Basic & Advanced Life Support (CPR/ACLS) - Memory Anchors
Memory techniques dramatically improve recall by connecting new clinical information to existing knowledge structures in your brain. Instead of memorizing isolated facts, you create vivid mental pathways — stories, images, acronyms, and analogies — that your brain can retrieve under pressure. In a real cardiac arrest or during the NLE, you will not have time to think slowly; these anchors train your brain to recall critical parameters automatically. Use these anchors actively: picture them, say them aloud, and teach them to a classmate. The more senses you engage, the stronger the memory trace becomes.
Memory anchors
BLS sequence: C-A-B (Compressions, Airway, Breathing)
Memory aid
Think of a CABBIE (taxi driver) rushing to the emergency. The CABbie always arrives FIRST — just like Compressions come first. C-A-B = Compressions, Airway, Breathing. Before you open the window (Airway) or talk to the passenger (Breathing), the CABbie must START MOVING (Compressions). No movement, no survival.
Why it works
The CABbie analogy creates a vivid action image and links C-A-B in correct order. The taxi metaphor resonates with Filipino students who use taxis/Grab daily.
Example usage
NLE question: 'What is the correct BLS sequence for an unresponsive adult?' Trigger: CABbie → Answer: C-A-B → Compressions, then Airway, then Breathing.
Recall trigger
Picture a yellow taxi speeding to a hospital. What does the driver do first?
Compression rate: 100–120 per minute
Memory aid
Sing 'Staying Alive' by the Bee Gees while doing compressions — this song plays at exactly 100 beats per minute! In Filipino context: imagine you are a drummer in a Rondalla band playing a fast, upbeat tempo — not too slow (less than 100) like a funeral march, and not too fast (more than 120) like a panic attack. The sweet spot is 100-120: 'One-hundred to one-twenty, keep the compressions plenty!'
Why it works
Music tempo is a powerful auditory anchor. 'Staying Alive' is a well-known mnemonic in BLS globally and creates a memorable auditory-motor connection.
Example usage
When asked about compression rate, hum the song. 100 BPM = minimum, 120 BPM = maximum. If the question gives a rate of 90 — too slow. Rate of 130 — too fast.
Recall trigger
Hear 'Staying Alive' — how fast? That is your compression rate.
Compression depth (adult): at least 5 cm, not more than 6 cm
Memory aid
Picture the standard width of a PHILIPPINE PESO COIN stacked five times — that is about 5 cm minimum depth. Now add one more coin — that is 6 cm, the maximum. Your hands press down at least a 5-peso-coin stack deep, but never deeper than 6 coins. If you press shallower, no blood moves. If you press deeper, you break bones unnecessarily. The coins are your depth meter.
Why it works
Visualizing a familiar everyday object (Philippine peso coins) creates a tactile and visual memory anchor tied to a specific measurement.
Example usage
NLE asks: 'What is the correct compression depth for an adult?' → Picture coin stack → Answer: at least 5 cm (2 inches), not more than 6 cm (2.4 inches).
Recall trigger
Stack of 5 peso coins = 5 cm minimum; 6 coins = 6 cm maximum.
Compression-to-ventilation ratio: 30:2 (single rescuer, all ages; two-rescuer adult); 15:2 (two-rescuer child/infant)
Memory aid
Use the BASKETBALL rule: A standard NBA game has 30-second shot clocks — 30 compressions. Then 2 free throws — 2 breaths. 30:2. For TWO rescuers saving a CHILD (smaller player, junior league), halve the compressions: 15:2 — like halftime shots, smaller game. Key rule: '30 is for ONE rescuer at any age and TWO rescuers saving an ADULT. 15 is for TWO rescuers saving a CHILD or INFANT.'
Why it works
Chunking the ratios with a sports analogy creates a familiar framework. Basketball is highly popular in the Philippines, making this culturally resonant.
Example usage
Question: 'Two nurses are performing CPR on a 3-year-old. What ratio?' → Junior league = 15:2. One nurse on an adult = 30:2.
Recall trigger
Basketball shot clock (30) and free throws (2). Junior league (child) = 15:2.
