Hi! Thanks so much for this review. I have been in respiratory 35 years- I go through the recertification and review as usual. But today when watching your review here, I had a Lightbulb Moment!!!! When you said electrically pacing or chemically pacing, the lightbulb went on for me to remember why/when to use Dopamine or Epinephrine. I know the process on the algorithm, but just hearing the bifurcation of electrical vs chemical just clicked for me! (All these years nobody said the term “chemically pacing”, and when you did- it just clicked for me. ) Thank you !
I have my ACLS in a few days and I was freaking out but found this gem of a series. The explanation and visual representation is so clear and easy to follow through. Thank you for this series 🙏
Eddie you videos are great! They have assisted my through my ICU and cardiac ICU journeys. Now I’m using them to study for CRNA school interviews. You’re doing great work, you really deserve all the best in life!
Hi Eddie, thank you for this excellent series! I’m a nursing student in CCU for my final practicum and these have been super helpful for learning and reviewing the massive amount of knowledge critical care nurses need.
Thank you! I am a retired RN w/ Dialysis 25+ years. I love keeping current on all the critical care and EMS updates; I am CERT MedOps trained and volunteer in my community as a volunteer resource nurse.
So happy I came across these videos while reviewing for my ACLS course! You do an excellent job making the content easily understandable, I definitely feel better prepared after watching them. Thank you!
Final year medic here! I wish I had known about this channel much earlier! It would have helped me massively during my surgical block! Thank you for your work!
As someone who took the ACLS course online for their first time, this video has been incredibly helpful! I go for my in-person skills check-off in a few days and I am so thankful to have come across your video.
Thank you for your time making this channel. you do such a great job making the difficult things easy to understand. the visual style on the screen is awesome and helps, instead of just a video of you speaking
Thank you so much for this algorithm. I came across with severe sinus brady - in its high 20s with no change in pressures. It lasted about 10 minutes. The patient was covid - intubated, sedated and paralysed. It is good to know about symptomatic bradycardia and its clinical symptoms so I will know next time not to panic unnecessarily. Again, thank you for sharing this video.
More than glad to help! Honestly though, if I were in your shoes, I'd probably be panicking too! Even maintaining a good blood pressure, I'd be worried they would decline further and would hope to get the rate up. At 20 there most probably were compensation mechanisms going on as I'd be real shock that such a low HR would maintain adequate perfusion. That said, I've been surprised by many things before. Were they on pressors already? What lead to the bradycardia? Hypoxia related? Curious if you ended up doing anything, or if they just resolved on their own.
Yes, the patient was on a small dose of Norad and was deproned 10 hrs prior to. Apparently has had episodes of bradycardia before but not as low as it did. I ended up just doing an ECG though I was not able to capture it as it resolved on its own.
Your amazing! The way you explain things are very easy to understand! Your videos are great for new nurses and nurses like myself who need a refresher! Thank you keep theses going please 😃
Listening to this channel has been better than any music that I’ve listened to. Also, a message to Eddie, keep on keeping on. Your good habits will be showcased and appreciated, stay consistent you’re doing great things.
So awesome to hear Hassan! I'm really glad to hear that you like these videos and are finding them helpful! I really appreciate the kind words and I definitely plan to keep making more videos!
Super helpful review! I am binge watching all your videos, I’ve been on med-surg units for a while now and I’ve been away from ICU Stepdown, I feel rusty!
I just discover your channel. I'm a tele nurse. Very interesting and helpfull channel. I wish if we could get this information in a way to print it. Thanks a lot
One other point before I move on to see where the algorithm takes me next: Returning to your illustration of narrow complex 2:1 AVB, giving atropine or other agents that can increase sinus rate, but esp. atropine, to such a pt. can convert a minor or moderate problem to a severe, life-threatening crisis. The reason is that such a pt's. AV node is so dysfunctional (temporarily or permanently) that it can only conduct alternate beats. It needs that much recovery time between beats. If you accelerate the sinus rate, the AV node will have no time to recover conduction amid the frequent assaults from above. Asystole can result. Passing a temporary pacing electrode takes only a few minutes and keeps the pt. much safer.
