I know this came out in 2014 but I just wanted to say if anyone is watching now that Vasopressin has been out of the protocol for a couple of years now.
You should know what to give, how much to give, when to give it and your route of administration by this point. If you don't know then get an RT to help you. They're the best!
I remember having a code after eating lunch. I did compressions and I felt like I wanted to vomit in the first 30 seconds :( I had to switch really bad.
This was great if you want to know which to need to do but it doesn't so you procedures like a medic's case in a ministration in how you actually start the IO /iv . Or how you set up the monitor . To do what want it to do
Why was the endotracheal tube not inserted in the first time they found the patient was at cardiac arrest? has the algorhythm been changed? i used to know the intubation attempt should be given at the very first time we found patient having cardiac arrest.
If atropine the first line in Bradycardia had been administered from the beginning none of the other steps would have been needed. The patient went from Bradycardia to tachycardia, which leads to other after care for the patient.
@@chewchin7052bradycardia but no pulse,so they continued cpr instead of giving atropine.Also atropine can increase myocardial oxygen demand and aggravate ischemia?
there is such a thing as pulseless electrical activity where it can show a rhythm like bradycardia on the monitor but the patient has no pulse, they are in cardiac arrest. plus even if it was real bradycardia a pulse, with the low blood pressure of 70/40 most doctors would choose to push epinephrine at that point in favor of atropine. atropine is for bradycardia that is symptomatic with fatigue sob or other signs of poor perfusion, not for a person without a pulse. in the video’s scenario the patient has just arrived and no iv access was able to be established, how are you going to give an iv medication without an iv? just stab a patient with a syringe hoping it will land in a vein (most of these patients who are sick enough to cardiac arrest will be difficult sticks to begin with)? going for the io access was the only way to go, most providers wouldnt waste time trying to get an iv in and just ggo for an io because they know theyre not going to be able to get an iv in a patient like that. we are treating the patient, not the monitor. always check for a pulse never forget your bls.
update from 2024, the hypothermia therapy(target temperature management, TTM) is aimed at 32-37.5 degree celsius. also, this is really quite a good video to illuminate how we should practice the mega code section.
@@Bfair123 1. no rush, be calm, that's the most important thing and actively apply each team member's position if you are the leader. 2. remember to check pulse/vital signs whenever there is a rhythmic change. 3. if the p't's alive (w/ pulse) be sure to note if the rhythm is regular/irregular, having a narrow or wide QRS complex and whether the patient is stable or unstable and choose the joule of charge accordingly. 4. when ROSC is achieved, aside from a secondary ABCDE evaluation, order a 12 lead ECG to assess if ST elevation is the case. That's the tips my poor brain notices at the moment, hope you pass your test tomorrow!
Somebody help my forgetful mind: What happened to the Pulse-Ox monitor the patient had on her finger when she arrived.? "Hypoxia"??? The PO not only measures oxygenation, but, also the quality of compressions during CPR. OK, i"m being picky. But, in this day and age, the PO is an indispensable monitor, which appears to be underappreciated in this video.
etco2 is what now monitors effective cpr as well as tube placement. etco2 < 10 shows need for improvement in cpr. fyi, in the scenario, the pt was initially at 92 pao2 and then went up to 95 pao2 on 2 lpm O2 prior to coding. As actor playing doc said, coronary thrombosis likely culprit as confirmed with STEMI in 12 lead. remember that pulse ox takes a bit to drop and accurately show hypoxia where as etco2 readings are much quicker. good video on acls cert.inst re " waveform capnography" which demonstrates this.
+Damon Jackson Vasopressin was removed to simplify the algorithm. This is unfortunate. Instead of expecting providers to improve their knowledge and skills. The update suggests providers can be remedial..
Well I think that characterisation is a little unfair. Vasopressin was initially incorporated to give ems providers time to do other interventions, because no other vasopressors were to be given for ten minutes. We now know through science that its effectiveness was not what was originally thought. If you look Narcan was added to the algorithm, and its effect in situations can be very pronounced.
+Damon Jackson Narcan, thiamine, and Epi were also standard code drugs. thiamine was removed because people were having anaphylactic reactions to it. narcan is making a comeback due to the increase of heroin and opiate overdoses
***** are you a healthcare provider? If so, I highly suggest that you surrender your license to the issuing agency as you are acting unprofessional and your attitude and decorum prove that you are unable to effectively provide care to patients and don't care about your job.