Switch compressors every 2 minutes to prevent fatigue
Memory aid
Think of a RELAY RACE at your university's intramural sports. The baton (compressions) must be passed every 2 minutes — not because the runner collapsed, but because quality degrades with fatigue even if the runner doesn't feel tired. In CPR, the 'baton' is chest compressions. After 2 minutes, the relay runner hands off — and the team keeps winning (the patient keeps getting high-quality compressions).
Why it works
The relay race analogy maps perfectly to the teamwork and timing aspect of switching compressors, making it a dynamic and energetic mental image.
Example usage
NLE scenario: Nurses A, B, C are doing CPR. When should they switch? → Every 2 minutes / after each rhythm analysis check.
Recall trigger
Relay race baton pass = switch compressors every 2 minutes.
Agonal gasping = NOT adequate breathing
Memory aid
Imagine you are a new nurse on duty and you see a patient on the floor making strange, irregular, gasping sounds — like a fish out of water. Your instinct says 'He is breathing!' But your preceptor grabs your arm: 'Agonal gasps are the body's last reflex — it is the heart's cry, not real breathing. START COMPRESSIONS NOW.' That gasping fish image — it looks alive but it is not — is agonal breathing. It does NOT count. Begin CPR immediately.
Why it works
A micro-story creates emotional engagement and a narrative hook. The fish-out-of-water image is universally recognizable and viscerally distinct.
Example usage
NLE stem: 'Patient is unresponsive with occasional gasping respirations.' Action? → Agonal gasping = no breathing → activate emergency response, begin compressions.
Recall trigger
Fish out of water gasping = agonal breathing = NOT real breathing → start CPR.
Shockable rhythms: VF and Pulseless VT; Non-shockable: Asystole and PEA
Memory aid
Use 'SAVE vs. CAVE': SAVE = Shockable Are VF and pulseless-VT (Evil rhythms you ZAP). CAVE (avoid the shock, go inside the cave without electricity) = Cannot shock Asystole and pVT... wait — try: 'SHOCK the VIPs (VF and pVT), but DO NOT SHOCK the FLAT LINE (Asystole) or the GHOST (PEA — organized electricity, no pulse = ghost heart).'
Simpler: Think of a BROKEN BLENDER — VF and pVT = the blender is running WILDLY but grinding nothing useful → SHOCK it to reset. Asystole and PEA = the blender is OFF (asystole = truly off) or APPEARS to run but has no blade (PEA = electrical signal, no mechanical output) → Shocking a dead blender or bladeless one does NOTHING. Use CPR + drugs instead.
Why it works
The blender analogy maps electrical vs. mechanical cardiac function visually. It distinguishes the mechanism of each rhythm, making the clinical decision logical rather than memorized.
Example usage
NLE: 'Rhythm shows a chaotic, irregular waveform with no identifiable QRS.' → VF = Shockable → Defibrillate immediately.
Recall trigger
Wildly spinning blender (VF/pVT) = SHOCK. Off blender (asystole) or bladeless blender (PEA) = NO SHOCK.
Epinephrine in arrest: 1 mg IV/IO every 3–5 minutes (1:10,000 concentration)
Memory aid
Remember '1-3-5 Rule for Arrest Epi': 1 mg, every 3 to 5 minutes, 1:10,000 (so dilute it is 1 in 10,000 — think of ONE drop of red ink in TEN THOUSAND drops of water — very dilute). Contrast this with Anaphylaxis Epi: 0.3–0.5 mg IM, 1:1,000 (much more concentrated — ONE drop in ONE THOUSAND). The cardiac arrest dose is BIGGER volume, MORE dilute. The anaphylaxis dose is SMALLER volume, MORE concentrated. Never mix them up — this is a HIGH-ALERT medication error on NLE.
Why it works
Chunking the numbers (1-3-5) and contrasting with anaphylaxis dosing creates a dual-coding memory — you remember both by knowing how they differ.
Example usage
NLE: 'What is the correct epinephrine dose for a patient in asystole?' → 1 mg IV/IO every 3–5 min, 1:10,000. NOT 0.3 mg IM.
Recall trigger
1-3-5 for cardiac arrest epi. Compare to anaphylaxis 0.3-0.5 IM 1:1000.
