Shock Delivered.
October 09, 2015
It has been 2 years since I had my last BLS & ACLS training at the Philippine Heart Center. The BLS training was not much of a problem but the ACLS was. And oh boy, that ACLS training was like a train running fast straight on me - hitting, colliding and leaving me almost dead on the spot. Yes, almost dead as I thought I would never survive the written and especially, practical exams ( I hate return demonstrations ). Literally almost all the information that was being poured on that training was a bit "above-of-my-level" kind of thing. There were these ECG readings, pharmacology, pathophysiology, all of which are really not my forte. And in this "megacode" of our practical exam, they were flashing these cardiac rhythms and I was like, "What the heck is that? All I know is an asytole" ( well, only on my mind ). Good thing I had experienced nurses and doctors as my group mates who were coaching me what these crazy lines were. But in the end, with God's grace and a bit of good luck and coaching, I passed.
As you may know, the validity of AHA's BLS & ACLS is only for two years, so ( yes, you are right ), I am in need of renewal. But this time, the train did not hit me straight on. It almost ran on me but did not hit me - it missed me. I was prepared.
I got my BLS & ACLS training under the FDM Training Center. Maybe because I had the training before or the instructors had made it everything understandable, I do not know; but one thing was for sure, I was now able to grasp every information that was offered. I have now understood, almost every concept of it, especially the cardiac rhythms; unlike before where my "kabisote" self was doing all the work and not even bothering to understand every single detail. Everything went well actually. I passed the written exam with flying colors. Mainly because I recognized the questions which were the questions I had when I took my first BLS and ACLS exams (though the answers were not really given after each exam). Anyway, the practicals went well too. I was now able to differentiate and recognize Supraventricular Tachycardia from A-Fib, Monomorphic Ventricular Tachycardia from Polymorphic Ventricular Tachycardia and so on. I had now understood each algorithm and management for each case and the reason behind them. I am now proud that I actually passed this training, with the understanding ( almost ) of all of its concept.
Here are some of simplified concepts that made my BLS & ACLS training a less complicated one:
- Always ensure to maintain safety throughout your BLS & ACLS survey. If not, it is an indication of withholding resuscitation.
- A conscious patient needs initial management of ACLS survey while an unconscious one needs BLS. I am only talking about the survey here okay?
- Immediately start defibrillating the patient as soon as the AED / defibrillator arrives. Even if you are still in the middle of your CPR and still not complete with the 30 compressions and the AED / defibrillator is ready, shock the patient immediately.
- You do not give any drug on the first 2 minutes of resuscitation , may it be asystole, PEA, or pulseless v-fib vtach. This is to check if the dysrhythmia will respond to or resistive to shock.
- Resume high quality CPR after each shock.
- Cardioversion is done in synchrony with the heartbeat , low-energy shock is delivered at the R-wave ; whereas asynchronous defibrillation is done irregardless with the heartbeat , that is a high-energy shock is delivered randomly, irregardless of the QRS complex .
- Polymorphic unstable vtach is treated with defibrillation . Any other vtach can be treated by either synhronized cardioversion or pharmacologic approaches.
- A patient is stable if he / she is asymptomatic and with a BP of equal or more than 90/60 whereas unstable patients are those with serious signs and symptoms and BP of less than 90/60.
- Epinephrine is given every 3-5mins , that is why it is alternated with any anti-arrhythmic drugs during the 2-minute rhythm analysis.
- Epinephrine is the only drug given during PEA / asytole.
- Carotid massage is not recommended for patients 60 y / o and above for the risk of dislodging a clot that might cause a stroke.
- Remeber to act FAST when a stroke is suspected. Use the Cincinnati Prehospital Stroke Scale . F ACIAL droop, A rm drift, S peech : inappropriate or slurred. I added T ime , which is when you first notice any of the signs and symptoms.
- ECG rhythms:
** These are a combination of what I learned for myself during my self-review and during the training itself. Feel free to question anything that might be incorrect.
Oh, and another thing, (I'm not actually sure if this was new, but this was definitely new to me) AHA's got this new feature where you can view your certificates and print your own just by logging in online! So, when you misplaced your certificates or somewhat has been accidentally ruined, you can now easily print one. All you need to do is go to cprverify.org the create an account. The name that you will register will be the one to show up on your certificates. After signing up, verify your account via your email. After verifying, log-in your account then enter your certificate number that can be found on either of your card or certificate. You need to give a feedback first before you can print your certificates, so just finish this feedback about your training and poof!... Your certificates are already print-ready.
But take note, this only applies on certificates not on card. So if you lost your card, better go to the training center where you had your training or any AHA accredited center to get another one.
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