ACLS Training for Dentists - Where did it say we had to save lives?

[gryffindor]

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Anyone else have to go through ACLS (advanced cardiac life support) training for their school/residency/job? Did you feel like a total idiot? I did.

My GPR requires all residents to be ACLS certified. I went into the training thinking "Geez, I have to learn to intubate a patient in this course, when am I ever going to use that?" After going through the 2-day training, intubating the mannequin was the least of my problems. ACLS skills are meant to be used when ordinary BLS (basic life support) isn't doing the job on a patient that is down. BLS works on about 85% of scenarios; ACLS is meant to try and save the patient's life in that other 15%.

The instructors (a group of paramedics) kept presenting pictures of various EKGs and how to manage the patient with different meds (epinephrine, atropine, amiodarone, nitroglycerin, etc.) in different scenarios. The skills section requried you to be able to hook up a defibrillator to the patient, read the EKG that presents on the screen, and then manage the patient according to the condition their heart is in based on the EKG and clinical presentations. The defibrillator we're talking about here is the kind with the paddles like you'd see on ER; this isn't the automatic defibrillator we used in BLS.

The last time I identified an EKG was in my Physio class 4 years ago; I don't remember a thing. I felt like such an idiot in the ACLS class b/c the nurses and physicians who were in there with me knew exactly what was going on whereas I had no clue. I finally had to ask the instructors at the end of the second day to leave so I could go home and study the manual in great detail, memorize all the different EKG presentations, and come back on a different day to finish my skill tests and take the multiple-choice exam. There was no way I'd pass that exam with the limited knowledge I gained in the 2 day course. The paramedics were like "You mean you've never had to read an EKG in your work before?" I couldn't get mad at them b/c it wasn't their fault I was there, but I really wanted to yell "I"m a dentist, I look for cavities and gum disease, neither of which can be found on an EKG."

So now, even though graduation is looooooong over, it's back to the books for me till the test on Tuesday. And to think I tossed all my Physio notes just last week thinking "I'm never going to need this info ever again." This must be the revenge of those now-recycled Physio notes.

In a recent issue of JADA, there was a lengthy debate on "Should dentists be referred to as 'Physicians of the Oral Cavitiy?'" After my ACLS debacle, I have no desire to ever be connected to the term "Physician" and am very happy in my chosen title as "Dentist."

 

[organic]

Griffin04

ACLS is a license that allows you to be a leader in a emergency team. You can call the mega call and give orders. IT doesn't mean that if you don't have ACLS license, you can not save patients, but with ACLS, you will be the leader of the team, others have to listen to you.

So dentists are not likely to be leaders of a life- saving team. That is true. Some oral surgeons, who passed the exam, told me they'd never want to call mega calls and act as leaders. Even some med students told me that unless you have lots of experiences reading EKG, it is also hard for them to tell what it is. THey just memorized the shape and hope for the best.

Have you notice that the scopes of ACLS and BCLS are quite different? ACLS is mostly useful when you have access to medications, and EKG machines-- in a hospital setting. There are more details about pharmacology, drug reactions and physiology. BCLS is mostly used when you are outside the hospital, and you try to save the golden time of that person who is crushing without any medication or machine.

Now we have those dummy's defibrillators ( don't know the proper name of it). You put the paddles on the chest and the machine tells you whether you need to shock this person. It is true that in 80 % of the time, if you know BCLS and have a dummy's defibrillator, it is plenty enough

But I do think there is a value in taking ACLS course, especially if you work in the hospital. You can participate in the emergency team in case patients around you crushed. You will know the protocols, what to do and become useful for the leader of the team.

last but not least, you will enjoy watching ER more and sometimes find mistakes in the episodes

😀

 

[gryffindor]

Thanks organic. If the Oral Surgeons aren't comfortable in calling mega codes, then I don't feel so inadequate.

I've taken BLS 4 times and I am finally beginning to get the hang of it. It's going to take more than 1 ACLS training for me to be comfortable with everything they demand.

I started to watch ER after I took Gross Anatomy b/c only then did I have a faint clue of what was going on. Now I have something else to watch for as well!

