Acls - page 2

Hello everyone. I am just curious about something. I graduated from nursing school in May. I have been working in a CVICU since September. I oriented for about 2 1/2 months and have been on my own... Read More

  1. by   Rollins
    Quote from bobnurse
    Places that are dependent on code teams.......thats where they let nurses work critical care without ACLS.......
    So what do you do until the code team arrives? I'm not being harsh, just honest. Do you all actually think a non-ACLS nurse should be in an I.C.U.?
  2. by   bobnurse
    Quote from Rollins
    So what do you do until the code team arrives? I'm not being harsh, just honest. Do you all actually think a non-ACLS nurse should be in an I.C.U.?
    Before code team

    BLS = Airway, CPR, Defibrillation----Primary Survey


    I dont think you have to be ACLS to work ICU.........Thats why i said many places have code teams.....Being ACLS is a formality.....Doesnt mean you can run a code....Especially how its taught today at most facilities. Its an exposure class...........

    In my opinion, all critical care nurses should be ACLS.......Not that they can run a code, but if everyone is ACLS, they can anticipate whats happening, whats happening next, and potential outcomes.....6 or 7 ACLS brains are better than 1....
    Last edit by bobnurse on Mar 3, '05
  3. by   Rollins
    Quote from bobnurse
    Before code team

    BLS = Airway, CPR, Defibrillation----Primary Survey


    I dont think you have to be ACLS to work ICU.........Thats why i said many places have code teams.....Being ACLS is a formality.....Doesnt mean you can run a code....Especially how its taught today at most facilities. Its an exposure class...........

    In my opinion, all critical care nurses should be ACLS.......Not that they can run a code, but if everyone is ACLS, they can anticipate whats happening, whats happening next, and potential outcomes.....6 or 7 ACLS brains are better than 1....
    Airway~Where do nurses learn to manage airway? Head-Tilt~Chin-Lift
    Jaw Thrust
    Oral Airway insertion
    Combi-Tube
    LMA
    Breathing~What rate to assist respirations with BVM, or how to use BVM?
    Circulation~Chest compressions(you got me there).

    I agree, when I took my first ACLS class, they wanted you to fail, and it was a difficult class. Now it's not even pass/fail. Everyone is passed no matter how they score on the written exam, or how they do the mega-code.

    And defibrillation, how do they learn that except trough ACLS? What rhythms to shock, how many joules, ect.?
  4. by   bobnurse
    Quote from Rollins
    Airway~Where do nurses learn to manage airway? Head-Tilt~Chin-Lift
    Jaw Thrust
    Oral Airway insertion
    Combi-Tube
    LMA
    Breathing~What rate to assist respirations with BVM, or how to use BVM?
    Circulation~Chest compressions(you got me there).

    I agree, when I took my first ACLS class, they wanted you to fail, and it was a difficult class. Now it's not even pass/fail. Everyone is passed no matter how they score on the written exam, or how they do the mega-code.

    And defibrillation, how do they learn that except trough ACLS? What rhythms to shock, how many joules, ect.?
    It sounds like you havent taken a CPR course lately.

    You learn to open the airway in BLS courses, both jaw thrust and head tilt.
    Combitube and LMA, and other airway adjuncts are an Advanced airway tool.

    BVM's are taught in BLS courses as well. CHest Compressions and Circulation.

    All defibrillators have an AED function. So they can utilize that on their defibrillators. (unless you have a dinosaur for defib)

    I would recommend you take the American Heart Association Basic Life Support for Healthcare Provider Course. Its the standard for most hospitals and clinical staff. IT covers just about everything you have stated besides the airway adjuncts. This has been the standard since 2001.
  5. by   Rollins
    My point is that you need to be proficient in all the above to work an I.C.U. You do learn all these things in B.L.S., but even housekeeping takes these courses. And you think that a nurse working an I.C.U., S.I.C.U., M.I.C.U., or CVICU can just get by because of BLS? Come on now!
  6. by   Rollins
    Would you want your grandpa who is post-op CABG, or major trauma patient, or critical patient on CVVHD taken care by a nurse who isn't AT LEAST ACLS qualified?
  7. by   bobnurse
    Quote from Rollins
    My point is that you need to be proficient in all the above to work an I.C.U. You do learn all these things in B.L.S., but even housekeeping takes these courses. And you think that a nurse working an I.C.U., S.I.C.U., M.I.C.U., or CVICU can just get by because of BLS? Come on now!
    Never said that. I posted that many hospitals do not require all their ICU nurses to be ACLS...That they have a code team that responds. The nurses provide BLS support until the code team arrives. This includes airway support, CPR, and defibrillation.

    Theres much more to working in ICU, you are correct. But should not being ACLS prevent you from working there? NO....

    ACLS does not prepare you to care for an ICU patient. It helps to prepare you for cardiopulmonary arrest. Caring for ICU patients takes years to develop the knowledge base. ACLS is a small peice of that knowledge base.

    But i do agree, all critical care nurses should be ACLS. It offers more knowledge to the nurse in emergency cardiovascular care.

