ACLS vs real life

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Specializes in Cardiac Transplant.

Hi all! Question regarding ACLS algorithms vs real life codes. For background I am a RN of 8years. Last 1.5 years I have been on a step down cardiac unit. On my floor we have a resource/crisis RN each shift that will respond to code blues throughout the hospital as the "med Nurse". I have recently been trained and have started taking on this roll a couple shifts a month. When I have gone to codes it seems that often the code captain(senior resident MD) does not follow the algorithms well. Often adding additional meds into the code (narcan, sodium bicarb, calcium gluconate, mag to name a few but not all)   So my question is so this normal/expected? It just seems that ACLS is very straightforward  on what to do and I've studied and studied to know it front to back so that I'm prepared and then they start sprinkling in these other meds(pretty early in the code) and it frustrates a little. But I don't have the experience with codes to know if it's expected! So I just would like to hear others experiences so I know wether I need to lighten up :). TIA. 

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This is not uncommon; the team leader will adapt her or his interventions based upon patient specifics.  From the Top 10 Take-Home Messages for Adult Cardiovascular Life Support in Part 3: Adult Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care:  

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Recognition that all cardiac arrest events are not identical is critical for optimal patient outcome, and specialized management is necessary for many conditions (eg, electrolyte abnormalities, pregnancy, after cardiac surgery).

If you haven't had oppurtunity to read them I recommend doing so as there is a lot of information that isn't included in the ACLS text.  You might find the Adult Advanced Life Support: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations  informative as well.

And, in my experience after the resuscitation is finalized most physicians are more than willing to  why he or she did or didn't perform a particular intervention.

Best wishes, and never stop asking why something is done.

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Specializes in Cardiac Transplant.
chare said:

This is not uncommon; the team leader will adapt her or his interventions based upon patient specifics.  From the Top 10 Take-Home Messages for Adult Cardiovascular Life Support in Part 3: Adult Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care:  

If you haven't had oppurtunity to read them I recommend doing so as there is a lot of information that isn't included in the ACLS text.  You might find the Adult Advanced Life Support: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations  informative as well.

And, in my experience after the resuscitation is finalized most physicians are more than willing to  why he or she did or didn't perform a particular intervention.

Best wishes, and never stop asking why something is done.

 

Thank you so much! I will definitely read these links! Knowing it's normal will really help my ability to work with it! 

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It just seems that ACLS is very straightforward  on what to do

Except for that little part about treating reversible causes....

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Specializes in Emergency (CEN) and Critical Care (CCRN-CMC)_SRNA.

ACLS algorithm assumes every patient follows the same timeline/criteria. ACLS doesn't differentiate between say...cardiac arrest d/t hypoxia vs STEMI vs PE vs severe sepsis vs DKA vs hypovolemic shock. 

ACLS only cares for electrical malfunction of the plumbing system. Real life is beyond that (think your H's and T's) aka your reversible causes like JKL33 stated.

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Specializes in Cardiac Transplant.

Thank you for answering. I think I was forgetting about H & Ts. I'm new to ACLS and codes and just want to understand  the process and be an asset to the team. For my ACLS course they have you run the codes right?  but you are only suppose to use the algorithms and I got a little hung up on that. I truly appreciate you guys taking the time to answer! 

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Specializes in ICU, trauma.

I think of it as patients' bodies haven't read the ACLS manual 😉... yes like others said, it's likely related to the Hs&Ts/reversible causes.  

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Specializes in Emergency Department.

ACLS is a recipe. Cooks can follow a recipe. One of the things with ACLS is that it also prompts the code lead/team to consider "reversible causes." Those are all things that aren't necessarily in the recipe for the "usual" stuff. So if you're the code team lead, you have to consider how to treat those other things. The physician is usually pretty well trained at treating those other causes so they can deviate from the ACLS recipe, more like a chef would. 

People that have been around the block a few times may recall that the recipe has been changed a few times over the years. Some of the drugs used are still around and can still be used but you'd better know why and how they work if you use them. 

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Especially in a code, narcan has no downside. Only a possible upside. 
Bicarb actually is really important because you need to help the body keep at least a normal-ish pH because it goes acidic during the code from, among other things, buildup of co2. Generally I'll give it every 3rd or so epi - unless I know low ph is the problem then they're getting more. 
Calcium can help with possible hyperkalemia, hypocalcemia, hypermagnesemia, or OD from calcium channel blockers.
While there are not specifically in the algorithm, remember that the algorithm includes finding and fixing the H's and T's - and that's what these meds attempt. 
 

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The reality is that if you have no idea what caused the arrest, every HandT on the list aside from those that you can objectively measure like temperature and glucose, everything is  on the table. Depending on where you are and what resources are available, throwing everything you have at the patient can be defensible. 

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