AHA ACLS

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BobLoblaw78

BobLoblaw78

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I am always looking for little ways to improve my anesthesia skills. Always willing to critique myself and find newer, maybe better ways to do things. I don't mind ACLS recert, MOCA, CME, etc. That being said..... I am recertifying with AHA ACLS..... and it is terrible! I honestly feel like I am getting more dummer. It is like they are not focusing on patient care or how to code a patient. Here are some of the questions:

"what are the four parts of patients systems?" And one of the answers was system.
Next question "do you suction patient, measure oral airway then insert OA or measure OA, suction patient then insert OA."
What tone of voice should you use?
"Which 3 members out of the 6 members make up the triangle of care?"
Should you encourage other members?
"Decrease chance of survival per minute from OHCA 5-7%, 7-10%, or 11-13%?"

Next code I walk into I am going to yell (nevermind, state in a kindly voice while encouraging) "How many minutes since his OHCA? Multiply that by 7.0-10.0% and give me his chance of survival. For god's sake this man is dying, someone quickly find out whether it is system, support, patient outcome and debriefing or if it is support, patient outcome, system and preparation that make up patient support systems! Bill get out of the triangle of care. You are pushing meds, you are not the manual defibrillator. What are you thinking?!?"

I think the Bob's have won. ACLS is now more about pushing pencils then helping the patient. Don't waste your time or money if you can help it!
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BobLoblaw78 said:
I am always looking for little ways to improve my anesthesia skills. Always willing to critique myself and find newer, maybe better ways to do things. I don't mind ACLS recert, MOCA, CME, etc. That being said..... I am recertifying with AHA ACLS..... and it is terrible! I honestly feel like I am getting more dummer. It is like they are not focusing on patient care or how to code a patient. Here are some of the questions:

"what are the four parts of patients systems?" And one of the answers was system.
Next question "do you suction patient, measure oral airway then insert OA or measure OA, suction patient then insert OA."
What tone of voice should you use?
"Which 3 members out of the 6 members make up the triangle of care?"
Should you encourage other members?
"Decrease chance of survival per minute from OHCA 5-7%, 7-10%, or 11-13%?"

Next code I walk into I am going to yell (nevermind, state in a kindly voice while encouraging) "How many minutes since his OHCA? Multiply that by 7.0-10.0% and give me his chance of survival. For god's sake this man is dying, someone quickly find out whether it is system, support, patient outcome and debriefing or if it is support, patient outcome, system and preparation that make up patient support systems! Bill get out of the triangle of care. You are pushing meds, you are not the manual defibrillator. What are you thinking?!?"

I think the Bob's have won. ACLS is now more about pushing pencils then helping the patient. Don't waste your time or money if you can help it!
Click to expand...
Sadly ACLS and BLS are part of credentialing for most hospitals
 
Members don't see this ad :)
BobLoblaw78 said:
I am always looking for little ways to improve my anesthesia skills. Always willing to critique myself and find newer, maybe better ways to do things. I don't mind ACLS recert, MOCA, CME, etc. That being said..... I am recertifying with AHA ACLS..... and it is terrible! I honestly feel like I am getting more dummer. It is like they are not focusing on patient care or how to code a patient. Here are some of the questions:

"what are the four parts of patients systems?" And one of the answers was system.
Next question "do you suction patient, measure oral airway then insert OA or measure OA, suction patient then insert OA."
What tone of voice should you use?
"Which 3 members out of the 6 members make up the triangle of care?"
Should you encourage other members?
"Decrease chance of survival per minute from OHCA 5-7%, 7-10%, or 11-13%?"

Next code I walk into I am going to yell (nevermind, state in a kindly voice while encouraging) "How many minutes since his OHCA? Multiply that by 7.0-10.0% and give me his chance of survival. For god's sake this man is dying, someone quickly find out whether it is system, support, patient outcome and debriefing or if it is support, patient outcome, system and preparation that make up patient support systems! Bill get out of the triangle of care. You are pushing meds, you are not the manual defibrillator. What are you thinking?!?"

I think the Bob's have won. ACLS is now more about pushing pencils then helping the patient. Don't waste your time or money if you can help it!
Click to expand...
I may or may not have heard of a person in my neighborhood who will sign your papers and send you off with acls recert as follows.

Him: "What do you do?"
Resident: "Anesthesia."
Him: "Oh, you do this for a living... Any questions?"
Resident: "Nah"
Him: "Alright man, sign this and this, see ya in 2 years for the recert."
 
abolt18 said:
I may or may not have heard of a person in my neighborhood who will sign your papers and send you off with acls recert as follows.