Wow, what a massive amount of informations, im an SSN in general medical ward and now rotating in cardiac allocation without any mintor around for 6 months - a self learner - gained all my informations from watching your videos.. Enjoying them all, keep doing it 💫 your doing a great thing to us
Thank you so much sir for this. You're not just a life saver… your indeed a liveS saver with this content. May i also ask what software do you use for making this?
Thank you so much for making these videos! I just found your channel while reviewing info for my upcoming recert in ACLS and I have to say, I'm looking forward to watching every video on your channel! You do a great job in explanation and I don't know if you're the one drawing, but you have great animations as well! On a separate note, if you don't already do a podcast, you definitely should, you've got the voice for it and I bet you have some good stories.
Truly my pleasure to help and thanks for the great comment. Yeah its a one man show here so I'm doing it all. I don't know if a podcast is up my alley or not. I certainly do have some interesting stories over the years thats for sure!
Your illustration of Mobitz II was just 2:1 AVB. One cannot determine with certainty that it was not Mobitz II but it's very unusual to encounter such severe conduction system disease (Mobitz II) with a narrow QRS. Urgent intervention is required for Mobitz II regardless of anything else. It can be very dangerous. If the pt. has active myocardial ischemia in the presence of a bradyarrhythmia, obviously it's much safer to give nitrates and place a temporary pacing lead than it is to give epi., etc. I would always start with 0.5 of atropine when indicated. Some pts. respond dramatically. You can always give more. Incidentally, the best effects of nitrates are rarely achieved with the pt. supine.
Excellent. Q? Pls remind us how to deliver the electrical pacing like dopamine or epi. Do we infused/mixed the dopa/epi first to a saline? If yes, what proportion? If I do not have pump (not in icu setting) what is the effective way? Again, thanks very much.
Just a quick comment - can consider dobutamine as well. one more thing stop the offending agent which is more likely cause than any other etiology in ICU. Great talk
Yes, but only in a stable Brady where we want to increase CO! Not the unstable, which is probably why that isn't mentioned in the ACLS algorithm recommendations. But yes, absolutely, treat the underlying cause. The great game of the ICU :)
Good morning Mr.Eddie regarding the atropine as you said we have to start with 1mg first not with 0.5mg But in our hospital there protocol they are started with 0.5 only then they are increasing the dosage so do you think it’s wrong or it’s ok and Also why we have to started with 1mg direct not .5 Thank you Mr.Eddie so much for you incredible work
Love how you teach, wondering if you can use visuals like showing the pacemakers, defibrillators, etc as you are reviewing which buttons to push? Also, always wondered why we shock pulseless Vtach, isn't it just PEA? Can you give amiodarone right after epinephrine. Since they are different classes of drugs, why do we have to wait 3-5 minutes?
Thank you! I purposely avoid device specific stuff as these videos go out all over the world and the equipment varies so much from place to place. I try to focus on foundational info that can be applied to whatever equipment you use. Also, Vtach is a disorganized rhythm that in most cases does not provide adequate perfusion. We want to stop that and allow the heart to resume a normal rhythm, hence the shock. As for the the 3-5 minutes, I don't know if I have a great answer to that. I know over the years these guidelines were developed from evidence based research by the AHA, so I'm sure there is something there. Also, we have to look at 1/2 life. 1mg of Epinephrine is quite large, especially when we compare to doses we give in Epi drips. Probably wouldn't make any difference to give it more often. And any longer and we probably don't sustain the high levels needed to provide that necessary coronary perfusion.
hi sir .the last few days watch your vedio ,very help me that improve my knowledge.sir can vmoyou know any ACLS AND BLS (AHA) demmo chanel.if have please mention me,thank you sir.
My friends all are debating this, do most hospitals do continuous bagging while doing compressions? (Pre-intubation while patient is on BVM with O2) Or do we go with the 30:2. I'm assuming most staff aren't counting to 30 aloud either...Thanks.
@@ICUAdvantage Isn't that against AHA recommendation (not being rude, just want to know). Lot of hospitals do this apparently, I guess its more practical? Although, how effective is bagging while doing compressions on a patient that doesn't have advanced airway yet
@@JohnDoe-jt8rc I'd have to dig deeper to see if AHA addresses anything like this. I know some of the though process is stopping compressions versus keeping them (and thus perfusion pressure) up. Breaths certainly can still be given while compressions are happening. It'd be interesting to look in to some research on this topic. I'm sure it has to exist. In my mind, it seems like continuous compressions without stopping would be better.