+Judith Tardo Excuse me, but are you deaf, dumb, delirious or disrespectful? I do alot more than ride ambulances and I do not appreciate you undermining my training nor do I appreciate swine like you tainting the reputation of the profession. most of us have spent more hours in a classroom than the average school student and have way more experience than a 9 year old like you would have. your incessant swearing does not make you educated in anyway and it actually makes you sound beyond dumb. I know how to resuscitate patients, I know the algorithms used in ACLS, I know how to interpret ECG tracings and know the pharmacokinetics, interactions and effects of each drug given. I also know a lot more than that but can't use those skills as my level of certification will not allow me to. some of the things you mentioned make you a danger to patients and you should not be practicing, your conduct is absolutely disgusting and unprofessional. you either clean up your conduct or leave the profession because I don't have the time to deal with your ignorance and sheer stupidity. on that note, I will stop responding to your tumultuous insults and be the bigger man here. I almost forgot, GO BACK TO FUCKING SCHOOL!
GOOD VIDEO. aint perfect but good somehow.. the second chest compressor should have been quicker in changing roles with the first compressor :) no unnecessary pauses in chest compressions..
+rom z Continuous bagging only occurs with an advanced airway (like an endotracheal tube). Otherwise you follow 30 chest compressions with two breaths.
+UnicornxApocalypse But the team leader decides how much shock should be delivered (unlike in BLS where an AED) and they're giving IV drugs. Isn't this advanced already?
I had to check this wasn't a joke. 'Code' on its own is a pretty silly name for a cardiac arrest/medical emergency. 'Megacode' is completely puerile. Do the AHA/ACLS actively encourage ridicule?
Just for people coming for information: we no longer use vasopressin in the 2015 cardiac arrest algorithm. (I know this is a somewhat older video)
Could update this really
This is 2010 algorithm I think
Thank you!
Thanks!
wow everytime I watch BLS,PALS and ACLS skills I have never remained the same. thnx AHA for this knowledge love you guys
This was the calmest code ive ever seen. Haha
It's for teaching purpose
In my oppinion this should be the correct posture. Loosing the calm makes you feel angry and take bad decisions.
this is the new protocol of acls. advanced cardiac life support.. it's team management, no panic.
Mitchell Turnbull no kidding. Very deceptive
Compared to screaming, yes xD
I always sit and watch BLS and ACLS videos to update my knowledge
Thank you for uploaded this video,, who has attending the ACLS, it will more help full
This is how the codes are in my hospital… even with teaching. Some doctors are just chill and confident
I agree! I'm a paramedic student and our er doctors are very chill running a code WHILE showing me the EKG and what it means
I know this came out in 2014 but I just wanted to say if anyone is watching now that Vasopressin has been out of the protocol for a couple of years now.
I see it used still
It’s 3rd line
How come. I’m in my last year just wanna get some field knowledge.
Mrs. Fernandez turned into a rubber.
showing the rhythms would have been beneficial and an explanation why each drug is given
You should know what to give, how much to give, when to give it and your route of administration by this point. If you don't know then get an RT to help you. They're the best!
I remember having a code after eating lunch. I did compressions and I felt like I wanted to vomit in the first 30 seconds :( I had to switch really bad.
Why can't all doctors be like this, so calm and understandable
Because of Ego and Sarcasm
cortisol, saliva, adernaline stress effects on voice (interesting read)
This was great if you want to know which to need to do but it doesn't so you procedures like a medic's case in a ministration in how you actually start the IO /iv . Or how you set up the monitor . To do what want it to do
Why was the endotracheal tube not inserted in the first time they found the patient was at cardiac arrest? has the algorhythm been changed? i used to know the intubation attempt should be given at the very first time we found patient having cardiac arrest.
"BP 70/40, HR 45" doc was like, 2L NASAL CANULA!??? lol
😂
Well coordinated assignment bravo
Thank you so much AHA for the good presentation
This was great!
Wow great looking staff, but where are their stethoscopes? and havent seen such well pressed lab coats.
If atropine the first line in Bradycardia had been administered from the beginning none of the other steps would have been needed. The patient went from Bradycardia to tachycardia, which leads to other after care for the patient.
Maybe this patient was suffering from III AV block and during the preparation of transcutaneous pacing the code was called?