Amiodarone for refractory VF/pVT: 300 mg first, then 150 mg
Memory aid
Amiodarone goes in THREE-ZERO-ZERO (300) — think: 'Three hundred is the first to go, then one-fifty for the second show.' Or use the DOUBLE-HALF rule: First dose = 300 mg. Second dose = HALF of 300 = 150 mg. If the blender (VF) is still spinning wild after the shock and epinephrine, amiodarone is the wrench — 300 first, then 150. Lidocaine is the backup wrench if amiodarone is unavailable.
Why it works
The rhyme creates an auditory anchor, and the 'double-half' rule provides a mathematical relationship that is easy to verify mentally.
Example usage
NLE: 'VF persists after 3rd shock and epinephrine. What antiarrhythmic is given?' → Amiodarone 300 mg IV/IO, then 150 mg if needed.
Recall trigger
300 first, then half (150). Amiodarone for refractory VF/pVT.
The Hs and Ts — Reversible Causes of Cardiac Arrest
Memory aid
Use the story of 'HOT (Hs) and COLD (Ts)': The Hs are HOT trouble inside the body: Hypovolemia (dry), Hypoxia (no air), Hydrogen ion/Acidosis (sour), Hypo/Hyperkalemia (potassium problems), Hypothermia (cold). The Ts are TRAUMATIC threats hitting from outside: Tension pneumothorax (lung collapse), Tamponade (heart squeezed), Toxins (poisoned), Thrombosis — pulmonary or coronary (clot).
Full mnemonic: '5Hs: Have Very Hot Kidney Problems' = Hypovolemia, (H)ypoxia, Hydrogen ion, (H)ypo/Hyperkalemia, Hypothermia. '4Ts: The Tension Tightens Things Tight' = Tension pneumothorax, Tamponade, Toxins, Thrombosis.
Why it works
Dual mnemonics with a narrative framework (hot vs. traumatic) organize 9 items into two memorable clusters, reducing cognitive load.
Example usage
NLE: 'Patient in PEA. What should the nurse look for?' → Search for the Hs and Ts. PEA especially requires aggressive search for reversible causes.
Recall trigger
Hs and Ts. 5 hot internal problems, 4 traumatic external threats.
After delivering a shock, resume compressions IMMEDIATELY for 2 minutes before rechecking
Memory aid
Picture a CODE BLUE scene: the nurse shocks the patient, the rhythm on the monitor looks like it might be changing, and a junior nurse reaches for the wrist to check a pulse. The senior nurse stops her: 'Two minutes first! The heart just got hit by lightning — give it time to organize while we keep blood moving. If we pause to feel for a pulse right after the shock, we waste precious seconds. COMPRESS NOW, CHECK LATER.' The rule: Shock → Immediately back to compressions → 2-minute cycle → THEN rhythm/pulse check.
Why it works
The micro-story creates an emotionally charged, vivid scenario that nursing students can project themselves into, making the sequence unforgettable.
Example usage
NLE: 'Defibrillation was just delivered. What is the next nursing action?' → Immediately resume chest compressions for 2 minutes before rhythm analysis.
Recall trigger
Shock is delivered → Immediately resume compressions → 2 full minutes → then recheck.
AED pad placement: below right clavicle and left lower lateral chest
Memory aid
Use the 'SHIRT POCKET / SIDE POCKET' image: Right pad = where a man wears a SHIRT POCKET (upper right chest, below clavicle). Left pad = your LEFT HIP POCKET on jeans (lower left lateral chest). If you can picture putting your right hand in your shirt pocket and your left hand in your jeans hip pocket — you have correct AED pad placement. Two pockets, two pads, electricity flows across the heart between them.
Why it works
Visualizing clothing pockets that everyone uses daily creates a spatial memory anchor tied to body position, making pad placement intuitive.
Example usage
NLE: 'Where should AED pads be placed on an adult?' → Right pad: below right clavicle. Left pad: left lower lateral chest (shirt pocket / hip pocket rule).
Recall trigger
Shirt pocket (right clavicle) and hip pocket (left lateral chest) = AED pad positions.
Choking in infants: 5 back slaps + 5 chest thrusts (NO abdominal thrusts)
Memory aid
Imagine your baby cousin is choking on a piece of kakanin. You want to do Heimlich (abdominal thrusts) like you saw on TV — but STOP. An infant's liver is large and unprotected — abdominal thrusts can rupture it. Instead: FIVE SLAPS ON THE BACK (firm, between shoulder blades) like burping a baby — then FIVE CHEST PUSHES (like infant CPR compressions on the sternum). Alternate: 5 slaps, 5 chest pushes. Repeat until the object flies out or baby loses consciousness (then start CPR). Remember: NO tummy thrusts on babies.
