Taking the ACLS. Some advice please.

Nurses General Nursing


Hello everyone!

I am trying to get prepared for the ACLS - two day provider class. I am having some problems with remembering some of the rhythms. I have used online resources including Youtube which were very helpful but I am still having difficulty. Not to fail to mention, I am also having problems with remembering the algorithms and the 10 cores.

The first time I went for ACLS, I went to a Paramedic for a one-on-one teaching. I know from past experience that EMTs and paramedics don't particularly care for nurses but this experience was ridiculous. He was harsh and brutal with me and told me that I will not make it through the megacode because my difficulty in identifying the rhythms. I was offended, humiliated and devastated.

Can someone please tell me the best way to study for this? If I don't get my ACLs, I WILL NOT have a job.


Specializes in Peds, School Nurse, clinical instructor.

  1. Use mnemonic devices to remember key algorithms. In ACLS, algorithms are a simple set of procedures that help you solve a treatment problem. Mnemonic devices can help you remember the steps to saving a life. Here are a few examples from the ACLS course:

  • If a patient displays bradycardia (an unusually low heart rate) remember “Pacing Always Ends Danger:” TCP (transcutaneous pacing), atropine, epinephrine, dopamine. Just remember, these are options for treatment of various forms of bradycardia, and not an ordered list. Usually atropine and epinephrine are tried first, then depending on the situation dopamine may be used and pacing is last. If the situation is acutely life-threatening, sometimes temporary pacing is indicated.

  • If a patient experiences cardioversion (an unusually rapid heart rate) remember “Oh Say It Isn’t So:” O2 saturation monitor, suctioning equipment, IV line, intubation equipment, sedation and possibly analgesics.

Mnemonic devices trigger faster recall, which is vital in emergency situations. The six H’s and five T’s are the most common mnemonic devices in ACLS – required learning for your ACLS exam.

The six H’s

  • Hypovolemia
  • Hypoxia
  • Hydrogen ion – Acidosis
  • Hyper- or Hypokalemia
  • Hypoglycemia
  • Hypothermia

The five T’s

  • Toxins
  • Tamponade – cardiac
  • Tension pneumothorax
  • Thrombosis – coronary or pulmonary
  • Trauma

  1. Know your pharmaceuticals. When performing ACLS, intravenous (IV) drugs are sometimes needed, and it’s important to know which drugs are pertinent in which situations.

  • Adenosine: An anti-arrhythmia drug often used for stable supraventricular tachycardia.
  • Amiodarone: Used when a patient is in v-fib (when the heart does not empty and contractions are mild quivers that cannot sustain life) or v-tach (when the heart is pumping too fast).
  • Atropine: Treats bradycardia (low heart rate) by blocking the vagus nerve.
  • Epinephrine: Increases cardiac output by momentarily decreasing blood flow to the limbs, which increases the blood output from the heart.
  • Lidocaine: Used to treat a ventricular arrhythmia (irregular heart rate) often preventing the heart from providing oxygenated blood to the body. New ACLS guidelines also recommend procainamide here.
  • Magnesium Sulfate: An anti-arrhythmia drug used for torsades de pointes, a peculiar and rare ventricular arrhythmia. It is otherwise seldom used unless a person is low in magnesium, or in other non-cardiac clinical conditions.
  • Procainamide: An anti-arrhythmia drug used to counteract a variety of arrhythmias.
  • Vasopressin: Administered to increase cardiac output and improve circulation to vital organs.

Health Education Solutions offers an ACLS Pharmacology Guide, available free to all ACLS students for use when preparing for the ACLS exam.

  1. It all comes back to CPR. In 2010, guidelines for CPR transitioned the A-B-C (Airway-Breathing-Circulation) approach to a new C-A-B (Circulation-Airway-Breathing) approach. The emphasis is on quickly initiating chest compressions in individuals with life-threatening loss of heart function so that blood flow is maintained. It primarily applies to single rescuer CPR. In the hospital setting and with teams, management of circulation and respirations are achieved simultaneously.

I got this stuff off line but it seems up to date...don't stress about ACLS...You will need to prepare but it is not nearly as stressful as it use to be. Just read and learn your algorithyms...you will do fine. Sorry you had such a bad time with the medic. Some of my best instructors were medics...

Specializes in Certified Med/Surg tele, and other stuff.

Do you have the study guide from the Heart Association? It comes with a CD and you can take the test, over and over. The book goes along with the test and is an excellent way to learn.

If the rhythms are difficult try the fun game at skillstat.com You can play against yourself.

For what it is worth, we were able to use our flip book during the megacode. How many codes do you see where guidelines aren't pulled out in case they are needed?

You still have to know the rhythm to pick the correct algorithm.

Don't let this paramedic get to you. Everyone learns differently, so do what is right for you.

Good luck!

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

First of all RELAX!!!! The goal of ACLS is to help you pass. Try not to get too bogged down and over whelmed with the algorithms. .Here is a web site that has some cute mneumonics to help you remember.