 

[DrJeff]

Anyone else have to go through ACLS (advanced cardiac life support) training for their school/residency/job? Did you feel like a total idiot? I did.

My GPR requires all residents to be ACLS certified. I went into the training thinking "Geez, I have to learn to intubate a patient in this course, when am I ever going to use that?" After going through the 2-day training, intubating the mannequin was the least of my problems. ACLS skills are meant to be used when ordinary BLS (basic life support) isn't doing the job on a patient that is down. BLS works on about 85% of scenarios; ACLS is meant to try and save the patient's life in that other 15%.

The instructors (a group of paramedics) kept presenting pictures of various EKGs and how to manage the patient with different meds (epinephrine, atropine, amiodarone, nitroglycerin, etc.) in different scenarios. The skills section requried you to be able to hook up a defibrillator to the patient, read the EKG that presents on the screen, and then manage the patient according to the condition their heart is in based on the EKG and clinical presentations. The defibrillator we're talking about here is the kind with the paddles like you'd see on ER; this isn't the automatic defibrillator we used in BLS.

The last time I identified an EKG was in my Physio class 4 years ago; I don't remember a thing. I felt like such an idiot in the ACLS class b/c the nurses and physicians who were in there with me knew exactly what was going on whereas I had no clue. I finally had to ask the instructors at the end of the second day to leave so I could go home and study the manual in great detail, memorize all the different EKG presentations, and come back on a different day to finish my skill tests and take the multiple-choice exam. There was no way I'd pass that exam with the limited knowledge I gained in the 2 day course. The paramedics were like "You mean you've never had to read an EKG in your work before?" I couldn't get mad at them b/c it wasn't their fault I was there, but I really wanted to yell "I"m a dentist, I look for cavities and gum disease, neither of which can be found on an EKG."

So now, even though graduation is looooooong over, it's back to the books for me till the test on Tuesday. And to think I tossed all my Physio notes just last week thinking "I'm never going to need this info ever again." This must be the revenge of those now-recycled Physio notes.

In a recent issue of JADA, there was a lengthy debate on "Should dentists be referred to as 'Physicians of the Oral Cavitiy?'" After my ACLS debacle, I have no desire to ever be connected to the term "Physician" and am very happy in my chosen title as "Dentist."

Your normal, when I started my residency, me and the 6 other 1st year residents had the joy of taking ACLS. Way more EKG rythms than I cared to see, and the entire running of the mega codes testing was stressfull to say the least. At the same point though, it really started to drive the point home to me that my GPR wasn't going to be just "a fifth year of dental school" (although if your's is in New York and that's where you're going to practice you know how important the PGY1 is now 😉 ) If you're lucky, you're going to have MANY more "I think I'm in over my head" experiences this coming year. With the back up your fellow residents and attendings can/will give you, you'll not only get ALOT quicker in the next 12 months, but more importantly you'll learn where your comfort level with procedures is, and where you'll refer out next year.

Word of advice to you, when I started my residency my program director met with all the residents and asked us what we really wanted to do (procedure wise) in the coming year. Of course everyone answers crown and bridge, endo and implants. Well not only did I say that, but I was the only one that also said dentures 😱 Let's just say that by June 30th of the following year, I had set my residencies record for the most arches of dentures in 1 year with 78 arches 😱 I think that I was going through border moulding motions in my sleep for about a year after that 😀 😉

Good luck, and enjoy, it will be a great experience, as long as you give it you're full attention. Or as my residency director put it, "you're now getting paid to be a doctor, not paying to become a doctor, so act like one!"

 

[ItsGavinC]

Ahhh, hell. Sorry to bump this old thread, but we start our mandatory ACLS 2-day course tomorrow.

Of course, I open the syllabus today and it says "Please carefully review your pretest and ACLS algorithms. Read chapters 1-9 in the quick review book and case presentations before class".

Yeah right. Chapters 1-9, the 10 cases, and the pretest comprise 563 pages of information. Not to mention so many EKGs that it makes my head spin.

80% is required to pass the written exam, and I'm fairly sure that most of my class will be retaking this course.

