ACLS algorithms

  1. 0 I am a new grad and landed my dream job in the SICU of a level 1 trauma hospital. It has been an incredible experience! However, I am freaked out. On Tuesday we will be running ACLS megacodes. Our nurse educator said we need to know all the algorithms without hesitation. YIKES! I have my ACLS card, but I basically just learned enough for the exam. Anyone have any suggestions for learning them AND remembering them? I googled, but all I find are learning aides for old versions of ACLS. I appreciate any help I can get! Thanks!
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  3. Visit  yesdog} profile page

    About yesdog

    Joined Aug '07; Posts: 182; Likes: 85.

    28 Comments so far...

  4. Visit  krb09} profile page
    1
    I am a new grad and have been working in an MICU since July. I just took ACLS and had to do a megacode. Basically, I just looked over my cards and would think to myself through each scenario. I would actually picture myself walking into a room and finding a patient in each situation.

    I know this probably doesn't help you that much but it really is about memorization and critical thinking. Knowing the drugs, what they do and what they are used for will help you remember the algorithms. Also remember what needs to be immediately defibrillated or cardioverted will knock out a couple of algorithms.

    Hope that helps a little!
    yesdog likes this.
  5. Visit  yesdog} profile page
    0
    Thanks for the advise! I will continue to review my cards. I do ok at home and did fine when I took ACLS the first time. I guess I am concerned because my nurse educator is so intense! He is a very good teacher, but he loves to just fire questions at us. It is pretty intimidating. Thanks again! Congrats on your job!
  6. Visit  detroitdano} profile page
    1
    I've been in the MICU since July and have yet to take ACLS, our manager won't let us for 6 months because she wants us to experience things on the unit first. I'm glad she did it this way. I took a practice ACLS exam the other day and rocked it, and I haven't even studied a lick.

    Hopefully they don't give you too much trouble. You're a newbie with little code experience. It should be an educational session, challenging but not stressful. If you walk away feeling defeated and that you learned nothing they're doing it wrong.

    A bunch of us new hires did mock codes with chest compressions, defibrillation, cardioversion, pacing, ACLS meds, etc. and went through about 10 scenarios in our simulation center and none of our "patients" died. It was a great experience, and I feel more relaxed in code situations now. Hopefully you walk away feeling the same way!
    yesdog likes this.
  7. Visit  detroitdano} profile page
    1
    Oh, and I guess a tip...

    Don't force yourself to memorize them. It's just something you have to study time and time again and it will come to you naturally. Cramming helps none. Understand the rationale behind meds, how they work, and applying them to practice will be much easier.

    I bought this book. 608 pages of ACLS goodness for $21:

    http://www.amazon.com/ACLS-Study-Gui.../dp/0323046959

    It's very detailed. Probably overkill for most, but it's helped me a lot. It also comes with a pocket guide with algorithms for that "just in case" moment.

    I did my unit orientation with lots of ACLS-certified RN's and I was answering dosage questions they couldn't even remember. Just because you have ACLS doesn't mean you know it. You can cram, pass, and then forget everything, which is completely useless.
    yesdog likes this.
  8. Visit  PDX_RN} profile page
    4
    The current emphasis in ACLS instruction is to teach people to use their tools. At my hospital, we keep the alogorithm cards on the code cart. We are expected to refer to them in an actual code. Trying to rely solely on memory is a recipe for error. I doubt you will feel confident in taking on this battle, but I think that if your nurse educator is actually expecting you memorizing the algorithms and run codes without the benefit of memory aides such as the AHA cards she is behind the times.
    hoopschick, NurseKitten, yesdog, and 1 other like this.
  9. Visit  yesdog} profile page
    0
    Quote from PDX_RN
    The current emphasis in ACLS instruction is to teach people to use their tools. At my hospital, we keep the alogorithm cards on the code cart. We are expected to refer to them in an actual code. Trying to rely solely on memory is a recipe for error. I doubt you will feel confident in taking on this battle, but I think that if your nurse educator is actually expecting you memorizing the algorithms and run codes without the benefit of memory aides such as the AHA cards she is behind the times.
    I completely agree. I am wondering if he told us we had to know the algorithms like the back of our hands just to make sure we are prepared for the practice megacode. I have a feeling we will be allowed to use the cards when we do it tomorrow. We would be using the cards during a real code.
  10. Visit  yesdog} profile page
    0
    Quote from detroitdano
    I've been in the MICU since July and have yet to take ACLS, our manager won't let us for 6 months because she wants us to experience things on the unit first. I'm glad she did it this way. I took a practice ACLS exam the other day and rocked it, and I haven't even studied a lick.

    Hopefully they don't give you too much trouble. You're a newbie with little code experience. It should be an educational session, challenging but not stressful. If you walk away feeling defeated and that you learned nothing they're doing it wrong.