My personal experience/what worked for me. I have been a tele nurse for 8 years. Working tele full time, doing the required every 4 hour manadatory tele strips/interpretation, and discussing with my fellow colleges over the years brings you to a level of arrythmia interpretation.( the preverbal learning from each other) As for the ACLS: with looking at a rhythm and recognizing it, you have to learn the ACLS 'INTERVENTIONS" I memorized the interventions, then I closed the book and recited them to myself out loud- I also memorized the rational for why the interventions are the way they are. ACLS is a/the Secondary assessment, a higher functioning assessment. ACLS takes for granted you have the BLS. All ACLS algorithms staet with IV, Oxygen- close your eyes and pretent you are coming into a code room, what do you see- personel doing CPR, pt on monitor, is their an IV, what are the VSS, is their a pulse, what is thye rhythm- this is where you have to be able to recite those algrithms- PEA, vtach- is it wide or narrow complexes, symptomatic brady very easy algorithm- hopefully this was caught BEFORE and don't see. Asystole- what do you do? If you can imagine every one of these senarios and know what the algorithm is at home- you should be able to be the "leader role" in an ACLS megacode test. And also know that every one going for this certif has to play leader to get certified and during this part of the practicum the instructors switch the rhythms- for example in your leader test-you can start off with a PEA, they flick the switch, to a wide complex vtach then to a asystole or a NSR because that's the way a real life code goes.

Specializes in M/S Short Stay/TCU.

this info helps alot....:)

Specializes in Telemetry.

1) Don't panic.

2) Think of ACLS like you do Basic CPR certification. Yes you need to study for it and try to be prepared, but you go to the class so someone can teach it to you! You probably don't panic about BLS, right? I'll tell you this, I can't remember all the algorithms either and I just took ACLS a month ago. This is going to be one of those things were you go to the class to learn it and then you have to keep going every 2 years so that you can keep it fresh in your mind. Eventually, because you have to keep going over it, you'll pick it up.

3) Don't let the mass of information scare you. Remember what you can and if someone is a jerk because you forgot a step, forget them. You'll get it eventually.

4) Learn your cardiac rhythms by searching 'Six Second ECG (or EKG) Simulator'. That is an excellent little web site that is very helpful.

5) Really don't panic and if you happen to pass ACLS but still feel like you don't know it keep studying and identify a nurse that's had more experience with codes than you every time you go on shift. That way when the poo hits the fan you can grab her/him to help you.

I've taken ACLS, PALS, and NRP (or whatever they call it now I think it's name has changed) for over 24 years, every two years. I have never had any experience close to what you had.

That "teacher" was an idiot and should have been reported to someone higher up!!!!. Don't let him scare you away from ACLS.

It is easy, it should be easy. It is a LEARNING class, NOT a "You'd better know this stuff cold I'm going to fail you," class.

Last few times I took ACLS the ONLY rhythms you needed to know were: 1) V tach, V fib. 2) Is it too fast. 3) Is it too slow. 4) Asystole. 5) Normal sinus rhythm.

The learning module or book might go over blocks, and other arrhythmias but they are not, should not, be part of the pass/fail mega code!!!!!

The LAST thing you'd want in a real cardiac arrest situation is responders studying the monitor and discussing "Oh that is a 1st degree block, see the P R interval." "No I think it is a 2 nd degree Wenkebach, look at that pause." etc. The purpose of ACLS is GOOD basic life support CPR and shock or drugs as indicated.

Specializes in med surg, ccu, icu, nursg home, md offic.

The last time I took ACLS it was pure torture. I had tendonitis of my wrist from shoveling 2 feet of snow. The guy doing the intubation part would not pass me unless I could sucessfully intubate. I have had my ACLS since 1999 have have NEVER had to intubate. The guy was a jerk. You are right. Most of them hate nurses. Even though we save their ass all the time. Good Luck!!!!!!!

Where are you guys taking classes??? Last few times they don't even have us intubate unless we want to for fun, or are paramedics or MD's!!!!!

Specializes in ER, Prehospital, Flight.
The last time I took ACLS it was pure torture. I had tendonitis of my wrist from shoveling 2 feet of snow. The guy doing the intubation part would not pass me unless I could sucessfully intubate. I have had my ACLS since 1999 have have NEVER had to intubate. The guy was a jerk. You are right. Most of them hate nurses. Even though we save their ass all the time. Good Luck!!!!!!!

1. To the OP, I am sorry the medic was harsh with you, however, you are going to need to know the rhythms to pass ACLS. Keep studying and you will do fine. You made it through nursing school and you can do ACLS.

2. Intubation is part of the class that must also be passed. Other professions use this class where it is required. I get 6-10 intubations a year in the field. I am a nurse.

3. Paramedics and EMTs do not hate nurses. Most have a healthy respect as we should for them. There are great medics and medics who are jerks, exactly like nurses. Sorry you met a jerk, most I know are great.

4. I really want to know how "we" save medics asses all the time. Please, do tell.

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