Why it works
The relatable Filipino family scenario (baby cousin, kakanin) creates an emotionally vivid story with a clear clinical reason (liver protection), making the rule memorable and meaningful.
Example usage
NLE: '8-month-old infant is choking on food, conscious. What is the correct intervention?' → Alternate 5 back slaps and 5 chest thrusts. Do NOT perform abdominal thrusts.
Recall trigger
Baby choking = 5 back slaps + 5 chest thrusts. NO Heimlich. Liver danger!
Blind finger sweep is PROHIBITED in choking victims
Memory aid
Imagine you dropped your earring down a dark drain. If you shove your finger in blindly, you might push it deeper into the pipe — gone forever. The same happens with a choking object: a blind finger sweep in the throat can push the object deeper into the airway, making a bad situation fatal. ONLY remove what you can SEE. If you open the airway for ventilation and you can see the object — remove it. If you cannot see it, do NOT sweep blindly.
Why it works
The lost earring analogy is familiar and creates an immediate visceral understanding of why the action is counterproductive.
Example usage
NLE: 'A choking patient becomes unresponsive. CPR is started. When opening the airway for breaths, what should the nurse do?' → Look for visible object; remove only if visible. Never perform blind finger sweep.
Recall trigger
Lost earring in drain = do not poke blindly. Only remove what you can SEE in the airway.
Pediatric/infant compression depth: one-third AP diameter (~5 cm child, ~4 cm infant)
Memory aid
Use the '1/3 SLICE RULE': Imagine slicing a child's chest from front to back like slicing a loaf of pan de sal in thirds. Compress only the FRONT THIRD. For a child, that front third is about 5 cm. For a baby (smaller loaf), the front third is about 4 cm. The reference point is ALWAYS 1/3 of the chest depth — not a fixed number. This way, you adapt to every child's size.
Why it works
The pan de sal (Filipino bread roll) analogy makes the '1/3 AP diameter' concept spatially intuitive and uses a familiar everyday object.
Example usage
NLE: 'What is the correct compression depth for a 2-year-old?' → About one-third the anteroposterior chest diameter, approximately 5 cm.
Recall trigger
Pan de sal sliced in thirds. Compress only the front third. Child ~5 cm. Infant ~4 cm.
Infant CPR compressions: two-finger technique (single rescuer) vs. two-thumb encircling technique (two rescuers)
Memory aid
Think of it as a PEACE SIGN vs. a HUG: ONE rescuer alone uses a PEACE SIGN (two fingers — index and middle finger on the sternum below the nipple line). TWO rescuers use a FULL HUG (both thumbs on the sternum, fingers wrap around the baby's back — the encircling technique). The hug is BETTER because it generates more consistent depth and force — use it when you have a partner. Remember: peace sign = one person; hug = two people.
Why it works
Mapping a hand gesture (peace sign, hug) to a technique creates a physical-motor anchor that nursing students can practice with their own hands.
Example usage
NLE: 'A single nurse is performing CPR on a 3-month-old. Which technique is used for compressions?' → Two-finger technique (peace sign). If two nurses: two-thumb encircling technique.
Recall trigger
Peace sign (two fingers) = solo. Hug (two thumbs encircling) = two rescuers.
Continuous compressions with advanced airway: 1 breath every 6 seconds (10 breaths/min)
Memory aid
Once the tube is in (advanced airway secured), NEVER STOP for breaths again. Instead: 'Every six seconds, give a breath with ease — ten per minute, compressions never cease.' Count: compress-2-3-4-5-6-BREATH, compress-2-3-4-5-6-BREATH. The airway is secured, so asynchronous ventilation is safe. 6 seconds between breaths = 10 breaths per minute. Compressions continue NON-STOP at 100–120/min.
Why it works
The counting rhyme creates an auditory pattern that can be practiced aloud, embedding the 6-second/10-breath relationship in procedural memory.
Example usage
NLE: 'An endotracheal tube has been placed during CPR. How should ventilation be delivered?' → One breath every 6 seconds (10/min); compressions continue without pause.