@@chewchin7052bradycardia but no pulse,so they continued cpr instead of giving atropine.Also atropine can increase myocardial oxygen demand and aggravate ischemia?
there is such a thing as pulseless electrical activity where it can show a rhythm like bradycardia on the monitor but the patient has no pulse, they are in cardiac arrest. plus even if it was real bradycardia a pulse, with the low blood pressure of 70/40 most doctors would choose to push epinephrine at that point in favor of atropine. atropine is for bradycardia that is symptomatic with fatigue sob or other signs of poor perfusion, not for a person without a pulse. in the video’s scenario the patient has just arrived and no iv access was able to be established, how are you going to give an iv medication without an iv? just stab a patient with a syringe hoping it will land in a vein (most of these patients who are sick enough to cardiac arrest will be difficult sticks to begin with)? going for the io access was the only way to go, most providers wouldnt waste time trying to get an iv in and just ggo for an io because they know theyre not going to be able to get an iv in a patient like that. we are treating the patient, not the monitor. always check for a pulse never forget your bls.
I wish all codes are as calm as this.
Grandma from Friday Night Lights!
The paths that they take cause many shocks...it is no different than the risk of medications.
vasopressin is now removed on the latest ACLS.
update from 2024, the hypothermia therapy(target temperature management, TTM) is aimed at 32-37.5 degree celsius. also, this is really quite a good video to illuminate how we should practice the mega code section.
Did u take your acls
@@Bfair123 yup
@@likevin9815 can you give an idea what to expect on the classroom, I will take my classroom acls tomorrow, thanks!
@@Bfair123 1. no rush, be calm, that's the most important thing and actively apply each team member's position if you are the leader. 2. remember to check pulse/vital signs whenever there is a rhythmic change. 3. if the p't's alive (w/ pulse) be sure to note if the rhythm is regular/irregular, having a narrow or wide QRS complex and whether the patient is stable or unstable and choose the joule of charge accordingly. 4. when ROSC is achieved, aside from a secondary ABCDE evaluation, order a 12 lead ECG to assess if ST elevation is the case. That's the tips my poor brain notices at the moment, hope you pass your test tomorrow!
@@likevin9815 thanks!
Nice Video
Somebody help my forgetful mind: What happened to the Pulse-Ox monitor the patient had on her finger when she arrived.? "Hypoxia"??? The PO not only measures oxygenation, but, also the quality of compressions during CPR. OK, i"m being picky. But, in this day and age, the PO is an indispensable monitor, which appears to be underappreciated in this video.
etco2 is what now monitors effective cpr as well as tube placement. etco2 < 10 shows need for improvement in cpr. fyi, in the scenario, the pt was initially at 92 pao2 and then went up to 95 pao2 on 2 lpm O2 prior to coding. As actor playing doc said, coronary thrombosis likely culprit as confirmed with STEMI in 12 lead. remember that pulse ox takes a bit to drop and accurately show hypoxia where as etco2 readings are much quicker. good video on acls cert.inst re " waveform capnography" which demonstrates this.
Amazing.
What a neat code!
No, there is really no benefit. As a matter of fact they have now taken vasopressin out of ACLS with the new update.
+Damon Jackson Vasopressin was removed to simplify the algorithm. This is unfortunate. Instead of expecting providers to improve their knowledge and skills. The update suggests providers can be remedial..
Well I think that characterisation is a little unfair. Vasopressin was initially incorporated to give ems providers time to do other interventions, because no other vasopressors were to be given for ten minutes. We now know through science that its effectiveness was not what was originally thought. If you look Narcan was added to the algorithm, and its effect in situations can be very pronounced.
+Damon Jackson Narcan, thiamine, and Epi were also standard code drugs. thiamine was removed because people were having anaphylactic reactions to it. narcan is making a comeback due to the increase of heroin and opiate overdoses
***** are you a healthcare provider? If so, I highly suggest that you surrender your license to the issuing agency as you are acting unprofessional and your attitude and decorum prove that you are unable to effectively provide care to patients and don't care about your job.
+Judith Tardo Excuse me, but are you deaf, dumb, delirious or disrespectful? I do alot more than ride ambulances and I do not appreciate you undermining my training nor do I appreciate swine like you tainting the reputation of the profession. most of us have spent more hours in a classroom than the average school student and have way more experience than a 9 year old like you would have. your incessant swearing does not make you educated in anyway and it actually makes you sound beyond dumb. I know how to resuscitate patients, I know the algorithms used in ACLS, I know how to interpret ECG tracings and know the pharmacokinetics, interactions and effects of each drug given. I also know a lot more than that but can't use those skills as my level of certification will not allow me to. some of the things you mentioned make you a danger to patients and you should not be practicing, your conduct is absolutely disgusting and unprofessional. you either clean up your conduct or leave the profession because I don't have the time to deal with your ignorance and sheer stupidity. on that note, I will stop responding to your tumultuous insults and be the bigger man here. I almost forgot, GO BACK TO FUCKING SCHOOL!
