ACLS/BLS for new interns

[AlexanderJ]

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Just how much of those 2 books do we need to read to pass the ACLS/BLS courses? Thanks.

 

[njbmd]

Originally posted by AlexanderJ
Just how much of those 2 books do we need to read to pass the ACLS/BLS courses? Thanks.

Hi there,
Almost none if you know the scenarios well.
njbmd🙂

 

[AlexanderJ]

Anyone else have an opinion on this thread?

 

[Voxel]

Have you taken BCLS before? If so that part will be easy.

I recommend knowing the algorithms associated with the different senarios. PEA, VT w/ and w/o pulse, V Fib, bradycardia. And the different causes listed for precipitating events. Whenever you start out a senario, just remember the ABCs and algorithms and you can easily pass that part. For the written, you need know the general BLCS proper sequence senarios for adults, children and infants. Also, I believe there were some questions about dosage for meds used in various senarios. Learn those as well. Also I recommending using those flash pocket cards that come with the ACLS pack.
Over all it's not too bad ACLS/BLS isn't too bad. Don't stress but definitely bone up on scenarios and algorithms (ie when to cardiovert, when to give meds and how much and what's the upper limit of certain meds you can give, and which do not have an upper limit).

 

[Winged Scapula]

I agree - its not too tough. You can memorize the algorithms pretty easily. ATLS is another matter ( much more difficult).

 

[edfig99]

at our training they just emphasized certain things more than others and gave hints during the skills such as "so if you see a question that says blah blah blah"

just look at the cards...and pay attention during the skills.

 

[southerndoc]

Recommended study aids:

www.acls.net

AHA Provider Textbook - familiarize yourself with the acute coronary syndromes, stroke, and all the algorithms and drugs associated with it

Find a paramedic to help you... I am not kidding about this. Most of the ACLS courses have at least one paramedic teaching the course. Paramedics are drilled on ACLS by their instructors and medical directors, and quite frankly, I rarely see a resident or attending physician that can even match a paramedic's performance at ACLS. (Of course the paramedic is taught to just do rather than think.)

If you need any help, feel free to email me.

 

[Apollyon]

Originally posted by Geek Medic
(Of course the paramedic is taught to just do rather than think.)

Unfortunate, but too true.

 

[Dr. SS]

what happens if u dont pass the written part at the end.

i just took acls, i was so buys moving i didnt study for it, i did fine on the oral part, and the algorithms and what not but on the written part, i think u are allowed to get a maximum of 5 wrong, where as i got 6 or 7 wrong. i was stupid also, because u are allowed to use the handbook during the test but i was so tired taht i did the test on my own. the instructor pulled me to the side and went over the questions i missed with him and that was it, said i could go home...

do they actually fail people?

 

[Tenesma]

please remember that ACLS is an algorithm set forward as a guideline - primarily for non-physicians. We as physicians need to make good clinical decisions based on the information we have... you also can't forget that most of the recommendations set forth in ACLS have no good substantive research to support anything - in fact, lidocaine was the "best" drug in the world up until 2000 when we all realized nothing supported it. The only three things we do - beyond managing the airway, that is supported by research 1) oxygen 2) defibrillation 3) amiodarone.

also for new interns - remember that futility of CPR is clearly stated in the ACLS guidelines!!!! if you run into a room and the patient is cold, blue w/ lividity (blood settling w/gravity) and no vital signs: patient is dead.. CPR is a waste of resources at that point. I would say that over 50% of codes are on dead (fully dead - not almost dead) people.

 

[fourthyear]

Yes, Dr. SS, they DO actually fail people - and really they should have failed you if you failed b/c you were just too lazy to use your book for an open book test!!! Come on, you cannot think that is a professional attitude to have towards a course you are taking because you are intereted in learning how to do something as serious as participate in a code situation!! The fact that you were tired is NOT a good excuse - is that what you'll use when you tell a patients family that grandpa didn't make it b/c you were too tired to bother to look up the proper med to treat afib???!!?!