Recall trigger
Tube in → count to 6 → breathe → count to 6 → breathe. Never stop compressions.
Check breathing and pulse simultaneously for NO MORE than 10 seconds
Memory aid
Use the '10-SECOND WINDOW' rule — think of a TRAFFIC LIGHT: You have 10 seconds at a yellow light to decide go or stop. Waste more than 10 seconds hesitating and you cause a crash (the patient deteriorates). During that 10-second window: feel the carotid pulse WITH ONE HAND while looking at the chest rise WITH YOUR EYES. Both checks happen at the same time. If you cannot confirm a pulse confidently in 10 seconds — START CPR. When in doubt, compress.
Why it works
The traffic light metaphor creates urgency and a clear time boundary. Simultaneous checking is reinforced by the image of two senses working in parallel.
Example usage
NLE: 'How long should the nurse assess for breathing and pulse before starting CPR?' → No more than 10 seconds, simultaneously.
Recall trigger
Yellow traffic light = 10-second window. Feel pulse AND watch chest at the same time. No pulse in 10 sec = start CPR.
Full chest recoil between compressions — do NOT lean on the chest
Memory aid
Think of a BASKETBALL PUMP: When you pump air into a basketball, you must pull the pump handle ALL THE WAY BACK before pushing again — if you only push halfway and hold, no air gets sucked in. The heart is the same: between compressions, your hands must FULLY RELEASE (lift slightly without losing contact) so the chest wall springs back, creating negative pressure that draws blood into the right heart. Leaning on the chest after compression = holding the pump handle halfway = the heart never refills = no cardiac output.
Why it works
The basketball pump is a universally familiar mechanical analogy that makes the physiologic reason for full recoil intuitive and unforgettable.
Example usage
NLE: 'Why is full chest recoil essential during CPR?' → Allows the heart to refill with blood between compressions, maintaining cardiac output. Leaning reduces venous return.
Recall trigger
Basketball pump: pull ALL THE WAY BACK between compressions. Full recoil = refilling.
Closed-loop communication in code team dynamics
Memory aid
Imagine a CODE BLUE in a Philippine government hospital. The team leader shouts: 'Give epinephrine 1 mg IV now!' In the chaos, two nurses both reach for the medication — neither confirmed who was doing it. Result: double dose or no dose. Closed-loop communication prevents this: Leader says 'Nurse Reyes, give epinephrine 1 mg IV.' Nurse Reyes repeats: 'Understood — giving epinephrine 1 mg IV.' After giving: 'Epinephrine 1 mg IV given at 10:32.' The LOOP is CLOSED. Think: ORDER → REPEAT-BACK → CONFIRM DONE. This is professional nursing practice under RA 9173 — safe, accountable care.
Why it works
The realistic CODE scenario (Philippine setting, RA 9173 reference) creates a culturally grounded, professionally relevant story that mirrors actual nursing practice on NLE scenarios.
Example usage
NLE: 'What communication technique prevents medication errors during a cardiac arrest team response?' → Closed-loop communication: receiver repeats the order, confirms when completed.
Recall trigger
Code team → Order → Repeat back → Confirm done. Closed loop. No double-dosing, no missed meds.
Revision game
I am the taxi driver of emergency nursing. My name has three letters. I tell you to start with the heart, then the airway, then the breath. Who am I?
Answer
C-A-B (Compressions → Airway → Breathing)
Memory link
A1 — The CABbie analogy. Picture the yellow taxi driving to the hospital.
A fish is lying on the floor, mouth opening and closing. Should you start CPR?
Answer
YES — agonal gasping is NOT adequate breathing. Treat as no breathing. Start CPR immediately.
Memory link
A6 — Fish out of water = agonal breathing. It looks like breathing but it is NOT.
You just shocked a patient in VF. The monitor shows a rhythm. A junior nurse starts to feel for a pulse. What do you say?
Answer
STOP! Resume compressions immediately for 2 minutes BEFORE checking rhythm or pulse after a shock.
Memory link
A11 — The CODE BLUE micro-story. Shock → Compress → 2 min → then check.
I have 5 internal troublemakers and 4 external threats. PEA calls for me whenever it shows up. What am I?
