ACLS algorithms

krb09 · Nov 30, 2009

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, BSN, RN · Nov 30, 2009

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!

detroitdano · Nov 30, 2009

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!

detroitdano · Nov 30, 2009

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-Guide-Barbara-Aehlert/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.

PDX_RN · Nov 30, 2009

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.

yesdog, BSN, RN · Nov 30, 2009

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.

yesdog, BSN, RN · Nov 30, 2009

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.

PDX_RN · Nov 30, 2009

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.

detroitdano · Dec 1, 2009

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, BSN, RN · Dec 1, 2009

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.

detroitdano · Dec 1, 2009

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.