Clinical Notes

Rhythms, codes, & case reviews.

Deep-dives on the rhythms that trip you up, the drugs that save lives, and the scenarios you'll see at 3 AM. Written by critical care clinicians for the people who run the code.

Latest 7

DOOR → CT · 25 MIN
How-To May 8, 2026 6 min

Stroke Alert to CT in Under 25 Minutes: The Team Choreography

Time is brain. Teams that hit the AHA door-to-CT benchmark consistently aren't smarter — they're more choreographed. The parallel-processing playbook.

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VF → SHOCK → EPI
Reference May 5, 2026 5 min

Epinephrine in Cardiac Arrest: What the 2020 Guidelines Actually Say

The timing of epinephrine in shockable rhythms changed. Exactly what the 2020 AHA guidelines recommend — and why the distinction matters clinically.

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ACLS PALS
Tutorial Apr 28, 2026 5 min

PALS vs ACLS: The Overlap Nobody Teaches

Most clinicians treat PALS and ACLS as separate certifications. Understanding where they converge makes you significantly better at both.

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? ? ? PEA · NO PULSE
Advanced Apr 24, 2026 6 min

H's and T's: The Deep Dive No One Teaches You

Every ACLS provider can recite the H's and T's. Recognizing one at the bedside during a PEA arrest is an entirely different skill. Here's the framework.

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HR 34 · SYMPT BRADY
ACLS Training Apr 22, 2026 12 min

When Atropine Fails: Managing Symptomatic Bradycardia

A 78-year-old in cardiogenic shock. Atropine 0.5mg IV. Nothing happens. The complete megacode: pacing, reversal agents, and what separates algorithms from expertise.

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ERRORS FLAGGED
Best Practices Apr 21, 2026 5 min

ACLS Mega Code: What Every RN Gets Wrong

Nurses who know the algorithms cold still freeze at the bedside. Three common failure points — and exactly how to fix each one.

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1mg 300mg 200J 3–5min 100bpm 10sec 0.5mg 25min 2.4"
Reference Apr 20, 2026 4 min

The ACLS Cheat Sheet: 10 Numbers Every Provider Must Know Cold

The 10 numbers that show up in every ACLS algorithm and every Mega Code scenario. Drill them until they're automatic.

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In the works 1

Coming soon
2° AVB · MOBITZ II
Rhythms Draft

Mobitz Type II: When the AV Node Fails Silently

Second-degree AV block is the rhythm that sneaks up on you — normal PRs, then a dropped QRS out of nowhere. Why Mobitz II is an electrical emergency even when the patient looks fine.