I have NO idea why we have to be ACLS certified to simply work in our clinic, even after reading the above posts. We won't have access to cardiac meds or defib machines.

 

[Yah-E]

Ahhh, hell. Sorry to bump this old thread, but we start our mandatory ACLS 2-day course tomorrow.

Of course, I open the syllabus today and it says "Please carefully review your pretest and ACLS algorithms. Read chapters 1-9 in the quick review book and case presentations before class".

Yeah right. Chapters 1-9, the 10 cases, and the pretest comprise 563 pages of information. Not to mention so many EKGs that it makes my head spin.

80% is required to pass the written exam, and I'm fairly sure that most of my class will be retaking this course.

I have NO idea why we have to be ACLS certified to simply work in our clinic, even after reading the above posts. We won't have access to cardiac meds or defib machines.

Your curriculum is unique. Most dental school's pre-doc's curriculum only requires BLS certification. Heck, although challenging, but it's cool that you'll be ACLS certified. I, too, wonder why Dillenburg implemented ACLS in your curriculum? Perhaps since your clinical years requires off-site rotations? Interesting.

 

[ItsGavinC]

Your curriculum is unique. Most dental school's pre-doc's curriculum only requires BLS certification. Heck, although challenging, but it's cool that you'll be ACLS certified. I, too, wonder why Dillenburg implemented ACLS in your curriculum? Perhaps since your clinical years requires off-site rotations? Interesting.

I don't know. Off-site rotations may have something to do with it, but that shouldn't be a determining fator.

 

[north2southOMFS]

You should consider yourself lucky, ACLS is very expensive to take out there privately.

As for the why should we have to take it??............Well, when the general population calls you DOCTOR you should maybe have some clue what to do when a person collapses in your office.....beyond just calling 911. Otherwise really, a lab tech could do our job. As far as not knowing the algorithms....that is why they give you the ACLS book like 3 weeks in advance. So you can do somthing called study. I know most 3rd and 4th year dental students havent done that in some time but if you read the book, which is very easy to read by the way, you will know the stuff hands down. Gavin your school has it right making you take ACLS. Most other dental schools should follow suit.

 

[kato999]

We are always told to read ahead for all of our modules. However, I truly doubt that anyone here in AZ really does that. Most of the time the reading is supplemental and is not necessary to pass the exam.

As for this ACLS, I am now just flipping through this book and realizing how screwed I am. It looks like reading this book might be somewhat important to pass this test.

I was going into this module just assuming it would be like passing the CPR or Lifeguarding tests. oops. 🙁

Here's to enjoying my Easter, and looking forward to retaking the test next week with ya Gavin.

 

[TucsonDDS]

Even though you will probably never use ACLS in your practice I think that if you are spending time in the hospital it would be really good for you to have. They are not making you take ACLS so that you can be the one to order an AMP of epi or CaCl, they are having you take it so that in a code situation you will have some what of a clue as to what will be going on. As an RN I would never expect a dentist who is doing an exam on my patient to intubate them, I would expect that dentist to know that there is an emergency and to get the hell out of the way or help with something that they felt comfortable with. This may be using the AMBU bag, drawing up saline flushes or whatever. By taking the class it will make you feel a little more comfortable and it will make you more useful if you happen to be in the room when somebody goes down and just being ACLS certified doesn't meen that you have to run the code.

A couple of weeks ago I had a 14 year old go apneic and lose his pulse while his dad and I were talking to him. I started baging him and luckily an respiratory therapist was there and started doing compressions. By the time the code team showed up there were probably 7 or 8 other nurses in the room, all ACLS and PALS (pediatric advanced life support) certified and they did nothing but stand there. Actually the only guy that did anything was a PCT (nursing assistant) who drew up some saline flushed and grabbed the code cart, which by the way was way out of his scope of practice. So don't worry about being in that situation, until you have been there a few times you will forget the patients name, their diagnosis, and just about everything else you know. But having the class will help you to understand the whole process.

Also, be glad you didn't have to take ACLS a couple of years ago, back then you couldn't bring the algorhythms with you and you had to memorize not only the rhythms but the meds, doses and everything else. I renewed my ACLS a couple of months ago and it was a hell of a lot easier than the previous class. Good luck.