    And you'd be surprised how many housekeepers have used an AED in the community with nurses standing around.
    Last edit by bobnurse on Mar 3, '05
  8. by   bobnurse
    Quote from Rollins
    Would you want your grandpa who is post-op CABG, or major trauma patient, or critical patient on CVVHD taken care by a nurse who isn't AT LEAST ACLS qualified?
    Being an ACLS Instructor.........Thats not at the top of my list. I know for a fact that most of the ACLS "certified" nurses couldnt pass a megacode 3 months out. I know nurses who've been ACLS for 10 years that dont know the color of lidocaine.......Have difficulty opening the boxes.....ACLS courses give you the theory but little hands on.....and some course, no hands on.....This is the rationale for the code teams....ER Docs and Nurses who have the hands on as well as theory due to repitition.

    So when my grandpa is post-op.......I look for CCRN, years of experience in the ICU, and maybe ACLS.....
  9. by   Rollins
    I know the many lay-persons have saved lives in these kinds of situations. But the original post was regarding when to take ACLS after a length of time in the I.C.U. (Whatever that length of time was). So, we BOTH agree that ALL I.C.U. nurses should be at least ACLS certifed? And believe me, I know this is a small piece of the knowledge base, but an important one. Anyway, let's end this by saying to all the new I.C.U. nurses out there, please take ACLS for yourselves and the sake of your patients. Bobnurse, I enjoyed talking with you. I'm SURE we'll be in contact again! And it's nothing personal, professional right? At least you sound like you've actually spent time in the S&*T.
  10. by   begalli
    ACLS Certified does not = able to perform ACLS.

    I think it's either the very first question on the test or the very last and it goes like this:

    When a student is issued an ACLS card, this implies:
    a) experitse in ACLS according to the standards of the AHA.
    b) licensure to perform the procedures taught in the course.
    c) qualification to perform the procedures in a hospital or prehospital setting.
    d) successful completion of a course in ACLS according to the standards of the AHA.



    ACLS is exactly what bobnurse is saying....an exposure to the protocol.

    We have many nurses in our ICU who are not yet ACLS certified. This is changing as our unit has decided to mandate everyone to be ACLS certified after they've been on the unit for one year.

    I've renewed my ACLS 3 times over the years. It really didn't sink in until this last time. The first time I was completely lost. The second time was fun and I could grasp the info a little bit more having some ICU experience. The third time was a blast!

    Codes NEVER go "by-the-book in the ICU. I really don't see what having the certification proves.

    By the way, the answer is d.
    Last edit by begalli on Mar 3, '05
  11. by   begalli
    Quote from Rollins
    Would you want your grandpa who is post-op CABG, or major trauma patient, or critical patient on CVVHD taken care by a nurse who isn't AT LEAST ACLS qualified?
    I know you're asking bobnurse, but if it were my grandpa (in reality, I wouldn't want him coded), I would want someone who's done it before....done it before lots of times. I would want a nurse with a clinical grasp of the situation to be able to bark out orders to the ones who don't yet have that grasp. I wouldn't give a second thought to an experienced RN running the show. It wouldn't matter if they were ACLS certified or not.

    On our unit we have many RN's who have been on the unit for 20-30 years! This year will be the first time ever that they will be ACLS certified because of the mandate.
  12. by   Rollins
    Quote from begalli
    ACLS Certified does not = able to perform ACLS.

    I think it's either the very first question on the test or the very last and it goes like this:

    When a student is issued an ACLS card, this implies:
    a) experitse in ACLS according to the standards of the AHA.
    b) licensure to perform the procedures taught in the course.
    c) qualification to perform the procedures in a hospital or prehospital setting.
    d) successful completion of a course in ACLS according to the standards of the AHA.



    ACLS is exactly what bobnurse is saying....an exposure to the protocol.

    We have many nurses in our ICU who are not yet ACLS certified. This is changing as our unit has decided to mandate everyone to be ACLS certified after they've been on the unit for one year.

    I've renewed my ACLS 3 times over the years. It really didn't sink in until this last time. The first time I was completely lost. The second time was fun and I could grasp the info a little bit more having some ICU experience. The third time was a blast!

    Codes NEVER go "by-the-book in the ICU. I really don't see what having the certification proves.

    By the way, the answer is d.
    That's kinda what I'm saying. What good is the little piece of paper saying you are ACLS certified, if you can't perform it or even actually retain what the class taught you? I'm agreeing with ya'll, people get the certification, but what good is it if you don't know how to use it?
  13. by   begalli
    Quote from Rollins
    ... but what good is it if you don't know how to use it?
    I think the point is exposure. Familiarizing.

    I think my biggest point is that codes don't go by the book in the ICU. Not that we don't follow the algorithms to some extent, but they never start from the beginning and go to the end.

    The drugs used in the ICU are the drugs of ACLS. We are constantly investigating why someone's pressure is dropping, or giving amio blouses for a-fib, or ordering chest x-rays for crappy 02 sats, tachycardia (tamponading?).

    I feel like some nights are just one long continuous code. With epi drips and external pacemakers, chest tubes and electrolytes, intubations and morphine.

    Hope I'm making sense. I'm still up after a very long night at work!!

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