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How to learn ACLS before internship

How to learn ACLS before internship

GETTING COMFORTABLE WITH IT

“ACLS: A minute to learn, a lifetime to master.No wait. That’s Othello. Applies here too.”

WORDS OF ADVICE

“ACLS the class isn’t so bad but the real code is a different story.

You just have to gradually learn your way in a code. The nurses are generally helpful and will help you out with doses and generally the whole crowd that is there will verify with you the right rhythmn on the EKG.

You just have to remember that something like less than 10% of code patients actually walk out of the hospital within 60 days. (and these patients are mostly your young patients, people visiting sick patients in the hospital and sudden MI).”

THE ALGORITHSM

– CAN BE FOUND AT THIS WEBSITE: uptodate

THE COST
The ACLS courses are expensive, ranging from $200-300. Most residency programs will pay for your ACLS course.

ACLS BOOK
You should get an ACLS handbook

THE CD THAT COMES WITH THE BOOK
The ACLS books comes with a CD that contains a lot more information than is in the book.
Has the ACLS preparation changed recently? I’m looking at the CD my program gave me at orientation on Monday. (We are supposed to read through the cases/algorithms and complete the assessments before attending the course this weekend)

THE CD only appears to contain self-assessment tests and these are definitely not timed. The CD also came with a brochure that contained the various cases and algorithms.

THE ACLS COURSE
You will need to attend an ACLS course to become certified in ACLS.

ONLINE SIMULATIONS
They are helpful for putting everything together, practicing managing transitions, and teamwork.

LEARNING FROM A REAL CODE
If you happen to get the chance to observe a real code, make sure to pay attention. It is another way to learn the algorithm.

THE INFORMATION YOU NEED TO KNOW

EKG
– You should be able to identify the important rhythms

DRUGS
– you should know the drugs, dosages, indications, contraindications

PRACTICE, PRACTICE, PRACTICE

Washington Manual has a real good Internship Survival Guide that I clutched onto throughout intern year. Good elevator reading en route to an unstable patient. And as you’re reading the guide, rehearse in your mind what you would do when you get to the room. And when you’re studying after hours, rehearse scenarios in your mind over and over again.

The more you visualize and practice these situations in your head, the more you’ll desensitize away your anxiety.

And afterwards, think about how you could have done better and rehearse the scenario in your head again. Or, think to yourself: what if the situation was different? What would I have done differently? Rehearse it.

Practice practice practice… like a concert pianist or basketball player”

“I would like to echo the practice, practice practice ethos. I think some people underestimate how much this helps. I have taken ACLS a gazillion times and I still need to go over it in my head occasionally so I know it well.”

THE ACTUAL COURSE

“I’m curious to know how many people found ACLS class to be hard. I just took a 2 day course and found that the class itself was quite detailed, with some cardiology professor getting all into the conduction pathways of the heart and pimping us on 12-lead EKGs, etc. (all review for me, but with the added aspect of drug dosages and energy levels for the defribilator). However, when it came to the practical test, even the dental student, who couldn’t identify V-fib, passed with flying colors.”

“ACLS the actual process is very stressful, and hard on people the first time. Mentally it is all an algorithm though, so it isn’t like you have to think that critically, you just have to recognize the patterns.”

THE ACTUAL COURSE EXAM

“I just did my ACLS for the first time last week. Not very difficult. Read the book before hand and know the algorithms. The hardest part was doing CPR on a wooden table…owie…

The final test is nothing like the pre-test, it’s much easier than the pretest.

Megacode = scenario. There are 4 different megacode scenarios and they put them in the back of the book, so it’s no secret what you’ll be doing.”

“I took it this week and it was super easy. All that was required to pass was a multiple choice test. In our small groups, people could volunteer to run the codes, but nobody was forced to do anything.”

” Nowadays, it is a freaking CAKEWALK compared to when I did it in med school and my primary care years in the mid and late 90s. I got 2 days off to do the course and it was like a vacation. So much so that I recommended colleagues to do the same if they just wanted a break. Now you can use the algorithm printouts during your megacode, also can ask for input from your colleagues who are observing…or if you are totally screwing it up they can offer guidance unsolicited by you to help you do the right thing. The big things you’d fail for were to shock a non-shockable rhythm or to completely forget to continue CPR while you were trying to figure out what to do next. Seriously, it has gotten much more user friendly, I wouldn’t sweat it at all.”

SISTERS AND BROTHERS OF ACLS
ACLS, BLS, PALS, and ATLS

DIFFICULT PATIENTS

“ACLS is good in theory, but can someone please tell me how I’m supposed to find the pulse on a 500lb patient who has collapsed? I’ve had 500lb pts sitting in my chair, alive and chirpy, and I have problems taking vital signs on them.”
“or how to do cpr on them. I had a guy like this the other night and I swear I could barely get the chest to recoil at all, despite putting all my weight into it. How are you supposed to do chest compressions on someone who is oh, 4 or 5x your weight?”

OTHER COMMENTS

“Well, the unfortunate truth is that residents who don’t need to think about ACLS everyday and aren’t exposed to it on a regular basis in real-life practice are gonna be a bit clueless when it has to be performed in real life. This is why 3rd year med students may know a lot of things that residents and attendings don’t know (they’ve been recently exposed) This is why a code in the ER or ICU will probably be a lot smoother than a code on the floors unless you ahve a dedicated rapid response team that isn’tjust the resident who happens to be assigned that day.”

THOUGHTS ON FUTURE IMPROVEMENTS
“Has nobody seriously invented a machine that does chest compressions??? ”
Answer: http://www.life-stat.com/index.html
http://www.zoll.com/medical-products/cardiac-support-pump/autopulse/
http://www.advancedcirculatory.com/resqpod/product_overview.htm

WHAT THE ACLS COURSES USED TO BE LIKE

“And I remember taking it for the first time waaaaaaay back when it was truly difficult. Many failed. And there was no hand-holding – no feedback whatsoever. Just go through the scenario and a “thank you. That’s all” from the tester. No cards allowed, no calculators. Very stressful. But you could definitely run just about any code when you were done.

These days ACLS is a cake-walk. Nobody fails. It relies heavily on the team approach to get you through a code. Totally non-stress, and very easy.”

ACLS ONLINE SIMULATIONS

http://www.acls.net/ – OUTDATED ALGORYTHM

‘ve been teaching ACLS for about 4 yrs. The only thing that I found that is worthwhile for ACLS was on www.acls.net But it seems that they haven’t updated the protocols (they are still doing 3 stacked shocks) But I believe they are updating as we speak. The quizzes are somewhat ok, there are a few odd questions.

SOURCES
http://forums.studentdoctor.net/showthread.php?t=653537&highlight=acls

http://forums.studentdoctor.net/showthread.php?t=640105&highlight=acls

http://forums.studentdoctor.net/showthread.php?t=614369&highlight=ACLS

http://forums.studentdoctor.net/showthread.php?t=534949&highlight=ACLS

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