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ACLS shmayCLS

Discussion in 'Clinical Rotations' started by neutropeniaboy, Jun 6, 2002.

  1. neutropeniaboy

    neutropeniaboy Blasted ENT Attending 10+ Year Member

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    Anyone else completely incapable of motivating himself/herself to open that ACLS manual despite the fact that internship starts in one week?

    Denial?
     
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  3. Voxel

    Voxel Moderator Emeritus 7+ Year Member

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    I haven't even gotten an ACLS manual. Am I in trouble? Lol. I guess I should crack open a book on EKGs and cardiac pharma. Except the motivation to look at EKGs and pack for the big move seem mutually exclusive.
     
  4. Ligament

    Ligament Interventional Pain Management Physician Lifetime Donor SDN Advisor Classifieds Approved 10+ Year Member

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    Umm,

    At least I purchased some ACLS/EKG books in anticipation for Internship...

    I've had a VERY hard time studying.
     
  5. mddo2b

    mddo2b STOP PAGING ME....PLEASE! 7+ Year Member

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    I've never even heard of ACLS.... <img border="0" title="" alt="[Wink]" src="wink.gif" />

    Denial is a magnificient thing <img border="0" alt="[Clappy]" title="" src="graemlins/clappy.gif" />
     
  6. Pinky

    Pinky and the Brain 10+ Year Member

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    I begin my internship in 10 days and I cannot imagine how I'm going to survive it.

    I've become so lazy and stupid over the past 6 months. To make the start of the internship even more hellish, I am starting in the ICU and will be there for 1 extra week for a total of 5 weeks. In addition, I'm on call on the first day. So much for an easy transition.

    I planned to go over Dubins's EKGs and Felson's CXRs before starting, but I'm rationalizing that it's not going to help anyway so I'm just going to enjoy the next 10 days.

    I picked a bad year to stop drinking.
     
  7. Stormreaver

    Stormreaver The Blade of Tyshalle 7+ Year Member

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    Those books are lying on the table making me VERY nervous...
     
  8. neutropeniaboy

    neutropeniaboy Blasted ENT Attending 10+ Year Member

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    USA
    </font><blockquote><font size="1" face="Verdana, Helvetica, sans-serif">quote:</font><hr /><font size="2" face="Verdana, Helvetica, sans-serif">Originally posted by Pinky:
    <strong>

    I picked a bad year to stop drinking.</strong></font><hr /></blockquote><font size="2" face="Verdana, Helvetica, sans-serif">At least you don't have to stop sniffing glue like me!
     
  9. Sheerstress

    Sheerstress Senior Member 10+ Year Member

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    Want to make learning ACLS fun?

    Check out Mad Scientist Software's "Cardiac Arrest!" CD-ROM program. It simulates code situations in a very real manner, quizzes you after each code, and allows you to pick various topics (e.g. V fib, PEA, etc.) to work on, or to have different cases thrown randomly at you. Check it out at <a href="http://www.madsci.com." target="_blank">www.madsci.com.</a> The company also has a neat trauma simulator as well.

    [ No, I am in no way affiliated with the company :) ]

    As far as learning EKG interpretation, I've gone through several books, including Dubin.

    In my opinion, the best book for learning EKGs, hands down, is called "Twelve Lead EKG: The Art of Interpretation" by Garcia and Holtz. It is also a programmed form of study, but gets you started on reading them right away, gives lots of examples and practice EKGs, and focuses on being clinically relevant. Five stars!

    Hope this helps things - good luck to everyone!
     
  10. Magree

    Magree Senior Member 7+ Year Member

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    Glad to hear I'm not the only one who feels like the last 6 months has turned my brains to mush. Internship is going to be a real shock to the system <img border="0" title="" alt="[Wink]" src="wink.gif" />

    Pinky - totally feel for you starting in ICU - and on call too - bummer. How'd you end up with 5 weeks instead of 4?

    M-
     
  11. gherelin

    gherelin Member 7+ Year Member

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    Just finished reading that ACLS book and found most of it to be lists of things you should already know or should learn "by the end of the course" without actually teaching most of it--they just keep referring you to the ECC Textbook. Anyone think that is worth buying, or, necessary to buy, if you're not going into emergency med?
     