Him: "What do you do?"
Resident: "Anesthesia."
Him: "Oh, you do this for a living... Any questions?"
Resident: "Nah"
Him: "Alright man, sign this and this, see ya in 2 years for the recert."
Click to expand...

Neat, I just recertified, should have tried this, but didn't mention I am a physician or an anesthesiology intern. Maybe next time when I recert I'll try it at the end of CA-2 year.
 
abolt18 said:
I may or may not have heard of a person in my neighborhood who will sign your papers and send you off with acls recert as follows.

Him: "What do you do?"
Resident: "Anesthesia."
Him: "Oh, you do this for a living... Any questions?"
Resident: "Nah"
Him: "Alright man, sign this and this, see ya in 2 years for the recert."
Click to expand...
This is how we do it in my neck of the woods. EM docs, intensivists, anesthesiologists have friends around here that rubber-stamp it.
 
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If we go to a code on the floor, they actually want to pin or hang a big sign on us that says Team Leader, CPR1, Airway, etc. It gets a little absurd at times.

That being said, our codes are run a little better than they used to be, but they still haven't mastered getting all the extra "help" out of the room. I actually like having someone announce the time every two minutes, which helps maintain focus and keep everyone informed of what's going on.
 
It’s all a giant money grab (like most certifications). The recommendations barely change every few years but they still want you to pay several hundred dollars just to get the cards. I feel like it personally hits our specialty hard because it seems like we’re always paying for recertification for SOMETHING whether it’s ABA, TEE, etc. I’ve never heard my surgeons complain about studying for a recertification, maybe a cardiologist but they probably make similar complaints
 
chocomorsel said:
Which one? I need one that’s easy and straightforward. Thanks.
Click to expand...
www.HeartCPRTrainingCenter.com I can't remember exactly who the trainer was, might have been the guy who emailed me when I signed up. Andy Williams. Course was about 200 bucks...that's for bls/acls. I think just acls was like $130 alone or something.
 
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BobLoblaw78 said:
I am always looking for little ways to improve my anesthesia skills. Always willing to critique myself and find newer, maybe better ways to do things. I don't mind ACLS recert, MOCA, CME, etc. That being said..... I am recertifying with AHA ACLS..... and it is terrible! I honestly feel like I am getting more dummer. It is like they are not focusing on patient care or how to code a patient. Here are some of the questions:
Click to expand...
I assume you meant dumber or more dumb, not "more dummer" - or perhaps the proof is in the pudding...
 
MirrorTodd said:
www.HeartCPRTrainingCenter.com I can't remember exactly who the trainer was, might have been the guy who emailed me when I signed up. Andy Williams. Course was about 200 bucks...that's for bls/acls. I think just acls was like $130 alone or something.
Click to expand...
Well this website no longer works. I don't know if I can sign up. Sent an email. We shall see.
 
chocomorsel said:
Well this website no longer works. I don't know if I can sign up. Sent an email. We shall see.
Click to expand...
Use either of these

ACLS, PALS, and BLS Online Certification Courses | eMedCert

eMedCert offers fast & easy nationally accepted medical certifications online. 100% money-back guaranteed courses are based on AHA guidelines. Learn more!
emedcert.com emedcert.com

advancedmedicalcertification.com

ACLS, PALS & BLS Online Courses, Certifications & Renewals (Home)

Our ACLS, PALS & BLS Certifications come with Category 1 AMA Credits. Accredited by the Postgraduate Institute for Medicine (PIM). Over 100,000 medical professionals and health care providers choose us for their recertification needs. 100% money back guarantee if not accepted by your employer.
advancedmedicalcertification.com advancedmedicalcertification.com

I've used both and multiple hospitals have accepted them for recred purposes.

And as an aside, while I think ACLS is generally trash, my opinion stems more from my critical care background than my anesthesiology background. To be honest, I think most general anesthesiologists are just OK at running OR codes because the cause is many times obvious based on the pt hx, surgery, and the anesthetic course, but when it comes to the undifferentiated floor code they're breathing a big sigh of relief that all they have to do is put in the tube and bounce.
 
vector2 said:
Use either of these

ACLS, PALS, and BLS Online Certification Courses | eMedCert

eMedCert offers fast & easy nationally accepted medical certifications online. 100% money-back guaranteed courses are based on AHA guidelines. Learn more!
emedcert.com emedcert.com

advancedmedicalcertification.com

ACLS, PALS & BLS Online Courses, Certifications & Renewals (Home)

Our ACLS, PALS & BLS Certifications come with Category 1 AMA Credits. Accredited by the Postgraduate Institute for Medicine (PIM). Over 100,000 medical professionals and health care providers choose us for their recertification needs. 100% money back guarantee if not accepted by your employer.
advancedmedicalcertification.com advancedmedicalcertification.com

I've used both and multiple hospitals have accepted them for recred purposes.