    A bunch of us new hires did mock codes with chest compressions, defibrillation, cardioversion, pacing, ACLS meds, etc. and went through about 10 scenarios in our simulation center and none of our "patients" died. It was a great experience, and I feel more relaxed in code situations now. Hopefully you walk away feeling the same way!
    That is really interesting that you aren't going to get your ACLS card until six months. It is a requirement for our position.
  11. Visit  PDX_RN} profile page
    1
    I think new hires to my ICU also orient for a period of time prior to taking an ACLS class. That is definitely the case on the step-down unit where I started. I think either way is fine. The point is that no new grad should be responding to codes as a code leader while they are still on orientation. And when you do, you shouldn't be alone. It's a team activity. Unfortunately, you probably won't have the same outcomes in terms of survival rates during a real code.
    yesdog likes this.
  12. Visit  detroitdano} profile page
    1
    Quote from yesdog
    That is really interesting that you aren't going to get your ACLS card until six months. It is a requirement for our position.
    It's a requirement here too, but what's the point of taking it when you've got no idea what the meds do? There seems to be this mentality with new ICU nurses that you should know every drug you can ASAP because now you're allowed to give them. There's no point in rushing it if you don't understand the mechanisms of the drugs, when not to give them (blocks and what not), what to assess, etc. 6 months gives you time to see how codes are handled, when meds are/aren't given, etc.

    They teach quite a bit of that in ACLS, but it's a 2 day few hour crash course and you'll certainly not remember it as a brand new hire with all that other information you're expected to learn, so what's the point?
    yesdog likes this.
  13. Visit  yesdog} profile page
    0
    Actually, I was hired in July, so this acls class is about six months into my orientation. I will be off orientation on Dec 14 (Yikes!) and it is required for us before we are on our own. I took acls before I was hired so it would look good on my resume. You are right. I had no idea what I was learning when I took it the first time. This time has been much easier. I just have performance anxiety for tomorrow to do the megacode in front of everyone. I am afraid my mind will just go blank. Hopefully, my brain will kick in and I will do fine.
  14. Visit  detroitdano} profile page
    1
    Quote from yesdog
    Actually, I was hired in July, so this acls class is about six months into my orientation. I will be off orientation on Dec 14 (Yikes!) and it is required for us before we are on our own. I took acls before I was hired so it would look good on my resume. You are right. I had no idea what I was learning when I took it the first time. This time has been much easier. I just have performance anxiety for tomorrow to do the megacode in front of everyone. I am afraid my mind will just go blank. Hopefully, my brain will kick in and I will do fine.
    Don't get yourself too worked up. It's a learning experience and treat it as such. Everyone has been in your shoes before, it's not something you wake up one day and just know.

    I've come across lots of advice on codes over the years but these are some of my favorite ones:

    1) When you're in a code, take your own heart rate first. If you can't control yours, you sure can't control the patients.

    2) When you walk into a situation that looks like it's about to get nasty, take 5-10 seconds after screaming for help to stand there and process what's going on. Your patient isn't going to croak from anoxia in 10 seconds, but if you can't get "the big picture" during a code it's a pretty good chance they will.
    yesdog likes this.
  15. Visit  WindwardOahuRN} profile page
    7
    Quote from yesdog
    I am a new grad and landed my dream job in the SICU of a level 1 trauma hospital. It has been an incredible experience! However, I am freaked out. On Tuesday we will be running ACLS megacodes. Our nurse educator said we need to know all the algorithms without hesitation. YIKES! I have my ACLS card, but I basically just learned enough for the exam. Anyone have any suggestions for learning them AND remembering them? I googled, but all I find are learning aides for old versions of ACLS. I appreciate any help I can get! Thanks!
    The truth of the matter is that you can kill yourself trying to memorize algorithms but it's only that---book learning by rote. The odds are all of what you have spent hours memorizing will blow out the window when the real thing happens.
    Learn the meds and what they do. Learn WHEN you are supposed to use them and, just as important, when they are contraindicated. Learn your shockable rythyms.
    IMHO your instructor is a bit of a bully and is being unrealistic and counterproductive.
    Reminds me of when I took my first ACLS many moons ago, when dinosaurs roamed the earth and defibrillators were hooked up to lightning rods. The instructor was an EMT whose head was so big his ears scraped the sides of the doorway when he entered the room. He was more interested in showing us how much he knew and showing us how much we didn't know than he was in seeing us learn anything. He was an ass. And this was back in the days when you could actually fail ACLS so we were all pretty much terrorized. Yep, pay your money, fail, and walk out the door with nothing. I passed but a few did not.
    You're not going to be running codes any time soon. As a member of the Code Blue team I can assure you that it will be a long time before you will be expected to be anything but a go-fer during a code. It depends on your facility, of course, but you might be expected to push meds if you are the patient's primary nurse. If you are the primary nurse please step up and offer information about the patient---why he's in the hospital, recent surgeries, co-morbidities, whether he's received narcotics, anything you think might be important.
    Offer to be the recorder, note the clock, the numbers of amps of epi and atropine (especially atropine), the defibrillation joules, the gtts that are running.
    The really messy codes usually involve difficult intubations, tracheotomies, chest tube insertions, TVPM insertions and of course traumas and surgical patients who are bleeding out while they're coding. The most awful, IMO, are the codes in L&D that require c-sections while the mom is coding. You won't be a major player or decision maker in these for quite a while.
    Mega-codes are nice and neat and all the "patients" live. It's so much easier to yell out the next step in an algorithm when you're not slipping in a blood slick and the patient is not vomiting into the ETT. You always have really good venous access with the ACLS dummy, they never weigh 500 pounds, and they're always found neatly on their backs (never wedged between a toilet and a wall, lying in a pool of liquid stool). Ahh, just reminiscing here..
    Advice? Learn what you can, learn WHY we give the meds when we do, why we shock when we shock and why we don't shock when we don't shock.
    The algorithms are a natural progression once you understand the basic mechanisms of the arrhythmias, the actions of the code meds, and the purpose of defibrillation.
    Good luck and don't beat yourself up over this.
    Last edit by WindwardOahuRN on Dec 1, '09


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