  12. Pinky

    Pinky and the Brain 10+ Year Member

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    Chicago, IL
    </font><blockquote><font size="1" face="Verdana, Helvetica, sans-serif">quote:</font><hr /><font size="2" face="Verdana, Helvetica, sans-serif">Originally posted by Magree:
    <strong>How'd you end up with 5 weeks instead of 4?
    M-</strong></font><hr /></blockquote><font size="2" face="Verdana, Helvetica, sans-serif">Magree,

    We start actual patientcare work on June 24th, That one week plus the whole month of July gives everyone 5 weeks for their first rotation. Next year, when we finish up, our last rotation will be 3 weeks long.

    pinky
     
  13. Pinky

    Pinky and the Brain 10+ Year Member

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    Aug 12, 2001
    Chicago, IL
    </font><blockquote><font size="1" face="Verdana, Helvetica, sans-serif">quote:</font><hr /><font size="2" face="Verdana, Helvetica, sans-serif">Originally posted by neutropeniaboy:
    <strong> </font><blockquote><font size="1" face="Verdana, Helvetica, sans-serif">quote:</font><hr /><font size="2" face="Verdana, Helvetica, sans-serif">Originally posted by Pinky:
    <strong>

    I picked a bad year to stop drinking.</strong></font><hr /></blockquote><font size="2" face="Verdana, Helvetica, sans-serif">At least you don't have to stop sniffing glue like me!</strong></font><hr /></blockquote><font size="2" face="Verdana, Helvetica, sans-serif">I love it when people can pick up obscure movie references.
     
  14. Magree

    Magree Senior Member 7+ Year Member

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    </font><blockquote><font size="1" face="Verdana, Helvetica, sans-serif">quote:</font><hr /><font size="2" face="Verdana, Helvetica, sans-serif">Magree,

    We start actual patientcare work on June 24th, That one week plus the whole month of July gives everyone 5 weeks for their first rotation. Next year, when we finish up, our last rotation will be 3 weeks long.

    pinky
    </font><hr /></blockquote><font size="2" face="Verdana, Helvetica, sans-serif">See what I mean about brains going to mush!! <img border="0" title="" alt="[Wink]" src="wink.gif" /> . I'm sure you'll do great in ICU -at least all the subsequent rotations should be a easy in comparison.

    M-
     
  15. neutropeniaboy

    neutropeniaboy Blasted ENT Attending 10+ Year Member

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    USA
    </font><blockquote><font size="1" face="Verdana, Helvetica, sans-serif">quote:</font><hr /><font size="2" face="Verdana, Helvetica, sans-serif">Originally posted by Pinky:
    <strong>I love it when people can pick up obscure movie references.</strong></font><hr /></blockquote><font size="2" face="Verdana, Helvetica, sans-serif">Watch me closely, my young Padawan. That's all I've got going for me...
     
  16. tussy

    tussy Senior Member 10+ Year Member

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    Get reading kids! I'm in my last month of my PGY1 year and on my ICU rotation. I ran my first code on the first day, and on that same day ran my second, third and fourth. It's crazy. You have to know those algorithms when you're on call and all alone. This week i ran a PEA arrest in the CT scanner! It was me, the RT, one nurse and the CT tech. The code team couldn't find us asi it was late at night and we were in the back of the radiology department. The guy lived; well, for a few hours anyway.
     
  17. NuMD97

    NuMD97 Senior Member 10+ Year Member

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    Tussy, thanks for reminding me. I'm recertifying in two weeks. &lt;ARGHHHH!!!&gt;
     
  18. gherelin

    gherelin Member 7+ Year Member

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    Tussy and NewMD97 (and anyone else who might have input)--were the provider manual and handbook enough or did you need to reveiw the textbook too? Thanks for any info.
     
  19. fourthyear

    fourthyear Senior Member 7+ Year Member

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    Provider manual is plenty. Focus mostly on the algorithms, those review pages in the end of each chapter, and the practice questions whose answers are in the appendix in back. Its not so hard. Reading the whole big textbook...that's hard, and not neccessary either.
     
  20. tussy

    tussy Senior Member 10+ Year Member

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    </font><blockquote><font size="1" face="Verdana, Helvetica, sans-serif">quote:</font><hr /><font size="2" face="Verdana, Helvetica, sans-serif">Originally posted by gherelin:
    <strong>Tussy and NewMD97 (and anyone else who might have input)--were the provider manual and handbook enough or did you need to reveiw the textbook too? Thanks for any info.</strong></font><hr /></blockquote><font size="2" face="Verdana, Helvetica, sans-serif">I didn't read the textbook much. The section on pharmacology is good and of course the algorithms. That's basically all you need.
     