It all depends on the policy of the center you take your ACLS course. In the past, ACLS was very intimidating and they failed people quite frequently. This was not good, because people came to dread ACLS and that did not foster a good learning environment. AHA decided the point was to train people well, not scare them away, so they tried to make the written test more straightforward, and encouraged training centers to focus on long term learning, not on the pass/fail idea. So, they let you do open book at a lot of testing centers b/c in real life you have access to your little algorithm book too. Everyone should know that not all training centers let you use the book for the written test, and many will have you come back another day and retake the exam after you've read more and reviewed what you missed, so you should come to class prepared if you want to walk out with your card.

 

[mikecwru]

Originally posted by fourthyear
Yes, Dr. SS, they DO actually fail people - and really they should have failed you if you failed b/c you were just too lazy to use your book for an open book test!!! Come on, you cannot think that is a professional attitude to have towards a course you are taking because you are intereted in learning how to do something as serious as participate in a code situation!! The fact that you were tired is NOT a good excuse - is that what you'll use when you tell a patients family that grandpa didn't make it b/c you were too tired to bother to look up the proper med to treat afib???!!?!

It all depends on the policy of the center you take your ACLS course. In the past, ACLS was very intimidating and they failed people quite frequently. This was not good, because people came to dread ACLS and that did not foster a good learning environment. AHA decided the point was to train people well, not scare them away, so they tried to make the written test more straightforward, and encouraged training centers to focus on long term learning, not on the pass/fail idea. So, they let you do open book at a lot of testing centers b/c in real life you have access to your little algorithm book too. Everyone should know that not all training centers let you use the book for the written test, and many will have you come back another day and retake the exam after you've read more and reviewed what you missed, so you should come to class prepared if you want to walk out with your card.

I don't know if my written test was open book, but they allowed us to use any books/reference for the practical stations (although it would have been awkward). They gave us a pretest, then answers, then at each station, they were "emphasizing" things that turned out to be test questions. The written test was not hard, and I too, would be reluctant to pass anyone getting 5-6 wrong regardless of reason.

On a side note, there were some non-EM residents that were making major mistakes in the practical stations and most of them got their cards.

mike

 

[Dr. SS]

whoa... harshness..

thanks for the replies but id like to clear up a few points. I am NOT making any excuses for myself. yes i was tired, but i dont attribute that to the cause of my not using the book during the test, even if it sounded like that. the questions i got wrong, i thought i knew... so i thought i didnt need to look at the book, but i was wrong. so fundamentally my knowledge isnt as great as yours perhaps. that doesnt mean im not going to look up the proper med to treat afib in grampa. as i said before, i felt like i did find on the oral practical stations. i would help out my team members and they would help me out. i thought it was a very good experience, and i feel that i learned alot. i did take the pretest before the course, and i had like HALF of them wrong (did not study before taking the pretest). i retook the test at the end of the course and greatly reduced that. if i had double checked the answers i thought were correct, with the book, i would have passed. which is what i should have done. i am a FMG and where i went to school we were not taught the material in ACLS in a structured practical way. the concepts i knew, but the practical application of the algorithms i had never experienced and i really got alot out of it. i should have double checked my test i admit that as my fault. but please dont judge me as being someone who wont even open a book to ensure the proper care of his patient..

later..

 

[fourthyear]

I didn't mean it as a personal attack on you, SS, but I guess it sounded that way.

I meant for my comments to make sure other people reading this thread don't blow off the course b/c all the posters here said it was an easy class. I actually have taught ACLS in the past, and the classes are much better for everyone participating if they all come somewhat prepared. If they wait for the instructors to spoon feed everything, they are less likely to get as much long-term knowldege and confidence out of the experience. And, as I said, not every center or every instructor will be forgiving of recent med school grads who are certainly smart enough to master this stuff, but just don't bother to look at the books.

I'm just trying to make sure the readers of this thread take ACLS seriously enough...and that they make a good impression on their new residency program by passing the first time thru!

 

[Dr. SS]

agreed....

i just hope i dont have to take it again. i wasnt told anything at all after the instructor went through the questions i got wrong with me. ill definately be more wary about it when i have to recertify....

 

[womansurg]

When I took it as a student, the Chief of Cardiology was having to recertify. He was this older, very arrogant, very self absorbed man who was disliked by a lot of people who weren't on his same or higher political level.