@@ICUAdvantage I believe the continuous ventilation while not having an advanced airway in (Supraglottic or ETT) leads to higher rates of gastric insufflation.
Yeah, I actually have a whole series covering temporary pacing, as well as video talking about the differences between cardio version, defibrillation, and pacing use on a defibrillator.
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Hi! Thanks so much for this review. I have been in respiratory 35 years- I go through the recertification and review as usual. But today when watching your review here, I had a Lightbulb Moment!!!!
When you said electrically pacing or chemically pacing, the lightbulb went on for me to remember why/when to use Dopamine or Epinephrine. I know the process on the algorithm, but just hearing the bifurcation of electrical vs chemical just clicked for me! (All these years nobody said the term “chemically pacing”, and when you did- it just clicked for me. ) Thank you !
God, please continue to bless Mr.Eddie. I needed this lecture ❤️❤️❤️. I listened to this lecture and took 94%and my ACLS 🙏🏾🙏🏾🙏🏾🙏🏾
This is amazing to hear!!! Way to go Agnes!
I have my ACLS in a few days and I was freaking out but found this gem of a series. The explanation and visual representation is so clear and easy to follow through. Thank you for this series 🙏
Woohoo! Glad to hear you enjoyed the series and best of luck on your ACLS. You got this!
I'm currently in paramedic school and going through ACLS and this was extremely helpful.
Eddie you videos are great! They have assisted my through my ICU and cardiac ICU journeys. Now I’m using them to study for CRNA school interviews. You’re doing great work, you really deserve all the best in life!
Hi Eddie, thank you for this excellent series! I’m a nursing student in CCU for my final practicum and these have been super helpful for learning and reviewing the massive amount of knowledge critical care nurses need.
So great to hear this Patrick! You are more than welcome and I'm just glad to be able to help!
I have ACLS test and your videos helps me a lot . THANK YOU MR.WATSON
Where would we be without your service/ lectures? Thank you ever so much!!!
Love this! So happy to hear you like them. Thank you!
We would read
Just finished the ACLS online portion. Your presentation is so much better.
Wow thank you Albert! I really appreciate the kind words!
It’s Valentine’s today. What would I do for brokencardia?
Chocolate? lol Not sure if that is AHA recommended or not!
Alcohol 🤣
Visit a “professional”.
Chocolatopine 2gr/kg/min
Lick some external pacemaker leads?
I am following your lectures from Haiti. they are really helpful and I try to share them as much as possible with my friends.keep up the good work.
How cool! Hello in Haiti! I appreciate the shares and glad you like the videos. Thanks for taking the time to leave a comment!
Thank you! I am a retired RN w/ Dialysis 25+ years. I love keeping current on all the critical care and EMS updates; I am CERT MedOps trained and volunteer in my community as a volunteer resource nurse.
Very cool! I'm sure I'll be the same way and still always wanting to stay current and aware of the current landscape. Glad you liked it.
So happy I came across these videos while reviewing for my ACLS course! You do an excellent job making the content easily understandable, I definitely feel better prepared after watching them. Thank you!
I feel more confident and equipped in managing my patients. Thank you for all your content. Its remarkable
SO great to hear this! You are very welcome and thanks for taking the time to leave a comment.
Final year medic here! I wish I had known about this channel much earlier! It would have helped me massively during my surgical block! Thank you for your work!
As someone who took the ACLS course online for their first time, this video has been incredibly helpful! I go for my in-person skills check-off in a few days and I am so thankful to have come across your video.
So great to hear this Paige. Best of luck on your check-off and glad the video was helpful for you!
Great videos. I’m studying for my CEN and starting a traveling career. Love your vids. 👍 thanks
Thank you Eddie, this will help in my preparation for my renewal in ACLS.
Happy to help! Glad you enjoyed it.
You are the greatest! I am amazed on how simple but objectively you explain the subject!
Wow, thank you so much! Really glad you liked it Karem.
U know blinks, during, pre, after...... Works every time would open up colors. Thanks.
You are a wonderful teacher. Thank you. I made a playlist on ACLS review with your lectures. Comes handy during ACLS renewal.