And as an aside, while I think ACLS is generally trash, my opinion stems more from my critical care background than my anesthesiology background. To be honest, I think most general anesthesiologists are just OK at running OR codes because the cause is many times obvious based on the pt hx, surgery, and the anesthetic course, but when it comes to the undifferentiated floor code they're breathing a big sigh of relief that all they have to do is put in the tube and bounce.
Click to expand...

Just keep in mind though that these are not AHA certifications. Although I don’t know of any cases personally, I could see it coming up if you have to defend a bad outcome.
 
NoodleIncident said:
Just keep in mind though that these are not AHA certifications. Although I don’t know of any cases personally, I could see it coming up if you have to defend a bad outcome.
Click to expand...

I find it hard to believe that a board certified physician would be hammered on the type of cpr participation trophy they hold.
 
GassYous said:
I find it hard to believe that a board certified physician would be hammered on the type of cpr participation trophy they hold.
Click to expand...

Although not medical in nature, I have lost someone close to me in a case where the advertised certification was not one recognized anywhere else. It was hammered on civilly and will be hammered on criminally.

I would expect a doctor to have his or her training and credentials gone through with a fine-toothed comb should an adverse event occur.
 
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vector2 said:
Use either of these

ACLS, PALS, and BLS Online Certification Courses | eMedCert

eMedCert offers fast & easy nationally accepted medical certifications online. 100% money-back guaranteed courses are based on AHA guidelines. Learn more!
emedcert.com emedcert.com

advancedmedicalcertification.com

ACLS, PALS & BLS Online Courses, Certifications & Renewals (Home)

Our ACLS, PALS & BLS Certifications come with Category 1 AMA Credits. Accredited by the Postgraduate Institute for Medicine (PIM). Over 100,000 medical professionals and health care providers choose us for their recertification needs. 100% money back guarantee if not accepted by your employer.
advancedmedicalcertification.com advancedmedicalcertification.com

I've used both and multiple hospitals have accepted them for recred purposes.

And as an aside, while I think ACLS is generally trash, my opinion stems more from my critical care background than my anesthesiology background. To be honest, I think most general anesthesiologists are just OK at running OR codes because the cause is many times obvious based on the pt hx, surgery, and the anesthetic course, but when it comes to the undifferentiated floor code they're breathing a big sigh of relief that all they have to do is put in the tube and bounce.
Click to expand...
I hardly ever ran codes in the OR so I wasn't exactly great at it like you said. Totally different in the ICU. Signed up for one and doing it now. Promed.
NoodleIncident said:
Although not medical in nature, I have lost someone close to me in a case where the advertised certification was not one recognized anywhere else. It was hammered on civilly and will be hammered on criminally.

I would expect a doctor to have his or her training and credentials gone through with a fine-toothed comb should an adverse event occur.
Click to expand...
It's not where you get your damn training. It is what you do with and what you put into that training. Kinda like colleges. It's what you put into it. Give me a break, seriously? They went after their certification? Idiotic.
 
chocomorsel said:
I hardly ever ran codes in the OR so I wasn't exactly great at it like you said. Totally different in the ICU. Signed up for one and doing it now. Promed.

It's not where you get your damn training. It is what you do with and what you put into that training. Kinda like colleges. It's what you put into it. Give me a break, seriously? They went after their certification? Idiotic.
Click to expand...

Yes, it’s kind of like colleges. You could do all you want with it, but then if your degree is from Southern Northern University of Western State and is a degree only recognized by that one school, it will be a factor if whatever case involves your claimed college degree. Of course this wouldn’t apply to a med mal case.

Likewise, if I ran an apartment complex and had my elevator fail and kill someone, I’d be a much better spot if I had it last inspected by the state’s licensing department than by ProfessionalOnlineElevatorLicensing.com - just snap a picture of the elevator and send it to us and we’ll give you a pretty certificate to hang in it.

In the case I’m referencing, someone died and when the defendants produced their certification in discovery, what they provided was akin to those examples. Personal injury attorneys eat that up.

But fine, you do you. Who knows, as idiotic as it may sound to you, a business had to close its doors and someone is dead. It may be a one time thing that will never happen again. I’ll just stick with the legitimate AHA courses.
 
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NoodleIncident said:
Yes, it’s kind of like colleges. You could do all you want with it, but then if your degree is from Southern Northern University of Western State and is a degree only recognized by that one school, it will be a factor if whatever case involves your claimed college degree. Of course this wouldn’t apply to a med mal case.

