This past Thursday, I spent the day recertifying for ACLS. It's a scheduled 8-hour refresher class that I have to take every other year. This year it took us about 6 hours to finish the class (which includes the refresher class, a 50-item test, and a "simulated code" where you are given a scenario and you lead a team of 4-5 other nurses through a variety of serious situations).
I have always been very confident during these "megacode" scenarios. My only problem is I have a hard time remembering to vocalize every step of the algorithm. I'll never code anyone on my own, and working a telemetry floor, all of the nurses that would assist me during the first few minutes of a code arrest are also ACLS-certified and we are all working the same algorithm. So the instructor will give me a case of, say, pulseless V-Tach and I'll be halfway through before I'll be reminded I haven't done something I would do so reflexively (such as verifying level of consciousness, or putting in an oral airway, etc.) After being a charge nurse for so long, it is like trying to vocalize the steps I take to put my pants on, or tie my shoes. I mean, of course I insert my foot before tying a basic square knot, and I do always verify the zipper is down before I insert my leg, that sort of thing).
Plus there are always changes. This year, I find out that the algorithm states to perform a defib shock and then immediately resume CPR WITHOUT verifying a cardiac rhythm until 3 cycles are complete. That's going to be hard for me to do. My instinct after delivering a shock is to look up at the monitor to see if we have some sort of workable rhythm. And I'll miss the drama of "three stacked shocks". We'll have to see about that one, in the real-world situation.
And apparently Vasopressin has fallen out of favor? When did that happen? Not that I've ever given it on my own -- I'm very old-school with the Epinephrine. I didn't read about it in the literature.
I was off for one night but I'm back at it for Sunday and Monday nights. The last time I recert-ed my ACLS, I had two codes the following week. Hopefully, we'll have none of that this year.
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