ACLS and Tabs for 12 leads

[green34]

Two different topics but I have questions about them.

First off, can anyone take ACLS? I was under the impression that AHA does not make rules on who can take it as it's a certification showing you took/passed a class and not giving you power to push drugs or act outside of your scope. I think the initial video has a disclaimer on it, but it's been awhile.

We had an argument where people insisted that only paramedics and nurses could take ACLS. I argued that I've seen respiratory therapists take it and they say that's because they are licensed. I argued that it's probably our hospital policy to not let everyone take it to cut down on costs or time spent teaching people who will not use it, may be tempted to over step their roles, or who may not understand it.

Then they argued why would a PCT need ACLS. I told them they wouldn't but they could take if they really wanted to shell out the 250 for the class at another provider. Another nurse who has been all over also said that ACLS does not require people to be "licensed."

2nd one. Do you know those philip EKG machines? Not the monitors. Those tabs. I've been told that it does not matter which way the tabs face so I usually always do it in the same direction. The old hospital I did also did it this way. A nurse insists it affects the reading negatively because it should be facing towards the heart, but I've never had an incorrect or altered reading this way. The pictures on the machine show circles and not dots.

Also, one tech flipped out when I put the limb leads on the limbs and not on the torso. She didn't believe me that is where you are actually supposed to put them (and went and asked a doctor about it who said the EKG was fine that way).

The policy in our healthcare system is kind of crazy, but they are supposed to go on the deltoids or wrist and then on the back of the knees for limb leads. It does not state have the sticker tabs face up or down.

[NICU Guy, BSN, RN]

First question--- ACLS is designed for all active participants in a hospital code. Primarily for the doctors, nurses, and parmedics, but I can see respiratory and PCAs being there to practice their roles in the scenario.

Second question--- The tabs are metallic foil with adhesive on them. You are measuring the electrical activity so it doesn't matter which direction they face. When I did 12 leads, our machines used the snap on electrodes. Which way do you point a round electrode with gel in the center?

We put the arm leads on the rotator cuff area and lower limbs toward the hip joint on the torso. We did it that way to reduce the artifact from movement of their limbs. It does not effect the result.

[K+MgSO4, BSN]

The resuscitation nurse educator at my Hospital agrees with me - the limb leads need to be 4 inches away from the other leads so the abdominal area and upper shoulder is fine. The only rationale for the leads all going in the one direction is so that they don't knock other leads Off with the wires going everywhere. My dream is a wireless 12 lead ECG.

I kind of disagree with the need for aides to have ACLS they do not have the baseline knowledge to know why they are doing various interventions. Can't comment on resp therapist as they don't exist anywhere I have worked UK Ireland or Australia.

[Altra, BSN, RN]

The problem with PCTs taking ACLS: while the content might fascinate you and there is never anything wrong with broadening your horizons, it does presume background knowledge in physiology that you may not have. ACLS is also largely structured as group learning - the skill stations and scenarios rely on each group member having the knowledge and skills to play a role.

[Esme12, ASN, BSN, RN]

I believe that (at least they used to) the ACLS is for active participants that participate in codes and can legally give meds or intubate the patient and perform interventions like IV starts, meds, defib....etc

The leads do not need to face a certain direction and they can be placed anywhere like K+MgSO4 says...however some cardiologists prefer consistency in application, what ever that is, as lead placement changes can be reflected as subtle changes in the 12 lead.