Likewise, if I ran an apartment complex and had my elevator fail and kill someone, I’d be a much better spot if I had it last inspected by the state’s licensing department than by ProfessionalOnlineElevatorLicensing.com - just snap a picture of the elevator and send it to us and we’ll give you a pretty certificate to hang in it.

In the case I’m referencing, someone died and when the defendants produced their certification in discovery, what they provided was akin to those examples. Personal injury attorneys eat that up.

But fine, you do you. Who knows, as idiotic as it may sound to you, a business had to close its doors and someone is dead. It may be a one time thing that will never happen again. I’ll just stick with the legitimate AHA courses.
Click to expand...
Not an unreasonable observation.

I think the "logistics" of running a code are slowly improving with ACLS, and the algorithms/treatments are definitely more evidence based that they used to be. When I was in EMS 40+ years ago, the first thing we gave in a code was 2 amps of bicarb "because you know you can't defibrillate an acidotic heart". We also had huge 500J defibrillators.

Our department guidelines now encourage involving a cardiologist or CCM ASAP on all OR codes.
 
NoodleIncident said:
In the case I’m referencing, someone died and when the defendants produced their certification in discovery, what they provided was akin to those examples. Personal injury attorneys eat that up.
Click to expand...
It'd be nice if you could provide some details of the case so we could deduce whether the source of the physician's ACLS card was really the crux of the case....as opposed to say just gross negligence / a big deviation from the standard of care / an actual deficiency in his medical training, i.e. things that usually matter in a malpractice suit.
 
This
vector2 said:
It'd be nice if you could provide some details of the case so we could deduce whether the source of the physician's ACLS card was really the crux of the case....as opposed to say just gross negligence / a big deviation from the standard of care / an actual deficiency in his medical training, i.e. things that usually matter in a malpractice suit.
Click to expand...

This particular case did not involve ACLS or even a healthcare setting. I was only giving an example I know of personally where the credentialing was not from a nationally-recognized authority and there were consequences.

I do know a little about another case, I believe in the Northwest. CPR on a young healthy person who went into respiratory arrest from choking. This was outside of a healthcare setting and the employed provider on site was CPR trained, I believe a lifeguard. During compressions, tore the aorta. That would be an interesting litigation. “So someone authorized by the AHA signed off on your CPR training? Even when they saw you demonstrate on the mannequin?” “Well, no. I didn’t have to demonstrate skills because it was an online-only course by First Aid Plus.” These quotes are just my conjecture. Now I don’t know barely enough details to say whether improper CPR caused the aortic tear, but I wouldn’t be surprised if it came up in litigation. If so, they may want to know who taught the CPR.
 
Last edited:
NoodleIncident said:
This

This particular case did not involve ACLS or even a healthcare setting. I was only giving an example I know of personally where the credentialing was not from a nationally-recognized authority and there were consequences.

I do know a little about another case, I believe in the Northwest. CPR on a young healthy person who went into respiratory arrest from choking. This was outside of a healthcare setting and the employed provider on site was CPR trained, I believe a lifeguard. During compressions, tore the aorta. That would be an interesting litigation. “So someone authorized by the AHA signed off on your CPR training? Even when they saw you demonstrate on the mannequin?” “Well, no. I didn’t have to demonstrate skills because it was an online-only course by First Aid Plus.” These quotes are just my conjecture. Now I don’t know barely enough details to say whether improper CPR caused the aortic tear, but I wouldn’t be surprised if it came up in litigation. If so, they may want to know who taught the CPR.
Click to expand...
I’m going to have to side with the statement from @GassYous that in the healthcare setting, the source of a physician’s almost meaningless cpr card is almost certainly not going to be an important factor in malpractice litigation (as compared to [lack of] board certification, deviating from well known guidelines or level I evidence etc), and one’s defense lawyer will 100% be able to line up a wall of expert witnesses who will attest to that fact if opposing counsel tried to make a big deal of it.

And in regard to the anecdote you shared, osseous injuries like sternum/rib fractures and subsequent vascular injury are known potential complications of even perfectly performed CPR, so even if lifeguards are somehow not privy to Good Samaritan laws, I can’t imagine one would be found negligent on those grounds. Regardless, I think the case would be evaluated on somewhat different grounds than the healthcare setting, where someone like a lifeguard who has absolutely no other medical training (unlike an acute care physician) might actually need a “certified” cpr card.
 