 

[ItsGavinC]

Kraig, if you or I are feeling screwed, then imagine how many of our other classmates are feeling.

 

[ItsGavinC]

Also, be glad you didn't have to take ACLS a couple of years ago, back then you couldn't bring the algorhythms with you and you had to memorize not only the rhythms but the meds, doses and everything else. I renewed my ACLS a couple of months ago and it was a hell of a lot easier than the previous class. Good luck.

I've heard this, so it gives me some hope. 🙂

 

[ItsGavinC]

You should consider yourself lucky, ACLS is very expensive to take out there privately.

As for the why should we have to take it??............Well, when the general population calls you DOCTOR you should maybe have some clue what to do when a person collapses in your office.....beyond just calling 911. Otherwise really, a lab tech could do our job. As far as not knowing the algorithms....that is why they give you the ACLS book like 3 weeks in advance. So you can do somthing called study. I know most 3rd and 4th year dental students havent done that in some time but if you read the book, which is very easy to read by the way, you will know the stuff hands down. Gavin your school has it right making you take ACLS. Most other dental schools should follow suit.

Thanks for your insights!

 

[TucsonDDS]

We are always told to read ahead for all of our modules. However, I truly doubt that anyone here in AZ really does that. Most of the time the reading is supplemental and is not necessary to pass the exam.

As for this ACLS, I am now just flipping through this book and realizing how screwed I am. It looks like reading this book might be somewhat important to pass this test.

I was going into this module just assuming it would be like passing the CPR or Lifeguarding tests. oops. 🙁

Here's to enjoying my Easter, and looking forward to retaking the test next week with ya Gavin.

Everything that you need to know, other than the actual rhythm, is on the flip card that they give you. Also remember to tell the instructor that you "reassessed" after all interventions that you did starting with your ABC's (Airway, breathing and circulation)

 

[DrJeff]

Also, when you're running your mega code, don't get upset when your "patient" dies. As my instructor put it, even when you do everything perfect, their going to die more than you save them 😱

 

[s204367]

I am on call here and just really bored, so I checked out the Dental forum here. I have to say that I believe all healthcare personnel should have to take ACLS. Especially dentists, who will be practicing alone more often than not. A few thoughts.........
ACLS absolutely does NOT mean that you will be running a code. This is not what it is about. Do not worry if you can not read a rhythm strip. The AED's read the rhythm on their own, and will not shock if the machine does not read the rhythm as a shockable rhythm( asystole).
Just a few reasonw shy I think you should take ACLS???

1.) you perform procedures on patients that are often old with other co-morbidities.

2.) you often give local anesthetics with EPI....know how much epi is in a 1:200k dilution. if you have a pt with some cardiac issues...use straight local. inject that local into a vessel and you can run into problems. I can not tell you how many pt's come to the OR stating they have a local allergy, only to find out that had some issue at the dentist's office where their heart started racing after injection.....Allergies to amide locals are extremely rare, this is often the sign of intravascular epi injection.

4.) you are a healthcare professional.

5.) It does not matter if you can not intubate someone.....However, you should have an AMBU in your office as well as some oxygen and a protocol of calling 911 as soon as a problem arises.

6.) the exam is pretty easy. They do not want to fail anyone. Most med schools require this before you enter pt contact, or ever get any EKG training. Just after the second year. If you fail it, most will let you retake the exam that same day..the exact same exam...........

On another note..... also learn which pt's need prophylactic abx and which don't...you can get this off of the AHA website.. it is a very concise and easy to follow chart.

good luck with it and don not fret it.......It is not even a bad idea to invest in an AED for your office......proably lesss than a grand now and a write off..........

 

[north2southOMFS]

Everything that you need to know, other than the actual rhythm, is on the flip card that they give you. Also remember to tell the instructor that you "reassessed" after all interventions that you did starting with your ABC's (Airway, breathing and circulation)

You got to use the flip card for you mega-code?

Weak man.

 

[TucsonDDS]

You got to use the flip card for you mega-code?

