ACLS algorithms

my point is actually really simple and can be summarized in three sentences. 1: deviations from standard clinical practice guidelines during in-hospital arrest are a very common occurrence - to simply say "not me"; "not my team"; "not my institution" is too live outside reality. 2: a major responsibility, perhaps the major, responsibility of the code leader is to make sure that the algorithms are being carried out correctly and optimally. 3: there are tools available, including the aha algorithm cards, which can be helpful to in some situations to assist the code leader in helping keep everything running smoothly.

i think if anyone who has been to very many codes has seen some that frankly were not run well. the evidence demonstrates that happens way too often. and like 'em or not, when we deviate from the guidelines, we are not giving are patients the best chance for survival.

Of course we see codes that would not be considered "run well" if the ACLS police were in the room. Main reason? We are working with real patients with many co-morbidities that get in the way of "neatness." In situations where the designated code leader (sometimes a resident who is given the job as a learning experience) calls for something that is not appropriate someone else will simply say "ummm....you probably don't want that now---why don't we go with this______?" and the "leader," recognizing his limitations, defers. And learns.

And sometimes we are working with real docs (sometimes old-school cardiologists) who insist on going out of protocol because this is what they know and this is what they want. Not bad practice but not current practice. Most of the time, LOL, their old protocol procedures work quite nicely. Over decades of ACLS I've seen the protocols change and many of the new protocols discarded after a few years. The fantastic new and improved versions were proven to be not only ineffective but sometimes counterproductive. So who can blame the old docs for sticking with what they know has worked for years and going with it.

When the kim chee truly hits the fan no laminated cue card is going to straighten things out. In a room full of practitioners, including physicians, nurses, RT's, and CRNA's, SOMEONE (and very likely more than one person IN MY EXPERIENCE) is going to be able to pull things together with a combination of knowledge and experience.

If the code is way out of control and someone calls for something that is patently ridiculous I will just refuse to prepare it and tell them why. Yes, this crap does happen and egos be damned, we advocate for the patient.

Honestly, except for the occasional med student standing in the corner with an ACLS pocket guide, I've never seen anyone refer to a cue card during an adult code.

Different scenario---peds code, where the Broselow tape may be used. Because of the tremendous variation of doses, max doses, and sizes of the pediatric code patient population this is a useful tool to have available in case we are confronted with a pediatric code. Many peds code carts are arranged according to the Broselow tape protocols which is wonderful but for those who are faced with a pediatric code without a color-coded Broselow cart and are unfamiliar with peds codes it is a great device. But you still have to know PALS algorithms when using the Broselow tape---it's not a "what do I do now??" reference. It's very simple to use and a wonderful tool that has undoubtedly saved the lives of many pediatric code patients. Just establish the color group to which the child belongs with the tape and your ETT size and med dosages are calculated for you on the tape. If you do have the Broselow pediatric code cart (and most places do these days) you just pull open the color-coded drawer and all your appropriately-sized equipment and calculated-dosage meds are there for you. Great stuff.

I so agree!!!!!!!!

rock it out windward!