Thankful that I saw the updated guidelines!!!!
I have exam after 5 days im listened to your lessons its better more than book . Thank you eddie .
Awesome! hope the exam went well!
Thank you Mr.Watson , this will help me with my preparation for ACLS Review
Most welcome!
Thank you for your time making this channel. you do such a great job making the difficult things easy to understand. the visual style on the screen is awesome and helps, instead of just a video of you speaking
Heart patient here, learned a lot Thank you!
Thank you so much for this algorithm. I came across with severe sinus brady - in its high 20s with no change in pressures. It lasted about 10 minutes. The patient was covid - intubated, sedated and paralysed. It is good to know about symptomatic bradycardia and its clinical symptoms so I will know next time not to panic unnecessarily. Again, thank you for sharing this video.
More than glad to help! Honestly though, if I were in your shoes, I'd probably be panicking too! Even maintaining a good blood pressure, I'd be worried they would decline further and would hope to get the rate up. At 20 there most probably were compensation mechanisms going on as I'd be real shock that such a low HR would maintain adequate perfusion. That said, I've been surprised by many things before. Were they on pressors already? What lead to the bradycardia? Hypoxia related? Curious if you ended up doing anything, or if they just resolved on their own.
Yes, the patient was on a small dose of Norad and was deproned 10 hrs prior to. Apparently has had episodes of bradycardia before but not as low as it did. I ended up just doing an ECG though I was not able to capture it as it resolved on its own.
Your amazing! The way you explain things are very easy to understand! Your videos are great for new nurses and nurses like myself who need a refresher! Thank you keep theses going please 😃
Yay! So awesome to read and hear this Anisha! Glad you liked it and thank you so much for taking the time to leave a comment.
Eddie you are literally and metaphorically a live saver!You videos helped me to prepair for my acls course!
Woohoo!! lol I'm just happy to be able to help Maria
Listening to this channel has been better than any music that I’ve listened to. Also, a message to Eddie, keep on keeping on. Your good habits will be showcased and appreciated, stay consistent you’re doing great things.
So awesome to hear Hassan! I'm really glad to hear that you like these videos and are finding them helpful! I really appreciate the kind words and I definitely plan to keep making more videos!
Another great video. You are a really good teacher. I appreciate your efforts. Thanks so much.
Thank you so much for taking the time to make educational content like this! God bless you!
You are very welocme Glad you enjoyed it!
Thank you so much for your excellent lecture.. More power and GodBless..
may you please develop an app, your lectures are very amazing
thank you so much for your lecture! it really helps me a lot while i’m studying for my first ACLS.
-SN from South Korea:)
Thanks for updating dosages. I appreciate you reaching method.
Thanks so much Eddie. Your efforts are so appreciated and invaluable.
Truly my pleasure. Glad you appreciate the effort. 😊
Thank you for your video. I am about to take my ACLS and PALS in one week and this helped me tremendously.
You are very welcome Mariza! Glad they are helpful for you!
Thank you. I was not updated with the new recommendation for Atropine and Dopamine. My ACLS is tomorrow!
Perfect timing! :)
Super helpful review! I am binge watching all your videos, I’ve been on med-surg units for a while now and I’ve been away from ICU Stepdown, I feel rusty!
You've got A LOT to binge watch these days lol
Very helpful and very informative. Thank you so much!
Nice delivery of scenario. I am doing ACLS next week and found your video.
Awesome. Best of luck!
Have to recert my medic by exam this cycle, and this has been a very helpful video series. 🤙
Awesome. Glad you enjoyed the videos!
This was great!! Thank you so much for taking the time to make these videos😊
So glad to hear you liked it! 😊 Happy to be able to help and let me know if I can in any way!
@@ICUAdvantage Thank you 😊😊
Awesome job. Thanks. Waiting for your 2025 lessons. Very easy to follow.
Shine Bright like a diamond❤❤❤thank you
I just discover your channel. I'm a tele nurse. Very interesting and helpfull channel.
I wish if we could get this information in a way to print it.
Thanks a lot
All I can say is, thank you Eddie
You’re welcome! 😊
This is the 2nd one I have watched and it is excellent! I needed something like this to help me review for ACLS/PALS skills check offs next Weds. Thx!
