Beta Blockers in ACS & Stable Tachycardia

01/13/22 • 3 min

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Beta blockers should be considered after MONA in the ACS algorithm and after Adenosine in the stable tachycardia algorithm. Beta receptors are adrenergic, meaning that they are stimulated by hormones released by the adrenal gland – primarily epinephrine (adrenaline) and norepinephrine. Beta receptors are located throughout the body but the receptors that we focus on for ACLS are beta 1 receptors, found in the heart. Beta 2 affects the lungs and beta 3, smooth muscle. Stimulation of beta 1 receptors have both a chronotropic and inotropic effect meaning that is speeds the heart up as well as making it contract more forcefully. Beta blockers in the case of ACS or STEMI helps to decrease the workload of the heart. Beta blockers slows conduction through the AV node and the transfer of potassium across cell membranes – slowing down the heart. A Beta blocker or calcium channel blocker should be considered for patients that have a heart rate over 150 and are not responsive to Adenosine. If the patient has bradycardia, heart block, or signs of cardiogenic shock, CHF, or bronchospasms - beta blockers are contraindicated. You do not need to be familiar with specific Beta blocker medications and their doses during your ACLS class. Connect with me: https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn Good luck with your class!

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Advanced Airways

Advanced airways include endotracheal (ET) tube, laryngeal mask airway (LMA), and the laryngeal tube. All three will help protect the airway from aspiration and can be attached to a bag. Staff that don't bag patients that often find it easier when using an advanced airway because a good mask seal is not required. These airways also decrease the dead space meaning more of the volume squeezed from the bag makes it to the trachea. Only experienced providers with training to insert an advanced airway device AND operating within their scope of practice should do so. After insertion of an advanced airway we should assess for bi-lateral breath sounds and for ET tube, confirm placement with a secondary device. Many places use end tidal capnography as a secondary device as well as a tool to assess the adequacy of CPR. We should not interrupt chest compressions longer than 10 seconds to insert an advanced airway. Once an advanced airway is inserted, we performed continuous chest compressions and deliver a single breath once every 6 seconds. Connect with me: https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn Good luck with your class!

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A Change in rhythm; which algorithm?

The ACLS algorithms are designed to make it easier to remember the key interventions we should deliver and the order in which they should be delivered to provide the best evidence-based care possible. While algorithms are helpful in this way, they can also cause some confusion when a patient’s condition changes. Generally speaking, if there’s a change in a patient’s condition, we should ensure we’re using the correct algorithm. Three points to remember: First, if a patient’s condition changes, we should do an assessment and use the algorithm that matches the patient’s current state. We do not need to go all the way through an algorithm once started. Second, if an action was already done, we don’t need to repeat it. Third, we only do actions that are clinically appropriate and within our scope of practice. If you cannot perform an intervention, ask someone that can if it’s needed. Common ACLS scenarios and how we could respond are presented to demonstrate these three principles. If you get confused during a code, remember that you have a team and reference cards to help you! Connect with me: https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn Good luck with your class!