  21. gherelin

    gherelin Member 7+ Year Member

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    Oh good. Thanks for the advice.
     
  22. bbbmd

    bbbmd Pain Doctor/Physiatrist 10+ Year Member

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    Hey all...

    What happens if I fail ACLS??? Just wondering because I havent looked at an ECG in months and I start next week!!! I have never felt so unprepared!!! Any advise on fluid and electrolyte management? For some reason I am more worried about screwing that up since there are no really good algorithms for it like there are for "running a code"!

    Good luck all!!! Enjoy your last few weeks! I was advised by a senior resident to SLEEP and that is exactly what I have been doing! :rolleyes:
     
  23. NuMD97

    NuMD97 Senior Member 10+ Year Member

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    Originally posted by gherelin:

    </font><blockquote><font size="1" face="Verdana, Helvetica, sans-serif">quote:</font><hr /><font size="2" face="Verdana, Helvetica, sans-serif"> Tussy and NewMD97 (and anyone else who might have input)--were the provider manual and handbook enough or did you need to reveiw the textbook too? Thanks for any info. </font><hr /></blockquote><font size="2" face="Verdana, Helvetica, sans-serif">To be honest, I was sent the BLS and ACLS handbooks put out by the American Heart Association. Until I read these posts I didn't even know there was a textbook! Tussy is right. The manual is more than sufficient. Know the algorithms cold. Check out the rhythm strips (though I do remember them throwing a curve during the course with a strip that wasn't in the text at all - no fair!), and learn the drugs well. Don't look elsewhere for more stuff to do in this regard. It's more than enough.

    As far as not passing, I do know it does happen. I'm not sure what the consequences might be, except to not be allowed to participate in a code situation (unless you are BLS certified at least). Probably you wouldn't be allowed to 'run the show' as it were. But as a PGY-1 you wouldn't be anyway, under normal circumstances.

    Hope this helps. Good luck!
     
  24. tussy

    tussy Senior Member 10+ Year Member

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    </font><blockquote><font size="1" face="Verdana, Helvetica, sans-serif">quote:</font><hr /><font size="2" face="Verdana, Helvetica, sans-serif">Originally posted by NuMD97:
    <strong>Originally posted by gherelin:

     
  25. Magree

    Magree Senior Member 7+ Year Member

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    Hi:

    I think if you fail you just retake the test. Not sure what happens if you fail it again but I would imagine they would help you if you had to retake it. Your program really wants you to pass <img border="0" title="" alt="[Wink]" src="wink.gif" /> .

    Anyone else freaking out? I was doing well but now as the day grows near I have butterflies coming out my ears <img border="0" title="" alt="[Wink]" src="wink.gif" /> .

    M-
     
  26. NuMD97

    NuMD97 Senior Member 10+ Year Member

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    Originally posted by Magree:

    </font><blockquote><font size="1" face="Verdana, Helvetica, sans-serif">quote:</font><hr /><font size="2" face="Verdana, Helvetica, sans-serif"> I think if you fail you just retake the test. Not sure what happens if you fail it again but I would imagine they would help you if you had to retake it. Your program really wants you to pass </font><hr /></blockquote><font size="2" face="Verdana, Helvetica, sans-serif">I do know of someone that happened to. He was allowed to retake it and passed on the second try. Sorry if I was a tad unclear.

    They have algorithm cards that they sell in bookstores for about seven or eight dollars. But in a code situation, although I have seen some of the bystanders review the cards, it's probably unwise not to know it cold.
     
  27. gherelin

    gherelin Member 7+ Year Member

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    I'm having trouble with the "quote feature"-quoting too much stuff...anyway-about the fluid and electrolytes-on rotation we always used that little tarascon book that has all the formulas...is that sufficient? Is that what you meant about fluid and elesctrolyte mgmt?
    On the ACLS thing again, sorry to keep having more questions NuMD but I didn't see any actual rhythm strips either in the provider manual or in the little 2000 handbook of ECC. Is there yet another handbook besides those and the textbook?
    pps-yes i am starting to freak out too....
     
  28. NuMD97

    NuMD97 Senior Member 10+ Year Member

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    Hi, Gherelin. First thing to do in a code, as they say, is take your own pulse. <img border="0" title="" alt="[Wink]" src="wink.gif" />

    Warn't me, ma'am, that mentioned the electrolyte stuff, sorry. As memory serves the Tarascon has the algorithms as well. It's the same. The ACLS handbook or manual or whatever you want to call it, put out by the AHA, has the rhythm strips in it to help you recall the most common ones encountered in a code situation.

