H’s and T’s of ACLS | ACLS-Algorithms.com

Comments

  1. Dominick Walenczak says

    Based on the evidence from Peng, et al, 2015… we should probably not be treating hypoglycemia during cardiac arrest as Dextrose administration was associated with worse survival and neurologic outcomes and no significant impact on obtaining ROSC. Glucose isn’t the primary source of myocardial ATP anyways.

    • Paulo Kraemer says

      Hi Dominick,
      What would be the primary source of myocardial ATP if it is not glucose?
      Thanks,
      Paulo Kraemer

    • paigeowenRN says

      It’s fatty acids that provide the most ATP. However, considering that we can’t really give someone a rapid fish oil infusion, glucose is a less optimal, but readily available intervention in an effort to try to generate ATP.

      The Peng, et all study did bring about the concern for the effect of dextrose used during in-hospital cardiac arrest patients, but could not establish a causal relationship between administration and lower survival rates… Definitely an interesting question. If anything, it encourages to establish the rationale verses doing things “they way we’ve always done it.”

      With so many multi-variable factors contributing to cardiac arrests, it’s no doubt a challenging task to prove EBP in arrest management…

      • Manuel Lam says

        Instead of dextrose administration, it would be interesting to investigate the administration of ketone esters for in-hospital cardiac arrest patients.

  2. Jeckson Mureri says

    Hi Jeffy

    Is there any difference between ACLS offered by AHA and the one from APC ( American Physicians College)?
    Can you sit for either of exams after studying through this website?
    And which one is better between these two?

    • Jeff with admin. says

      There’s a big difference. Most hospitals only except American Heart Association ACLS provider card. The American physicians college ACLS is avery questionable ACLS certification. This is true for any online ACLS course.

      I recommend that you check with your education department and find out what ACLS course is they will accept. Most will only accept AHA.

      As a sidenote, I checked the ranking status of the American College of physicians on the web. The rank status basically tells how important the website is compared to other websites. It was ranked very poorly. Out of all the websites on the Internet, it was ranked over 14 millionth. The closer the number to the #1, the better the ranking. Any website ranked less than about 1 million is invisible on the web unless they advertise.

      Be careful with this website and make sure that anything that comes from it will be accepted by your employer.

      Kind regards,
      Jeff

  3. David 576 says

    Hi I’m guessing this is the American version of H’s and T’s as we still,have trauma and hypoglycaemia as part of out H&T’s

    • Jeff with admin. says

      According to AHA guidelines, trauma is no longer included in the H and T’s and is included in the “Special circumstances of resuscitation.”

      Hypoglycemia was removed because there is not sufficient evidence to support its being a cause of PEA or Asystole. It is also considered standard of practice to always check a blood sugar to ensure hypoglycemia is not present.

      Kind regards,
      Jeff

  4. Emmily Tkach says

    Dear Jeff,
    Can you please explain why bradycardia would be present in a tension pneumothorax?
    Thanks

    • Jeff with admin. says

      The bradycardia could simply be an impending late sign of cardiovascular collapse related to tension pneumothorax. Also, tension pneumothorax can stimulate the vagus nerve and cause hypervagotonia leading to sinus bradycardia. Kind regards, Jeff

    • Jeff with admin. says

      AHA has removed these from the H and T’s for the following reasons:
      Trauma now has it own specific treatment recommendations within AHA ACLS protocol under special resuscitation situations.
      Hypoglycemia was removed because the blood glucose check is now a routine standard that is expected to be done with any changes in level of consciousness. It is still very important and should not be neglected.
      Kind regards,
      Jeff

      • Paulo Kraemer says

        Hi Jeff,
        I understand that hypoglycemia was removed from the list as a cause of cardiac arrest because the blood glucose check is now a routine standard that is expected to be done with any changes in level of consciousness. The patient under cardiac arrest is, obviously, unconscious (not responding).
        My questions are:
        1) Should blood glucose level be checked during the CPR?
        2) If so, what would be the most appropriate moment to check blood glucose during CPR?
        3) Once checked during CPR, and the patient is said hypoglycemic, would it be wise (or indicated) to give IV glucose in order to correct the hypoglycemic state during CPR?
        Thank you.

      • Jeff with admin. says

        1. Yes, a blood sugar should be checked during CPR.

        2. As soon as possible.

        3. Yes, the hypoglycemic state should be initally treated with 1 amp IV D50 push.

        Kind regards,
        Jeff

      • Paulo Kraemer says

        Hi, Jeff
        I agree with yours answers about he importance of checking and managing hypoglycemia during CPR , but my concern is that this is not stated in the AHA CPR Guidelines.

  5. Jessica Rose says

    I apologize if this has been covered somewhere else before, but is there any particular reasoning behind removing Hypoglycemia and Trauma from the list of H’s and T’s? I haven’t been able to find any reasoning or research that supports the removal of these items and It seems to me that these factors are still very valid in Cardiac assessments.

    Thanks for the help!

    • Jeff with admin. says

      AHA has removed these from the H and T’s for the following reasons:
      Trauma now has it own specific treatment recommendations within AHA ACLS protocol under special resuscitation situations.
      Hypoglycemia was removed because the blood glucose check is now a routine standard that is expected to be done with any changes in level of consciousness. It is still very important and should not be neglected.

      Kind regards,
      Jeff

  6. Wendy says

    Amazing , helpful , and very good info. Very helpful study guide and simulations! Highly recommended.
    Thank you.

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