Answer
The Hs and Ts — Reversible Causes of Cardiac Arrest (5 Hs + 4 Ts)
Memory link
A10 — HOT internal Hs vs. TRAUMATIC external Ts mnemonic.
A 7-month-old infant is choking on a piece of food. The baby is still conscious. You should do... what exactly? (Be specific about number and type!)
Answer
Alternate 5 back slaps and 5 chest thrusts. Do NOT perform abdominal thrusts on infants.
Memory link
A13 — Baby cousin choking on kakanin. 5 slaps + 5 chest pushes. No tummy thrusts — liver danger!
Two nurses arrive at the bedside of a 4-year-old in cardiac arrest. What is the correct compression-to-ventilation ratio?
Answer
15:2 — two rescuers, child under 8 years old.
Memory link
A4 — Junior league basketball. Two rescuers + child = 15:2. One rescuer or adult pair = 30:2.
I am an anti-arrhythmic drug. My first dose is 300 mg, my second dose is exactly half of that. I am used when VF/pVT won't quit after multiple shocks. Name me and my doses.
Answer
Amiodarone — 300 mg first dose, 150 mg second dose, given IV/IO for refractory VF/pulseless VT.
Memory link
A9 — THREE HUNDRED THEN HALF rhyme. 300 mg → 150 mg for the wrench that won't let VF win.
Nurse A shouts: 'Someone give epi!' Nurse B quietly gives it. Then Nurse C gives it too because she thought no one responded. What went wrong and how do you fix it?
Answer
No closed-loop communication. Fix: Team leader names the person (e.g., 'Nurse Reyes, give epinephrine 1 mg IV'), receiver repeats the order, confirms when done.
Memory link
A20 — CODE BLUE double-dose story. ORDER → REPEAT-BACK → CONFIRM DONE = closed loop.
Formula mnemonics
Compression Rate: 100–120 compressions per minute
Mnemonic
'Staying Alive' BPM = 100. Stay in the zone: ONE-ZERO-ZERO to ONE-TWO-ZERO. Think 'Staying Alive to Staying Safe' — 100 to 120.
When to use
Every time chest compressions are initiated for any cardiac arrest in an adult, child, or infant — the rate is always 100–120/min regardless of age.
What each part means
100/min = minimum effective rate to generate cardiac output. 120/min = maximum before depth and filling time are compromised. Outside this range = ineffective CPR.
Compression Depth — Adult: ≥5 cm (2 in), ≤6 cm (2.4 in); Child: ~5 cm; Infant: ~4 cm (all = ~1/3 AP diameter for peds)
Mnemonic
Adults: FIVE TO SIX — no less, no more. Kids: ABOUT A THIRD of chest depth. Infants: FOUR centimeters. '5-6 for grown, 1/3 for little, 4 for the newborn.'
When to use
Applied every compression throughout the arrest. Used in NLE questions that ask for correct depth or identify errors in CPR technique.
What each part means
≥5 cm = minimum to generate adequate forward blood flow. ≤6 cm = upper limit to prevent rib/sternal injury. Pediatric 1/3 AP = adapts to variable body sizes. Infant 4 cm = standard for average-sized infant.
Compression-to-Ventilation Ratio: 30:2 (single rescuer all ages; two-rescuer adults) | 15:2 (two-rescuer child/infant)
Mnemonic
SINGLE OR ADULT PAIR = 30:2. CHILD WITH A PARTNER = 15:2. 'One alone or adult pair: thirty and two. Child with a friend: fifteen will do.'
When to use
Set the ratio before starting CPR. Adjust when a second rescuer arrives for a pediatric patient. Once advanced airway is in place, ratio becomes irrelevant — continuous compressions with 1 breath every 6 seconds.
What each part means
30 compressions = one set; 2 breaths = one pause for ventilation. 15:2 for pediatric two-rescuer allows more frequent ventilation for children who have higher oxygen demand. The ratio changes ONLY with (1) two rescuers AND (2) a child/infant.
Epinephrine (Arrest): 1 mg IV/IO every 3–5 minutes; concentration 1:10,000
Mnemonic
1-3-5 ARREST EPI: 1 mg, 3-to-5 minutes, 1:10,000. Vs. ANAPHYLAXIS EPI: 0.3–0.5 mg IM, 1:1,000. Arrest = dilute (10,000); Anaphylaxis = concentrated (1,000). 'Arrest epi is BIG dose in WEAK solution; Anaphylaxis epi is SMALL dose in STRONG solution.'
