PALS in the morning, any tips?

[cableguy]

I am attending a PALS course in the morning even though I am on my 1 wk break 😡, so here I am studying a tad the nite before. It doesn't look too bad, but I've heard its a killer two day course.

Any tips for success?

thanks,

-will

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[pinipig523]

Know the dosages.

 

[nymbarra]

They really emphasize the whole pentagon / rectangle / triangle thing, so you should be in good shape if you remember to cover each point in the mock codes.

 

[deleted65604]

You'd have to be basically ******ed to not pass. Think of it from the perspective of the instructors. They can either continue to drill it into your head for hours on end, until they are sure that you are competent, or they can say, "Dude, it is not my problem that this ***** can't grasp these concepts." Trust me, they will err on the side of "Let this person through and if they don't learn the material, it is their problem." These training sessions are generally meaningless political exercises on the part of hospitals to decrease their liability when physicians screw up. They can say, "Yes Dr. Jones killed that kid out-right, but we did our best to train Dr. jones, and he didn't follow the PALS guidelines that we told him to follow, therefore, you should sue him for all he's worth and go easy on us."

 

[Jeff698]

I agree with Jarabacoa, except that he left out the most important part to getting through a PALS class.

Coffee. Lots and lots of coffee.

Take care,
Jeff

 

[cableguy]

You'd have to be basically ******ed to not pass. Think of it from the perspective of the instructors. They can either continue to drill it into your head for hours on end, until they are sure that you are competent, or they can say, "Dude, it is not my problem that this ***** can't grasp these concepts." Trust me, they will err on the side of "Let this person through and if they don't learn the material, it is their problem." These training sessions are generally meaningless political exercises on the part of hospitals to decrease their liability when physicians screw up. They can say, "Yes Dr. Jones killed that kid out-right, but we did our best to train Dr. jones, and he didn't follow the PALS guidelines that we told him to follow, therefore, you should sue him for all he's worth and go easy on us."

What you're talking about I sensed when I took ACLS and I did sense it today too during PALS. Here's my question, wouldn't it be a liability for AHA to have their instructors push people thru who really aren't meeting the standards and demonstrating their competency?

-will

 

[deleted65604]

AHA doesn't care about patients. They care about money. OK, maybe that's not true, but they certainly incur no liability in setting up classes to instruct health-care providers. They can recommend that instructors do a certain thing, but they have no control over their instructors. When you get into these courses, everybody tends to get in the "Let's get the heck out of here mode." The instructors invariably (as I would in their place) say, "we can take 6 hours like they recommend, or we can go with the accelerated, say, 2.5-3.5 hour schedule. Does anyone mind?" I've never seen a hand go up.

 

[jbar]

What makes me a little upset is when the accelerated mode is applied to people who haven't learned the material. It's one thing to push EM residents or attendings through who have already done ACLS. But this year my third year med student classes did the whole course in about 6 hours total. And the mega codes were done in teams of two, just by talking through the situations, not by actually running them on a dummy. It's sorta embaressing, epecailly since I'm doing research on medical students and dealing with codes and realizing that their ACLS background is terrible.

 

[deleted65604]

Good chest compressions, shock fib and unstable tachycardia, use lots of epi. Be suspicious of SVT in kids with heart rates above 220. Know where your Breslow tape is. When in doubt, use amiodarone. When they are dead, they will likely still be dead after you are done with them. ACLS, PALS, BLS, usually work in the first 5-10 minutes if they are going to work, and after that, you start praying they don't come back because you know they'll be brain-dead vegetables.

 

[dchristismi]

What makes me a little upset is when the accelerated mode is applied to people who haven't learned the material. It's one thing to push EM residents or attendings through who have already done ACLS. But this year my third year med student classes did the whole course in about 6 hours total. And the mega codes were done in teams of two, just by talking through the situations, not by actually running them on a dummy. It's sorta embaressing, epecailly since I'm doing research on medical students and dealing with codes and realizing that their ACLS background is terrible.

It's also another thing to make EM residents and attendings, who run codes IN THEIR SLEEP, redo the entire thing if their certification lapses.

Last I checked, med students, labor and delivery nurses, and RTs don't run codes, but have to take ACLS. In real life, whoever is most senior takes over, unless they're lazy. (Like the EP lab code when the cardiologist defers to the 3rd year IM that showed up.) Hopefully whoever is there first opens the airway and starts compressions. And hits the button on the wall.

(Disclaimer: I'm an ACLS instructor) Really, the team-teaching where they make everyone be team leader works in theory... but never happens in real life.

As far as PALS, yes to Amio, yes to chest compressions, get the Broselow, and pray. And DEFINITELY YES to coffee.

 

[deleted6669]

ACLS and PALS are very different creatures now then they were 15 yrs ago.
the whole "team code" concept was not really taught then. folks were tested individually on each component and either they knew it or they didn't. if you didn't know it you failed and had to retake the course. I was an acls instructor for over 10 yrs but when the new "kinder/gentler" format came out I refused to teach it and let my instructor status lapse.
I still don't think it's ok to give out cards to folks just for showing up....
fortunately ATLS and ABLS are still taught the right way with individual codes which you either pass or you don't.

 

[jbar]

Last I checked, med students, labor and delivery nurses, and RTs don't run codes, but have to take ACLS.

True, but the med students will be running codes some day, and may be helping with them on rotations (doing CPR, bagging etc). You can argue if you should be teaching it to them at all, but I think the more times you are exposed to the material the better the retention. It would be pretty terrifying to see ACLS for the first time the beginning of intern and possibly have to do it a week later. I argue if you are going to teach it to anyone, but especially med students who will run it in the future, you might as well teach it right. If you are going to spend 6 hours teaching it, take the extra two hours to do real scenarios.

 

[Jeff698]

ACLS and PALS are very different creatures now then they were 15 yrs ago.

Ain't that the truth. My first PALS class was in 1990 and I still have nightmares about it. Those damn pediatric intensivists who taught it put the fear of God into my little paramedic heart.

While not as bad, my first ACLS class in 1988 was also pretty scarry. Nothing like the big-group-hug things we do today.

Take care,
Jeff