Weak man.

The American Red Cross started allowing you to use the flip cards during the test out a couple of years ago when they revised the program to be more like PALS. Also if you have ever been in a real code you will find that pretty much any doctor, even the very seasoned doctors, will use some reference material. This doesn't show weakness but it does show that it is a good idea to refer to guidelines when a patients life is at stake.

 

[toofache32]

On another note..... also learn which pt's need prophylactic abx and which don't...you can get this off of the AHA website.. it is a very concise and easy to follow chart.

Huh? This is basic info from the 1st year of dental school and is utilized daily. How can you not know this?

 

[omfsres]

I am on call here and just really bored, so I checked out the Dental forum here. I have to say that I believe all healthcare personnel should have to take ACLS. Especially dentists, who will be practicing alone more often than not. A few thoughts.........
ACLS absolutely does NOT mean that you will be running a code. This is not what it is about. Do not worry if you can not read a rhythm strip. The AED's read the rhythm on their own, and will not shock if the machine does not read the rhythm as a shockable rhythm( asystole).
Just a few reasonw shy I think you should take ACLS???

1.) you perform procedures on patients that are often old with other co-morbidities.

2.) you often give local anesthetics with EPI....know how much epi is in a 1:200k dilution. if you have a pt with some cardiac issues...use straight local. inject that local into a vessel and you can run into problems. I can not tell you how many pt's come to the OR stating they have a local allergy, only to find out that had some issue at the dentist's office where their heart started racing after injection.....Allergies to amide locals are extremely rare, this is often the sign of intravascular epi injection.

4.) you are a healthcare professional.

5.) It does not matter if you can not intubate someone.....However, you should have an AMBU in your office as well as some oxygen and a protocol of calling 911 as soon as a problem arises.

6.) the exam is pretty easy. They do not want to fail anyone. Most med schools require this before you enter pt contact, or ever get any EKG training. Just after the second year. If you fail it, most will let you retake the exam that same day..the exact same exam...........

On another note..... also learn which pt's need prophylactic abx and which don't...you can get this off of the AHA website.. it is a very concise and easy to follow chart.

good luck with it and don not fret it.......It is not even a bad idea to invest in an AED for your office......proably lesss than a grand now and a write off..........

Man, I wish they would have taught us this in dental school. Now I feel a lot more comfortable using epi on patients. I think I will present this thread to the curriculum commitee.

 

[ca_dreamin']

4.) you are a healthcare professional.

I agree with you completely. I know that we are all often overwhelmed with the vast amt of material and courses that we have to take, but I think that AZ is lucky to have the class in their curriculum.

I think that we can agree that most of us hopefully never have to use all of the info, but...if you were the one patient whose life was in jeopardy, I think that you would be thankful that your dentist had the knowledge.

Also, I know that there are a few people interested in the military as a career option. I have been told that, depending on where deployed, this info can also be quite useful.

We pay for education, so the more opportunities we have to learn how to positively impact our patients lives, the better. Just my 2 cents.

 

[ItsGavinC]

We finished up our ACLS training on Tuesday, and got recertified in BLS while we were at it. No big deal. We didn't have any easy reference cards for the various algorithms, but it wasn't too difficult to remember everything.

 

[BlueToothHunter]

I just finished the ACLS training today. I was the only orthodontic resident and there was another dentist who was going into oral surgery. The others were medical residents and they were like "so how many times do you think you will need to use the ACLS in your orthodontic practice?". I said, "Hopefully, zero!"

Learning about different degree of heart blocks, VT/VF and asystole were totally useless for my ortho residency but it felt good to pass that hurdle. I learnt a lot over the two days about life support and a little of cardiac physiology... it was a lot harder because I hadn't covered many of the physiology and pharmacology for the last three years!

If you are offered an ACLS provider course, do it!

 

[DrJeff]

I just finished the ACLS training today. I was the only orthodontic resident and there was another dentist who was going into oral surgery. The others were medical residents and they were like "so how many times do you think you will need to use the ACLS in your orthodontic practice?". I said, "Hopefully, zero!"

QUOTE]

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