When to use
In ALL cardiac arrest rhythms (shockable and non-shockable). In shockable rhythms: given after the 2nd shock. In PEA/asystole: given as early as possible. NEVER used for anaphylaxis at this dose/concentration.
What each part means
1 mg = standard arrest dose for vasoconstriction and aortic diastolic pressure. Every 3–5 min = repeated dosing cycle aligned with CPR rhythm analysis. 1:10,000 = 1 mg in 10 mL (more dilute, IV-safe for central/peripheral access). Compare: anaphylaxis 1:1,000 = 1 mg in 1 mL (more concentrated, for IM use only).
Amiodarone (Refractory VF/pVT): 300 mg IV/IO first dose, then 150 mg second dose
Mnemonic
300 THEN HALF: 300 mg → if still in VF → 150 mg (half of 300). 'Three hundred first, then half the rest.' Lidocaine is backup if amiodarone unavailable.
When to use
Only for VF or pulseless VT that persists after ≥3 defibrillation attempts AND epinephrine. Not for asystole or PEA.
What each part means
300 mg = initial loading dose to suppress refractory ventricular arrhythmias. 150 mg = second dose for continued VF/pVT after additional shocks. Both given as rapid IV/IO push during cardiac arrest (unlike maintenance infusion in stable patients).
Post-Advanced Airway Ventilation Rate: 1 breath every 6 seconds = 10 breaths/minute
Mnemonic
SIX SECONDS TO TEN: count 1-2-3-4-5-6-BREATHE. Ten times per minute. 'Every six seconds, breathe once.' Compressions NEVER stop.
When to use
Once an advanced airway is confirmed and secured during cardiac arrest CPR. Replaces the 30:2 or 15:2 ratio entirely.
What each part means
1 breath every 6 seconds = 10 breaths/min = physiologic ventilation rate during CPR. Compressions run continuously at 100–120/min. The asynchronous delivery is possible because the advanced airway (ETT or supraglottic) protects the airway from gastric aspiration.
Quick recall chains
BLS Sequence for Unresponsive Adult
Recall test
Without looking: list the 8 steps of adult BLS in order. Start with 'Ensure...' Can you name all 8 before the count of 30?
Memory chain
Use the SAFE-CAB-AED story: 'SAFETY FIRST (check scene) → SHAKE AND SHOUT (responsiveness) → FEEL AND LOOK (pulse and breathing, 10 sec) → EMERGENCY CALL (activate + get AED) → CABbie DRIVES (Compressions 30 → Airway open → Breathing 2 breaths) → ZAP WITH AED (defibrillate if needed).' The CABbie always drives the story from assessment to action.
Items to remember
- Ensure scene safety
- Check responsiveness (tap and shout)
- Assess breathing and pulse simultaneously ≤10 seconds
- Activate emergency response and get AED
- Begin chest compressions (30:2)
- Open airway after 30 compressions
- Deliver 2 rescue breaths
- Apply AED as soon as it arrives and follow prompts
The Hs and Ts — Reversible Causes of Cardiac Arrest
Recall test
Say all 9 reversible causes in 20 seconds. Start with 'H' list then 'T' list. Which ones are most associated with PEA?
Memory chain
Hs story: 'The FIVE H patients came to the ER: Hypo-VOLUME (dehydrated), Hypo-OX (no oxygen), ACID burn (H+), Hypo/Hyper-KALI (potassium chaos), Hypo-THERM (cold).'
Ts story: 'Four THREATS struck from outside: The lung COLLAPSED (tension pneumo), the heart was CHOKED in a sac (tamponade), they were POISONED (toxins), and a CLOT blocked the vessel (thrombosis).'
Full chain: 5 internal Hs (body chemistry gone wrong) + 4 external Ts (structural/toxic threats).
Items to remember
- Hypovolemia
- Hypoxia
- Hydrogen ion (Acidosis)
- Hypo/Hyperkalemia
- Hypothermia
- Tension pneumothorax
- Tamponade (cardiac)
- Toxins
- Thrombosis (pulmonary or coronary)
ACLS Shockable Rhythm Algorithm (VF/pVT)
Recall test
When is epinephrine first given in VF/pVT? When is amiodarone first given? What is the 2-minute rule about?