    Not to worry, it'll all work out fine. Just know the algorithms cold. I find writing them out from memory on a white board helpful. That way you can't cheat. :)

    Believe me, rote recall at my age doesn't come easy, but we all get through this, and you will, too. Now back to the algorithms for me. :)

    Good luck! And congratulations on your match.

    Nu
     
  29. Winged Scapula

    Winged Scapula Cougariffic! Staff Member Administrator Physician Faculty Lifetime Donor Classifieds Approved 15+ Year Member

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    </font><blockquote><font size="1" face="Verdana, Helvetica, sans-serif">quote:</font><hr /><font size="2" face="Verdana, Helvetica, sans-serif">Originally posted by tussy:
    <strong>Get reading kids! I'm in my last month of my PGY1 year and on my ICU rotation. I ran my first code on the first day, and on that same day ran my second, third and fourth. It's crazy. You have to know those algorithms when you're on call and all alone. This week i ran a PEA arrest in the CT scanner! It was me, the RT, one nurse and the CT tech. The code team couldn't find us asi it was late at night and we were in the back of the radiology department. The guy lived; well, for a few hours anyway.</strong></font><hr /></blockquote><font size="2" face="Verdana, Helvetica, sans-serif">Interesting. We have a "Code Team" here in house at all times. Comprised largely of Anesthesia/Crit Care people, their pagers go off automatically when a Code is called. When I've had patients code on service the secretaries have paged me, but by the time I answer and show up the code is well in progress. I cannot imagine a intern running the code except when the patient codes right in front of you...hence my tendency to get in and out of patients rooms as fast as possible! <img border="0" title="" alt="[Wink]" src="wink.gif" />
     
  30. bbbmd

    bbbmd Pain Doctor/Physiatrist 10+ Year Member

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    I used that little book of formulas too. It was helpful, but does anyone know of a source that gives an algorithmic approach to treating electrolyte abnormalities? A stepwise approach to diagnosing and working up suspected electrolyte abnormalities and the steps in management? Which fluid to give and so on? Am I the only one worried about this? From my experience during clerkship, managing fluids seemed more complicated than following the protocol of the "code". Also, I probably would not be alone during my first year actually leading a code, but I am sure I will be expected to know what to do (with confidence) if my patient is hyperkalemic, hypokalemic, hypernatremic, fluid overloaded, dehydrated and so on... If I am the only one clueless in this regard, please tell me what you guys know! I know the practice of medicine is not only following protocols and algorithims, but knowing them will certainly help this soon to be intern in the middle of a night on call!!!
     
  31. bbbmd

    bbbmd Pain Doctor/Physiatrist 10+ Year Member

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    Thanks NuMD! Guess I am just freaking out! :(

    Ill start writing those algorithims over and over until I remember them!!!
     
  32. Winged Scapula

    Winged Scapula Cougariffic! Staff Member Administrator Physician Faculty Lifetime Donor Classifieds Approved 15+ Year Member

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    </font><blockquote><font size="1" face="Verdana, Helvetica, sans-serif">quote:</font><hr /><font size="2" face="Verdana, Helvetica, sans-serif">Originally posted by bbbmd:
    <strong>I used that little book of formulas too. It was helpful, but does anyone know of a source that gives an algorithmic approach to treating electrolyte abnormalities? A stepwise approach to diagnosing and working up suspected electrolyte abnormalities and the steps in management? Which fluid to give and so on? Am I the only one worried about this? From my experience during clerkship, managing fluids seemed more complicated than following the protocol of the "code". Also, I probably would not be alone during my first year actually leading a code, but I am sure I will be expected to know what to do (with confidence) if my patient is hyperkalemic, hypokalemic, hypernatremic, fluid overloaded, dehydrated and so on... If I am the only one clueless in this regard, please tell me what you guys know! I know the practice of medicine is not only following protocols and algorithims, but knowing them will certainly help this soon to be intern in the middle of a night on call!!!</strong></font><hr /></blockquote><font size="2" face="Verdana, Helvetica, sans-serif">I think that you will find that most of your patients do not have some bizarre electrolyte imbalance but something simple. For example, hypokalemia is probably most likely due to a patient wasting K+ from Lasix.

    What to do? Give him some K+!! Check the level again after replacement. Give some more (don't give more than 40 mEq at at time PO, patients will barf on ya).

    Hyperkalemic? Oops...you've given them too much K+ replacement, they're dehydrated or they can't get rid of it (ie, renal failure).