Hope the check offs went well!
One other point before I move on to see where the algorithm takes me next: Returning to your illustration of narrow complex 2:1 AVB, giving atropine or other agents that can increase sinus rate, but esp. atropine, to such a pt. can convert a minor or moderate problem to a severe, life-threatening crisis. The reason is that such a pt's. AV node is so dysfunctional (temporarily or permanently) that it can only conduct alternate beats. It needs that much recovery time between beats. If you accelerate the sinus rate, the AV node will have no time to recover conduction amid the frequent assaults from above. Asystole can result. Passing a temporary pacing electrode takes only a few minutes and keeps the pt. much safer.
Wow, what a massive amount of informations, im an SSN in general medical ward and now rotating in cardiac allocation without any mintor around for 6 months - a self learner - gained all my informations from watching your videos.. Enjoying them all, keep doing it 💫 your doing a great thing to us
I am INLOVE with your channel! Thank you for making this content!
Yay!!! Awesome! Glad you are liking it and truly my pleasure to do so!
Thank you very much. It was very enriching
Great knowledge and very useful summary 👍
Thank you so much sir for this.
You're not just a life saver… your indeed a liveS saver with this content.
May i also ask what software do you use for making this?
Wow, thank you so much for that! I just use Photoshop and screencast to an iPad to write with Apple Pencil.
Thank you so much for this awesome video!!! You are a life saver!! ❤❤
Hi thank you for your time and help very nice and helpful video
Glad you liked it!
You are a good teacher
Thank you so much Burton! Happy to be able to help.
thank you so much for a great video on ACLS !!
I appreciate that! Glad you like it!
Thank you so much for making these videos! I just found your channel while reviewing info for my upcoming recert in ACLS and I have to say, I'm looking forward to watching every video on your channel! You do a great job in explanation and I don't know if you're the one drawing, but you have great animations as well! On a separate note, if you don't already do a podcast, you definitely should, you've got the voice for it and I bet you have some good stories.
Truly my pleasure to help and thanks for the great comment. Yeah its a one man show here so I'm doing it all. I don't know if a podcast is up my alley or not. I certainly do have some interesting stories over the years thats for sure!
Great video & easy to grasp! Thanks!
Your illustration of Mobitz II was just 2:1 AVB. One cannot determine with certainty that it was not Mobitz II but it's very unusual to encounter such severe conduction system disease (Mobitz II) with a narrow QRS. Urgent intervention is required for Mobitz II regardless of anything else. It can be very dangerous. If the pt. has active myocardial ischemia in the presence of a bradyarrhythmia, obviously it's much safer to give nitrates and place a temporary pacing lead than it is to give epi., etc. I would always start with 0.5 of atropine when indicated. Some pts. respond dramatically. You can always give more. Incidentally, the best effects of nitrates are rarely achieved with the pt. supine.
Thank you Icu nurse, studying
You are very welcome and best of luck on your studies!
Excellent thank you so much for the review!
Excellent.
Q?
Pls remind us how to deliver the electrical pacing like dopamine or epi. Do we infused/mixed the dopa/epi first to a saline? If yes, what proportion?
If I do not have pump (not in icu setting) what is the effective way?
Again, thanks very much.
Just a quick comment - can consider dobutamine as well. one more thing stop the offending agent which is more likely cause than any other etiology in ICU. Great talk
Yes, but only in a stable Brady where we want to increase CO! Not the unstable, which is probably why that isn't mentioned in the ACLS algorithm recommendations. But yes, absolutely, treat the underlying cause. The great game of the ICU :)
Great lessons made so easy indeed.
New subscriber here from Dubai
Very cool! Welcome aboard!
Wow,explanation very nicely
sorry, stupid question, but there is no need to dilute the atropine right for the IV push? thanks in advance
Your videos are educative
Lovely and useful presentation 👌
Glad to hear this!
Thank you very much 🙏🏼 can you please explain VT with pulse
You are very welcome. That is actually coming next week!
Please elaborate how to increase dopamine and titrate it in full detail
ua-cam.com/video/yeeJDt966DU/v-deo.html
Here's a good video where I give some insight on to titrating pressors which I think you might find helpful.
Thanks. Awesome. Great grip to me
Great to hear!