NoodleIncident said:
Yes, it’s kind of like colleges. You could do all you want with it, but then if your degree is from Southern Northern University of Western State and is a degree only recognized by that one school, it will be a factor if whatever case involves your claimed college degree. Of course this wouldn’t apply to a med mal case.

Likewise, if I ran an apartment complex and had my elevator fail and kill someone, I’d be a much better spot if I had it last inspected by the state’s licensing department than by ProfessionalOnlineElevatorLicensing.com - just snap a picture of the elevator and send it to us and we’ll give you a pretty certificate to hang in it.

In the case I’m referencing, someone died and when the defendants produced their certification in discovery, what they provided was akin to those examples. Personal injury attorneys eat that up.

But fine, you do you. Who knows, as idiotic as it may sound to you, a business had to close its doors and someone is dead. It may be a one time thing that will never happen again. I’ll just stick with the legitimate AHA courses.
Click to expand...
Seriously, personal injury attorneys are the scum at the bottom of the pond. The troll the EDs looking for cases. Are we using that as our measuring stick?
I personally can't stand that whole, "name brand" crap as I went to a public TX School and turned out fine. Problem for me was going to NM for residency. That no name brand and lack of proximity did nothing to help me and hindered me for sure.
So if our measuring stick is personal injury attorneys, then yeah, I am gonna keep doing me thanks.
Someone could have died had the attending doc gone to Ivy League and done and AHA certification if they were incompetent. Let's be real. You are educated and you ought to know that.
 
ACLS is an absolute joke - there is nothing advanced about it.

BLS i actually do agree with.
I was at a lot of codes yesterday. Thanks Cath lab! Not even at one of them did cards or anyone have oxygen running even by simple face mask.

Too busy trying to get lucas to work or drain a bloody pericardial effusion that they caused in the first place...

BLS every 3 years is about right. For some it should probably be mandatory daily training until they learn
 
ACLS is fine for non-MDs, residents, and docs who don't deal w resuscitations, to allow more folks to just follow the flowchart but it seems pretty crude to me (non MD obviously). 1mg epi is a LOT, is there much utility in additional doses? I understand the need to raise afterload to maintain adequate CPP but at some point the cerebral vasculature is gonna be so constricted that even with ROSC Neuro outcomes will be abysmal. Plus I'm not sure that a stunned myocardium appreciates beating against a super clamped down system in general

Coming from the ICU, ordering 1mg/hr epi for hypo would raise some eyebrows but nobody blinks at pushing 5-10mgs over the course of the code. Seems to this nurse like nobody dares question it bc "OMG the patient is dying!!!!"

Any thoughts?
 
Fart Daddy Smooth said:
ACLS is fine for non-MDs, residents, and docs who don't deal w resuscitations, to allow more folks to just follow the flowchart but it seems pretty crude to me (non MD obviously). 1mg epi is a LOT, is there much utility in additional doses? I understand the need to raise afterload to maintain adequate CPP but at some point the cerebral vasculature is gonna be so constricted that even with ROSC Neuro outcomes will be abysmal. Plus I'm not sure that a stunned myocardium appreciates beating against a super clamped down system in general

Coming from the ICU, ordering 1mg/hr epi for hypo would raise some eyebrows but nobody blinks at pushing 5-10mgs over the course of the code. Seems to this nurse like nobody dares question it bc "OMG the patient is dying!!!!"

Any thoughts?
Click to expand...
The entirety of ACLS is based off prehospital data from witnessed and sometimes unwitnessed events caused by coronary syndromes from ruptured plaques, where "skilled" help at even the most basic EMT/firefighter/cop level is at BEST minutes away, more often a bunch of minutes. Plus an ambulance ride to an ER.

That we even use ACLS as a loose framework for handling in-hospital codes and especially intraoperative codes is ... bizarre.

But the AHA has sold itself well. They have great marketing and slick training videos and a horde of nurses and nurse-like administrators who believe in it.

I get free Red Cross BLS and ALS certification and recertification through my .mil job, but most non-military hospitals I work at require AHA. So I have to pay and spend the time to get the AHA cards. It's a complete scam.
 
most of the hospitals I work at do not require ACLS but a few that I occasionally go to do require it and so I am forced to go along with the pain. But yes it is a joke compared to what we do every day.
 
Anyone have a link to an AHA specific BLS/ACLS course for re-certification? I noticed the links above were not AHA certified.
 
Mman said:
most of the hospitals I work at do not require ACLS but a few that I occasionally go to do require it and so I am forced to go along with the pain. But yes it is a joke compared to what we do every day.
Click to expand...
There’s nothing like having a nurse or EMT BLS instructor criticize your bag masking technique.
 
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