He was post call and tired and, truth be told, maybe showing just a wee bit of early dementia by that point in his career. The RN leading the group was just merciless with him - correcting him in front of the group with derision in her voice, making him repeat things over and over, rolling her eyes and talking to him like he was a child; while she was encouraging and positive with everyone else. One of his more senior residents, or maybe he was a Fellow, was in the class too. He tried to soften things up for him, but you could see how shamed and angry this poor old guy was. It was just painful watching this guy's ego get deconstructed like that.

Geez, I hate universities...

 

[fourthyear]

You have to wonder if this RN had personal experience with the "arrogant" doctor outside of the class and was just taking the opportunity to put him in his place for once. Sounds like a sad story, but maybe he was getting what he dished out to others so to speak??

 

[robinhudster]

(Of course the paramedic is taught to just do rather than think.)

Actually, as a paramedic myself (or at least a paramedic whose certification just expired), I must strongly disagree. While there certainly are some medics who practice "cook book" medicine in the field and don't "think", this is not always the case. Not that I'm trying to show-off, but I've run codes with physicians on scene in which they were the ones not thinking and I was the one thinking "out of the box" and ended up resuscitating the patients. One case that comes to mind is the elderly female who was in asysytolic arrest (yes, asystolic) on whom the doc was ready to give up after about 12 mins. of BLS/ACLS when I asked the home attendant to show me the pt.'s list of meds once again. When I saw that the pt. was on a beta blocker that had just been prescribed the day before, and after quickly counting the pills and noticing that this might be an unintentional OD I administred Glucagon IV and, what do you know, we transported the pt. to the hospital w/ a bp of 160/100 and a sinus tachy at a rate of 115.
I also transported a pt to the ED in arrest and watched as the EM attending simply ran the code w/o thinking while the medic I was working with was actually very carefully thinking through some possible reasons the 26 y.o was in PEA. It was the MEDIC who came up with the idea that the pt. might just have pericardial tamponade and it was b/c of this idea that the doctor decided to perform a pericardiocentesis which worked.
So, I'm sorry that the medics you've encountered haven't impressed you, just be aware that not all medics are like those that you've evidently come across. Also, while it's true that as a physician one should "think" but before you can think you have to know your algorithms COLD so that when the situation gets tense you don't have to fumble for your ACLS handbook (as I've also seen EM docs do and was very unimpressed). Just my 2 cents.

 

[DR]

Thought I'd respond since my ACLS experience was quite different. We had teaching stations where they would indeed emphasize certain things, and let us know that certain things were likely to show up later...but there was no open book! No way. Additionally, the practicals did not allow any books during the exam, and they threw different situations at us than what was presented during the teaching session (kinda sneaky, actually). So, it was tough. One definitely needed to read and memorize the algorithms. One of the nurses teaching was a nurse that as luck would have it works on the floor I am on; she knew my name, as did the others, and I asked how they knew...and they said "we want to know the ones we can trust in a code situation". So they know who didn't know what they were doing during the test, even if they passed.

 

[southerndoc]

Originally posted by robinhudster
So, I'm sorry that the medics you've encountered haven't impressed you, just be aware that not all medics are like those that you've evidently come across. Also, while it's true that as a physician one should "think" but before you can think you have to know your algorithms COLD so that when the situation gets tense you don't have to fumble for your ACLS handbook (as I've also seen EM docs do and was very unimpressed). Just my 2 cents.

All of these things are still part of "cookbook medicine," as they are listed in the differentials of the respective condition. That beta blocker overdose? Well you're supposed to rule out drug overdose as a possible cause of asystole -- it's in the cookbook. The cardiac tamponade? Also in the cookbook.

I had the opportunity to work with some of the most highly trained paramedics I have seen. These paramedics are actually considered among the nation's best. However, they still practice cookbook medicine the vast majority of the time. They are taught to do rather than theorize. Simply thinking about drug overdoses is second nature to them. They don't theorize why a beta blocker overdose will cause arrest, they just recognize it and treat it. Most can't tell you the mechanism by which glucagon works in a beta blocker overdose.

Regarding my experience with paramedics, keep in mind that I am still a nationally registered paramedic that has 10 years of field experience.

Cheers!