Awesome explanation vro ..🎉❤
Great teaching ❤❤❤❤❤
This is wonderful! Thank you!
Happy to help Shellz!
Great lecture and video.
Thank you:)
You're welcome. Glad you liked it! 😊
This is great!! Thank you!
Glad you like it!
Excellent. Thank you.
What is the use of isoprenaline in Bradycardia?
Can you give Atropine, give pace and give either of dopamine or epinephrine?
super helpful!
Insane speaking skill
Thank you!
Brady without a pulse is pea. What a great thought to run an ACLS scenario.
Good morning Mr.Eddie regarding the atropine as you said we have to start with 1mg first not with 0.5mg
But in our hospital there protocol they are started with 0.5 only then they are increasing the dosage so do you think it’s wrong or it’s ok and
Also why we have to started with 1mg direct not .5
Thank you Mr.Eddie so much for you incredible work
I'm just referring to the newest guidance from the AHA. They used to recommend 0.5mg but now the latest is 1mg.
Very useful! Thank you!
Glad it was helpful!
Very helpful! Thankyou
Love the.presentation!!!
Glad to hear this Jane!
Thank you 😊
EXCELLENT PRESENTATION
Thank you kindly!
Love how you teach, wondering if you can use visuals like showing the pacemakers, defibrillators, etc as you are reviewing which buttons to push?
Also, always wondered why we shock pulseless Vtach, isn't it just PEA? Can you give amiodarone right after epinephrine. Since they are different classes of drugs, why do we have to wait 3-5 minutes?
Thank you! I purposely avoid device specific stuff as these videos go out all over the world and the equipment varies so much from place to place. I try to focus on foundational info that can be applied to whatever equipment you use.
Also, Vtach is a disorganized rhythm that in most cases does not provide adequate perfusion. We want to stop that and allow the heart to resume a normal rhythm, hence the shock.
As for the the 3-5 minutes, I don't know if I have a great answer to that. I know over the years these guidelines were developed from evidence based research by the AHA, so I'm sure there is something there. Also, we have to look at 1/2 life. 1mg of Epinephrine is quite large, especially when we compare to doses we give in Epi drips. Probably wouldn't make any difference to give it more often. And any longer and we probably don't sustain the high levels needed to provide that necessary coronary perfusion.
hi sir .the last few days watch your vedio ,very help me that improve my knowledge.sir can vmoyou know any ACLS AND BLS (AHA) demmo chanel.if have please mention me,thank you sir.
My friends all are debating this, do most hospitals do continuous bagging while doing compressions? (Pre-intubation while patient is on BVM with O2) Or do we go with the 30:2. I'm assuming most staff aren't counting to 30 aloud either...Thanks.
Almost always continuous from what I've experienced
@@ICUAdvantage Isn't that against AHA recommendation (not being rude, just want to know). Lot of hospitals do this apparently, I guess its more practical? Although, how effective is bagging while doing compressions on a patient that doesn't have advanced airway yet
@@JohnDoe-jt8rc I'd have to dig deeper to see if AHA addresses anything like this. I know some of the though process is stopping compressions versus keeping them (and thus perfusion pressure) up. Breaths certainly can still be given while compressions are happening. It'd be interesting to look in to some research on this topic. I'm sure it has to exist. In my mind, it seems like continuous compressions without stopping would be better.
@@ICUAdvantage I believe the continuous ventilation while not having an advanced airway in (Supraglottic or ETT) leads to higher rates of gastric insufflation.
Hello icu advantage
I have one query about injection norepinephrine infusion you says 2--10mcg/min ! Is this correct?
Its not 0.02--02mcg/kg/min
So the dosing can either be in mcg/min OR mcg/kg/min. Everywhere I have worked used the mcg/min, but a lot of places, do the weight based dosing.
thank you, very useful info
Thank you so much Fe! Really happy to hear this.
great video! its so odd you got only 100+ views
Haha thank you! Well, it did just release ;)
Thanks for the update on the Atropine!
Awesome, very very useful
Glad to hear it!
New EMTB/A student. Do you have a video about Pacing?
Yeah, I actually have a whole series covering temporary pacing, as well as video talking about the differences between cardio version, defibrillation, and pacing use on a defibrillator.