    What to do? Depends on HOW high they are. We have a protocol here, but in general 5.0-5.3 we recheck in 6 hrs and get an EKG. Above 5.3 you start trying to get rid of K with some Calcium, D50, and Kayexelate (also getting an EKG and looking to T wave changes). Call renal if its REALLY high and isn't coming down - they may need to be dialyzed. If the patient isn't monitored, get them on tele.

    Hypernatremic? Probably dehydrated.

    What to do? Give some free water boluses or dilute their tube feeds with free water.

    and so on...I find the Washington Manual for Interns has some good algorithms as does Surgery On-Call. Since you aren't going into Surgery I don't expect you to purchase the latter, but presumably any Medicine On-Call series will have the same information.

    I find that a lot of the time you aren't asked WHY the patient has the imbalance, just whether or not you did something about it. Most electrolyte imbalances are iatrogenic and aren't great mysteries.
     
  33. gherelin

    gherelin Member 7+ Year Member

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    NuMD, I'll second the thanks for your friendly words of reassurance. I still don't see actual rhythm strips in the book they sent :rolleyes: but I can look them up any number of other places. I've also been enjoying the toolivenurse.com website with their ACLS songs. I'd say memory comes hard at my age too except it was never anything to brag about. Oh well.
     
  34. NuMD97

    NuMD97 Senior Member 10+ Year Member

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    New York
    Originally posted by gherelin:

    </font><blockquote><font size="1" face="Verdana, Helvetica, sans-serif">quote:</font><hr /><font size="2" face="Verdana, Helvetica, sans-serif"> I still don't see actual rhythm strips in the book they sent </font><hr /></blockquote><font size="2" face="Verdana, Helvetica, sans-serif">Hmmm....granted my manual is a bit dated (it's the 1997-1999 version), but I have them in Chapter 3 titled "Arrythmias". They're the most frequently encountered arrhythmias.

    As for the algorithms, just to make ya feel a tad better, there are "only" 14 in the whole text. I know, because I counted. <img border="0" title="" alt="[Wink]" src="wink.gif" />

    Hope this helps.

    Nu
     
  35. neutropeniaboy

    neutropeniaboy Blasted ENT Attending 10+ Year Member

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    The amount of attention this ACLS thread is getting is bothering me.

    It's not like you're doctors or anything. It's not like you'll be saving lives or anything.

    Sheep...mere sheep!
     
  36. NuMD97

    NuMD97 Senior Member 10+ Year Member

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    Wryly noted by Neutropeniaboy:

    </font><blockquote><font size="1" face="Verdana, Helvetica, sans-serif">quote:</font><hr /><font size="2" face="Verdana, Helvetica, sans-serif"> The amount of attention this ACLS thread is getting is bothering me. </font><hr /></blockquote><font size="2" face="Verdana, Helvetica, sans-serif">See what thou hath wrought, Neutropeniaboy? "A pox on your house." :)
     
  37. gherelin

    gherelin Member 7+ Year Member

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    No section on arrhythmias in the new provider manual, NuMD, it's all case-based.
    too live nurse has a cute song about the bradycardia algorithm as well as some others.
     
  38. Voxel

    Voxel Moderator Emeritus 7+ Year Member

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    Well I finally got my ACLS book and not through my program. I'll be reading the ACLS provider manual on a plane ride from coast to coast. Sounds exciting, doesn't it?
     
  39. NuMD97

    NuMD97 Senior Member 10+ Year Member

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    Feb 1, 2002
    New York
    Originally posted by gherelin:

    </font><blockquote><font size="1" face="Verdana, Helvetica, sans-serif">quote:</font><hr /><font size="2" face="Verdana, Helvetica, sans-serif"> No section on arrhythmias in the new provider manual, NuMD, it's all case-based. </font><hr /></blockquote><font size="2" face="Verdana, Helvetica, sans-serif">Oh goodie! I was told the only difference between the previous text and the new one was one new drug (I'm guessing amiodarone). I never understood how they expect you to get through a manual that is over 300 pages in just two days. But looking over my old one now, I realize they really need a new editor. They repeat a lot. Odd, though, that they would take out the rhythm strips. I'll let you know when I get my new one next week.
     
  40. emedpa

    emedpa GlobalDoc 10+ Year Member

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    Taking an Away team....
    2 new drugs actualy: amiodarone and vasopresin. also, no more bretylium because it's not made anymore. emedpa, acls instructor x 7 years.
     

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