How to Master ACLS with 10 Essential Tips

Advanced Cardiac Life Support (ACLS) is the gold standard of clinical guidelines when it comes to managing and treating life-threatening cardiac emergencies. ACLS expands on basic life support (BLS) and mastering it is essential for frontline healthcare providers. The significance of knowing your ACLS guidelines can make all the difference in those critical life-threatening moments when the stakes are high and every second counts.

At first glance, the complexity of ACLS can feel overwhelming – that was certainly my reaction the first time I learned about the course. But with a few tips, it can be broken down into digestible, bite-size pieces. In this guide, I share with you 10 essential tips that helped me learn and master ACLS to in turn help you increase your knowledge and confidence in managing cardiac emergencies.

Tip 1: Master the Art of Rhythm Recognition

It’s not a coincidence that rhythm recognition is the first tip in the list! Knowing how to read and interpret ECGs is paramount to ACLS. Recognizing the rhythm is the first step to determining which ACLS algorithm to follow to try and get the heart back to beating normally. Learning ECG interpretation can be daunting without a comfortable understanding of basic concepts, including the PQRST properties.

Learning ECG interpretation and practicing rhythm identification is something I would strongly encourage. I would invite you to take a look at our free ECG rhythms course, which serves as an engaging and comprehensive approach to reviewing the core rhythms of ACLS, including ventricular fibrillation, pulseless electrical activity, and asystole. 

Tip 2: Memorize the ACLS Algorithms Inside Out

Managing cardiovascular emergencies can be stressful. ACLS algorithms are flowcharts that are designed to simplify clinical decision-making during these emergencies. The algorithms are the backbone of ACLS and being familiar with them can be the difference in saving a life. My biggest piece of advice in mastering ACLS is to learn the algorithms early and review them frequently. Some of these algorithms include:

• Adult cardiac arrest
• Adult tachycardia with pulse
• Adult bradycardia with pulse
• Adult coronary syndrome
• Adult immediate post-cardiac arrest care

Tip 3: Understand ACLS Pharmacology

Regardless of your role, every member of a resuscitation team should be familiar with commonly used ACLS medications, including doses and routes of administration. Even if you’re not the one ordering or administering a medication, knowing what is being given, when, and why, enables you to understand the resuscitative efforts being made, keeping all team members on the same page. Medication guidelines are based on evidence-based recommendations but can change dynamically. Therefore, your knowledge of current ACLS pharmacology should always be up-to-date.

ACLS medication classes include antiarrhythmic, anticholinergic, and inotropic drugs, such as adenosine, amiodarone, atropine, and epinephrine. Blindly memorizing details of these medications can be counter-productive. Instead, I suggest using mnemonics or tricks to help you remember what drug to give for what scenario. For example, atropine turns up the heart rate (indicated in symptomatic bradycardia) and adenosine decreases the heart rate (indicated in supraventricular tachycardia).

Tip 4: Develop Strong Team Communication Skills

One thing (among many) that I have always appreciated and admired about emergency medicine is what I call “controlled chaos.” During an active resuscitation, things move very fast. There are several team members, each person has a specific role, and there are multiple concurrently moving parts – It’s chaos, but it’s controlled chaos, because each member knows exactly what they need to be doing. The dynamic of your team is as important as the medications you’re administering and the arrhythmias you’re trying to stabilize. A fast rhythm, but the PQRST wave configuration is normal: Sinus tachycardia

If you’re given an assignment outside your scope of practice or are not knowledgeable about that particular role, it’s your responsibility to speak up and make the team leader aware. Further, it’s imperative that you ASK for another role and not simply assign yourself a new one. Another important point that facilitates “controlled chaos” is closed loop communication. Make it a habit to repeat what the team leader has called out and advise them once it is completed. For example, leader: start chest compressions, you: starting chest compression.

Tip 5: Practice High-Quality CPR

It seems mundane in the context of all the advanced algorithms, medications, and techniques to provide a tip on a rudimentary BLS concept. But ACLS builds on BLS concepts, and your chest compressions and rescue breaths need to be optimal, leaving no room for error. CPR is effective for long-term survival outcomes for patients in cardiac arrest, but only when it is performed quickly and correctly. Check out our 5-minute CPR training video that walks you through the life-saving skills needed for adult, child, and infant BLS.

Tip 6: Know When to Defibrillate

External defibrillation can be a highly effective primary intervention during a cardiac emergency, but only in cases that involve disorganized electrical activity, such as ventricular fibrillation and pulseless ventricular tachycardia. These are the only two shockable rhythms that exist and are thankfully, often the easiest arrhythmias to recognize on a cardiac monitor. Peaked T waves and widened QRS complex indicate hyperkalemia

1. Ventricular fibrillation

This is an arrhythmia that causes quivering (or fibrillation) of the lower chambers of the heart because of chaotic electrical signals, leading to compromised cardiac function. It is the most frequent cause of sudden cardiac death and in most cases, occurs during or shortly after a heart attack. Defibrillation can help stop these chaotic signals and “reset” the normal electrical signal of the heart.

2. Pulseless ventricular tachycardia

This is an arrhythmia similar to ventricular fibrillation. However, here, the ventricles aren’t fibrillating but contracting rapidly and out of sync. However, the same problem exists in that the ventricles are receiving abnormal electrical signals, leading to compromised cardiac function. Therefore, defibrillation remains the most effective intervention to help restore a normal signal.