Memory chain
Use 'ZAP-2-CHECK-ZAP-DRUG-ZAP-AMIO-HS&TS-ROSC': Every loop = ZAP (defibrillate) → 2 min CPR → CHECK rhythm → ZAP again if needed → Layer in DRUGS (Epi after 2nd shock, Amio after 3rd) → Keep searching Hs and Ts → ROSC when achieved. Think of peeling an onion — each layer adds a new intervention while the core (compressions) never stops.
Items to remember
- Recognize VF or pulseless VT on monitor
- Defibrillate immediately
- Resume CPR for 2 minutes
- Rhythm check — if VF/pVT: shock again
- Resume CPR for 2 minutes
- Give epinephrine 1 mg IV/IO every 3–5 min
- Give amiodarone 300 mg (if refractory after ≥3 shocks)
- Continue CPR cycles, treat Hs and Ts
- ROSC: post-arrest care
Choking Management by Patient Type
Recall test
What do you do for a conscious 6-month-old choking? A conscious 8-year-old? A pregnant woman who is choking? Any patient who loses consciousness?
Memory chain
The CHOKE DECISION TREE: 'Can they cough? → LET THEM COUGH (mild). Can't cough at all? → Are they ADULT/CHILD? → HEIMLICH (or chest thrusts if pregnant/obese). INFANT? → 5+5 BACK-CHEST. UNCONSCIOUS? → CPR + look and see.' The tree always branches based on: (1) severity, (2) age, (3) consciousness.
Items to remember
- Mild obstruction (any age): encourage coughing, do not intervene
- Severe obstruction, responsive adult/child: abdominal thrusts (Heimlich)
- Severe obstruction, pregnant/obese responsive: chest thrusts
- Severe obstruction, responsive infant: 5 back slaps + 5 chest thrusts (alternate)
- Any patient becomes unresponsive: lower to ground, activate EMS, begin CPR
- When opening airway for breaths: look for visible object, remove if seen
- Never perform blind finger sweep
High-Quality CPR Checklist
Recall test
List all 7 parameters of high-quality CPR without looking. Which one is most commonly done incorrectly in real resuscitations?
Memory chain
Use 'RATE-DEPTH-RECOIL-MINIMIZE-RATIO-SWITCH-NO OVERVENTILATION' = 'Really Deep, Really Minimal Ratio Switches No Overventilation' → RDRM-RSNO. Or the quality checklist acronym 'REFRESH': Rate (100-120), Every compression fully recoils, Fraction of compressions high (≥60%), Ratio correct (30:2), Exchange compressors (2 min), Switch off excessive breaths.
Items to remember
- Rate: 100–120/min
- Depth: ≥5 cm (adult), ~1/3 AP (peds)
- Full chest recoil
- Minimize interruptions (CCF ≥60%)
- 30:2 ratio (or 15:2 two-rescuer peds)
- Switch compressors every 2 minutes
- Avoid excessive ventilation
Diagrams
Adult BLS Algorithm — Step-by-Step Decision Flowchart
A complete visual algorithm of the adult BLS sequence showing decision points for responsiveness, pulse/breathing assessment, CPR initiation with C-A-B sequence, and AED integration. Color-coded branches distinguish assessment from action steps.
BLS and ACLS Key Concepts Mind Map
A comprehensive mind map showing all major CPR/ACLS concepts organized hierarchically: BLS fundamentals, AED use, ACLS rhythms, emergency drugs, reversible causes, and choking management. Use this as a final review visual before the NLE.
ACLS Algorithm — Shockable vs. Non-Shockable Rhythms
A decision flowchart for the ACLS algorithm showing the critical branch between shockable (VF/pVT) and non-shockable (asystole/PEA) rhythms, with timing of epinephrine and amiodarone, CPR cycles, and the path to ROSC.
2-Minute CPR Cycle Timeline — Code Blue Sequence of Events
A timeline showing the progression of a cardiac arrest resuscitation over 12+ minutes, illustrating when each intervention occurs within the 2-minute CPR cycle. This helps students visualize the rhythm of a real Code Blue and understand drug timing.