This video is now outdated and you should look at the newer 2015 AHA guidelines.
Atropine cause a increase in heart rate in Bradycardia but not tachycardia.
tube in, while the guy in charge is not bagging. lol.
Amiradone must be the go to medication?
BGM sounds like Dr. House's. ㅋㅋㅋㅋㅋㅋㅋ
Yeah but the pads should be really well in contact with thevskin before attempting def... :) excellent video
Who is watching 2024, have my acls this wk
after watching this, I realised that the doctor seems look like dr. John Carter in ER..
vasopressin has been removed from the ACLS guidelines 2015.
lady said bp is 70/40 so calm lmao
Doesn't help anybody to have an excited nurse.
Do you have the one that is the "wrong way" where the communication is chaos?
Damn it Mandel
😆
This is old video and we can still use this for future trainings
Can you please make video of more Simman family's
Thanks for your video
Aortic in the stomach is in pain...they all usually complain of abdominal pain.
shocking on 3! 1 2 3 shocking! shock delivered.. 6 seconds wasted for compression!
Minimal interruption is 10 seconds i believe in 2015 and is allowed for rhythm analysis, ventilation and shock
Vasopressin is pretty much out for 2023.
We all work with a Mandell or two :/
What does that mean?
Someone who sucks at compressions
matt saracen's grandma!
Oh Shelly lol
Hey! Angela here from Philadelphia. Visit, it's a beautiful place.
Can you please make videos more videos of simman
GOOD VIDEO. aint perfect but good somehow.. the second chest compressor should have been quicker in changing roles with the first compressor :) no unnecessary pauses in chest compressions..
thnx :)
air way?.....hipoxia???
Mendel and Shelly have some chemistry there!
I saw that 😏
do you have a guideline for this ?
Shouldn't the first dose of adrenalin have been administered after the 3rd shock (instead of 2nd)?
Thank you
Vasopressin removed from acls protocol
Should be updated
I am waiting for my assessment right now
I think the acls leader needs to be shocked to get some energy.
2010 ACLS guideline
Fibrinolytic protocol...
Shouldn't this be continuous ambu bagging???
+rom z Continuous bagging only occurs with an advanced airway (like an endotracheal tube). Otherwise you follow 30 chest compressions with two breaths.
+UnicornxApocalypse But the team leader decides how much shock should be delivered (unlike in BLS where an AED) and they're giving IV drugs. Isn't this advanced already?
not until an advanced airway is placed
Im glad you're not a doctor or nurse
Zondares I'm studying to be one of that, which is why I asked a question to be enlightened. I see that you're a corpsman, and that's awesome! :D
Sinus Bradycardia...
Oxygen, iv fluid resuscitation...
Sinus bradycardia with no pulse and you shock it?
PEA is the rhythm, pulseless electrical activity
@@TheGibby13 if pea is rhythm, you cant give shock, it should be chest compression unless VF or VT
@@semdavidtimothysitanggang9491 correct
but they didn't shock it.
Why is Mandel wearing an earpiece?!
3:53 - Torsades!
Nahh, artifact while administering compressions but good thought
They did say it was VF probably coarse VF
@@TheGibby13 Showed on defibrillator w/compressions paused, Torsades
cmon mendel. pick it up
Do we still vasopressin??
no
Man the team doesn't seem to respect Mandel much... "pick up the pace"... and the doc didn't even acknowledge his "hypoxia" theory to him
how they knw the pt went into vfib without any leads??
Hbk Jgreezy defib can also assess rhythm
defib patches when applied are "fast patches" for showing rhythm on monitor till either 3 lead or 12 lead are applied
Artery issue...
According AHA
Coronary artery
"shocking on three, one two three shocking....... ". what a waste of time. just CLEAR: and press button ! for christ sakes.....
Saben si lo puedo oir en español?
This video in spanish please. Thank you
The person with the breathing balloon did not do right work？Why？
Gta sn doctor
O2
Miss keesha Miss Kesha... OMG SHES FUCKING DEAD
isn't 1g adrenaline.. or 1mg. .u r wrong
g
Vfib...atropine treatment
N
It doesnt work this way in real situation. Haha
I had to check this wasn't a joke. 'Code' on its own is a pretty silly name for a cardiac arrest/medical emergency. 'Megacode' is completely puerile. Do the AHA/ACLS actively encourage ridicule?
Fake!
In ALL video codes the leader running the codes are always male! Haha
maybe 6 years ago.
He is not identifying the rhythm.
Didn't like it. Racist and paternalistic towards nurses.
Where's the racism? Are you for real????