milligram every three to five minutes and we continue CPR moving on to our bradycardic patients so if you have a stable patient that's able to talk to you in aspirated cardiac meaning that their heart rate is less than 60 therefore these patients who we usually just monitor and observe every facility is gonna be a little bit different but for ACLS guidelines that's really what it's all about if they're stable then we just want to turn to deserve them however in contrast if they're not stable we treat them immediately we do not hold back we do not wait so what do we treat them with well usually medications so we start with atropine um atropine we give point five milligrams bolus every three to five minutes we max out at three milligrams once you've reached three milligrams it's obviously not going to be effective and we move on to something else and again this is based on facilities so sometimes they'll stop way before that but for this purposes our max is three dopamine infusion is another big one we give that IV it's usually 2 to 20 micrograms per kilogram per minute based on a lot of variable factors just make sure that you listen to your physician to follow your orders and drink that bradycardia moving on to our tachycardia considerations for patients 150 beats per minute equal to or above that so for our stable patients any stable patient that we have we're always going to do a 12 lead EKG an all stable patients and I'm going to repeat that because that's important any stable patient that we have we're gonna repeat a 12 lead EKG we're gonna ask these patients that are stable 2 vagal maneuvers they're gonna you know clutch down and hold their breath and try to vagal out of those rhythms if that doesn't work then we move on to adenosine we're gonna give six milligrams rapid IV push we're gonna monitor the patient there's gonna be a brief period of time that their heart kind of stops and then restarts itself and hopefully that takes the problem now for unstable patients obviously they can't follow commands they can't do those things so what do we do we do synchronized cardioversion some facilities it's gonna be a little bit different but for the purposes of ACLs that is the number one thing that we're gonna do for unstable patients that are in these tachycardias if it is a regular narrow complex you might want to consider a Dennison again that's up to the facility but that's just also another good rule to follow torsades de pointes s which is a ventricular tachycardia rhythm it kind of looks like it's doing this on the monitor you're gonna give magnesium sulfate that's kind of like the bottom-line treatment and regards to that and that's probably potentially gonna be on that test so after a CPR at first if we do achieve a return of spontaneous circulation meaning Ross you hear that a lot with these posts on resuscitation patients then we kind of follow a different algorithm and refers to how we maintain these patients so of course like we spoke to about before we want to maintain a oxygen saturation of 94 percent or better we're gonna treat their hypotension again their systolic blood pressure needs to be greater than 90% that is the minimum in regards to what they find as an effective perfusion for systolic blood pressure I'm 12 leave EKGs all of our stable patients once they're stable and they still might be critical but stable we do 12 lead EKG s and then immediately we start temperature therapy now again facilities are different but for the purposes of ACLs we start temperature therapy immediately and we continue rechecking that therapy every 24 hours for its effectiveness so good we're to follow is you want to know your rhythms so in order to know your rhythms you need to know what they look like my suggestion for you to review is to review all your blocks you're your first three blocks for second-degree type 1 type 2 also look at your complete heart blocks they may or may not show up but it's also a good thing to know because they are quite different you want to know your ventricular tachycardias you your ventricular fibrillation no those a Sicilies know what that pulseless electricity activity is make sure you know that there is no pulse but they're showing a rhythm that's basically the initial things that you need to know that could potentially be in your megacode as well as your tests so I want to talk a little bit regarding dynamic rules these are the rules that everybody plays during a procedure whether that be cardiac arrest or any of the other kind of procedure that happens everybody has an assigned role and everybody is knowledgeable in that role I'm not gonna go too much into everything specifically regarding dynamic roles but what's important so what is important if a person is a sign of rule that they are not knowledgeable at or it is outside of their scope of practice that person needs to speak up and tell them I'm uncomfortable with that role heart I don't know that role or that is outside of my scope of practice that person is not allowed to ask another individual to do that role it needs to be whoever the team leader is that way the team leader is aware of who is doing roles during these processes another thing that is extremely important is closed looped communication you want to repeat whatever the person has said and it advised them when something is done so if a doctor tells you give epinephrine one milligram all right I'm gonna give up a nephron one milligram pulling it up now I have epinephrine one milligram ready to go once the doctor or team leader informs you okay give it you're gonna put it in there and you're gonna push I am giving epinephrine one milligram now so that way everybody knows it's a very close loop there is no questions that needs to be answered is what you're doing when you're doing it so those are really important things to know regarding your dynamic team roles and lastly we're gonna just touch a little bit on stroke guidelines your book has a very good outline in regards to what you need to know and what steps you need to follow things that are really big in regards to stroke guidelines is giving fiber lemak therapy immediately as long as there are no contraindications every facility is different in regards to the contraindications I know there also a time period in which you can give those medications um they're all different just make sure that you fall facility guidelines and the last thing is is you want to get them into a CT scan without contrast immediately the quicker that they're in there that we can find out if it is an ischemic stroke or a hemorrhagic stroke the quicker we can treat the patient I hope this video was very helpful to you it was very helpful for me when I started taking my ACLs renewal if you have any comments or any questions regarding anything that I covered today I would love for you to leave them down below I love answering them make sure that you check out my ace on my pals video in case you're renewing that anytime soon I'm gonna go ahead and leave a link up here in the corner for you I'm gonna post also a blog post regarding this ACLs so check out my website there's a lot more information over there

Channel: Nurse Cheung

Views: 474,720

Keywords: acls certification, bls certification, acls recertification, bls recertification, tips for acls certification, tips for bls certification, tips for acls, tips for bls, american heart association, aha, aha tips, tips acls, tips bls, aha certifications, how to pass acls and bls certifications like a boss, how to pass acls and bls certifications, how to pass acls, how to pass bls, nursing tips, nursing, american heart association certifications, 2019

Id: lJ4LlxW4LBI

Length: 20min 31sec (1231 seconds)

Published: Sat Dec 23 2017