Tip 7: Know Your H’s and T’s

Delivering chest compressions, mechanical ventilation, and medications are key components of resuscitative cardiac care. However, it is equally important to identify and treat the underlying causes of reversible cardiac arrest. The H’s and T’s are a set of 10 reversible conditions that can lead to arrhythmias including ventricular tachycardia, ventricular fibrillation, pulseless electrical activity, and asystole. The list includes 5 H’s and 5 T’s:

• Hypovolemia Rapid HR, narrow QRS on ECG, signs of low fluid volume
• Hypoxia Slow HR
• Hydrogen ion excess (acidosis) Low amplitude QRS
• Hypokalemia/hyperkalemia Flattened T waves / Peaked T waves and wide QRS
• Hypothermia Think environmental exposure
• Toxins Typically prolonged QT with or without neurological findings
• Tamponade (cardiac) Rapid HR, narrow QRS
• Tension pneumothorax Slow HR, narrow QRS, shortness of breath
• Thrombosis (pulmonary) Rapid HR, narrow QRS
• Thrombosis (coronary) ST elevation, ST depression, inverted or flattened T waves

Note: Hypoglycemia is not officially considered a reversible cause of cardiac arrest according to ACLS teaching, but it can still lead to pulseless electrical activity, particularly in children.

Tip 8: Learn How to Stay Calm

A true cardiac emergency is very real, and as an ACLS provider, it can be stressful to be placed in the hot seat when the stakes are high. But it’s important to find ways for you to stay calm and composed during an emergency. Here are some tips I’ve gotten over the years:

1. Call for help

ACLS isn’t meant to be done solo, but sometimes, you’re the first on scene. Do what you can within the scope of your practice to get the ball rolling, but without delay, remember to ask for help. It can feel tremendously reassuring and supporting to know that additional help is on the way.

2. Deep breaths

I’m sure you’ve heard it before, but it’s because it works! Taking slow, deep breaths is an excellent way to reduce your anxiety and calm you down. Personally, I love box breathing. This proven strategy is used by athletes, military and first responders to gain control and stay focused in high-stress situations. Here are the ways you can practice:

• Step 1: Slowly inhale deeply through your nose for four seconds
• Step 2: Hold your breath for four seconds
• Step 3: Slowly exhale through your mouth for four seconds
• Step 4: Repeat steps 1-3 as needed until you feel calm

If you find that you’re an anxious person at baseline, this approach is particularly beneficial. If this sounds like you, you may benefit from practicing relaxation techniques at home. Although this isn’t directly related to ACLS, having a clear head at the start of your shift can make a big difference!

3. Stay focused

I know this is easier said than done, but it’s critical to stay mindful during a medical emergency and remind yourself of your role and what your team is trying to achieve – you’re trying to save a life!

Tip 9: Keep Up with ACLS Updates

The pace of change in the realm of healthcare is relentless and staying up to date with CPR and ACLS guidelines is pivotal in maintaining good clinical practice. ACLS protocols are revised and updated regularly in accordance with the most recent scientific updates – something we strive to reflect in our training materials.

The advantages of staying up-to-date and remaining current on ACLS guidelines are significant. Firstly, it enhances patient care and optimizes outcomes by empowering you to use the most effective strategies in managing cardiac emergencies. Secondly, keeping your knowledge current instills a sense of confidence and competence, which are synergistic factors for delivering high-quality clinical care. Lastly, focusing on continuous learning and skill improvement contribute to personal and academic growth, reflecting strong qualities of a healthcare professional. 

Some recent updates include:

• Ventricular fibrillation or pulseless ventricular tachycardia that is refractory to external defibrillation may be treated with amiodarone or lidocaine
• It is no longer recommended to treat cardiac arrest with routine administration of the following medications: sodium bicarbonate, calcium, and magnesium.
• Deliberate strategies for temperature control should be included in the treatment protocol for all adults who are unable to follow commands after return of spontaneous circulation (ROSC)

Consider the following strategies for staying up to date:

1. Access reliable resources

Take advantage of reliable educational resources like peer-reviewed journals that publish evidence-based information about resuscitation. To this end, I would strongly encourage you to check out journals such as Resuscitation and articles on the National Library of Medicine website.

2. Participate in simulations

Whether via conferences, workshops, or self-directed learning tools, simulation is at the forefront of clinical training for enhancing your skills and staying current with advancements in ACLS.

3. Get involved

Joining professional or student-led associations, participating in engaging conversations with colleagues about ACLS, and sharing your experiences with your peers are great ways to foster collaborative learning environments.

Tip 10: Practice ACLS Megacodes

Like anything, practice makes perfect, and ACLS is no different. If anything, I think practice is the only way to perfect your ACLS skills. One great option is to practice ACLS Megacodes, which is often a component of ACLS certification. Megacodes are timed, multiple-choice quizzes that involve step-wise decision making to move through a specific ACLS scenario.

Simulation has emerged as the cornerstone of clinical training. Megacode simulations help place you in a specific medical situation and test your knowledge on following the correct course of action for that given situation. Our ACLS megacode scenario simulations are a fantastic resource to help you get the most out of your training and master ACLS!

Ready to Test your Skills?

Whether you’re a healthcare student getting certified for the first time or a veteran lifesaver looking to recertify, practicing these tips can make all the difference. Enroll in our ACLS course today and get yourself one step closer to mastering ACLS!