wonder what the opinion is on the "new" ACLS guidelines

[MassED, BSN, RN]

I just took my recert today for ACLS and found it to be incredibly dumbed-down. I am shocked the primary focus is on compressions, mainly. It is a lot easier than it was two years ago, but is this better for us, as nurses?

[XB9S, BSN, MSN, EdD, RN, APN]

There was some fairly good rationale for the emphasis on compressions, without a decent circulation there will be little left of the myocardium to allow a successful shock if CPR not initiated immediately.

I understand that changes to compressions were based on animal studies and on how engorged the left ventricle gets without compressions. In BLS the effort and time spent on airway management detracts from the compressions so basically yes try with your rescue breaths but don't spend too much time on them.

The advanced stuff again emphasis on the compressions because of the need to maintain coronary perfussion.

I have taught the new guidelines a few times and although it is getting easier I do find myself slipping occasionally. It is easier for nurses who are the first responders to manage especially if like we have in the hospital I work in there is easy access to semi-automatic defibrillators, if they are shockable it is done before they crash team arrive.

[MassED, BSN, RN]

There was some fairly good rationale for the emphasis on compressions, without a decent circulation there will be little left of the myocardium to allow a successful shock if CPR not initiated immediately.

I understand that changes to compressions were based on animal studies and on how engorged the left ventricle gets without compressions. In BLS the effort and time spent on airway management detracts from the compressions so basically yes try with your rescue breaths but don't spend too much time on them.

The advanced stuff again emphasis on the compressions because of the need to maintain coronary perfussion.

I have taught the new guidelines a few times and although it is getting easier I do find myself slipping occasionally. It is easier for nurses who are the first responders to manage especially if like we have in the hospital I work in there is easy access to semi-automatic defibrillators, if they are shockable it is done before they crash team arrive.

I do agree there needs to be the focus on "fast and hard" compressions for continued perfusion, but feel that ACLS is focusing on BLS rather than on "advanced cardiac life support." Also there was a large emphasis on team leaders and "closed end communication" for specifying members' jobs within the code.

I just didn't feel challenged and felt let down a little.....

[penguin2]

I have been taking ACLS since 1987 when it first became a requirement in my hospital. Most of us have seen the changes & 'dumbing down' of ACLS (as well as other courses) from the previous years. However, I think in the process of taking the pressure off & having to learn less details, (under the guise of making it 'easier to learn') something has been lost in the knowledge & skills gained. Those of us who use it daily are at an advantage over someone who just has to have it b/c it's a hospital-wide requirement for all RNs.

[RockyCreek]

Since the purchase of the new AED's, ACLS on the floor is not even mentioned. It seems that the machines are considered infallable but the nurses are! I asked to have the moniters back on the crash carts and I was told that the we 'wouldn't know what we are looking at' so the moniter comes with the Rapid Response or Code Blue Teams.

Personally, after 22 years of nursing, this seemed to me lilke a major insult.

[suanna]

Wait 4 years and it will change again. "Based on current research" I'm sure. Remember when fast shock was the most important thing, before that it was high dose epi, before that-antiarrhythmics. Now CPR-fast and hard compressions. Bottom line survival to discharge is still the exception rather than the rule. When the body is sick enough to die- it usually does. A few percentage points one way or the other isn't going to change that.

[MassED, BSN, RN]

Since the purchase of the new AED's, ACLS on the floor is not even mentioned. It seems that the machines are considered infallable but the nurses are! I asked to have the moniters back on the crash carts and I was told that the we 'wouldn't know what we are looking at' so the moniter comes with the Rapid Response or Code Blue Teams.

Personally, after 22 years of nursing, this seemed to me lilke a major insult.

wow, wouldn't know what you were looking at? That's pretty ballsy of management, or nursing administration to take that kind of position, and how untrue I might add. Unless it's M/S where you might not have a need to read any type of rhythm, but the majority of nurses on any unit (ER, ICU, TELE) need to be able to respond to and recognize a lethal rhythm. Well if they want to wait until RR or a code team arrive for the use of an AED, then so be it. They're not thinking of the patient outcome with that kind of position, seeing as how if it's a shockable rhythm someone on the floor could've placed the pads and started the process.... that's just a shame.

[MassED, BSN, RN]

Wait 4 years and it will change again. "Based on current research" I'm sure. Remember when fast shock was the most important thing, before that it was high dose epi, before that-antiarrhythmics. Now CPR-fast and hard compressions. Bottom line survival to discharge is still the exception rather than the rule. When the body is sick enough to die- it usually does. A few percentage points one way or the other isn't going to change that.

amen on that one. Personally, I've never witnessed a successful code.

[penguin2]

Since the purchase of the new AED's, ACLS on the floor is not even mentioned. It seems that the machines are considered infallable but the nurses are! I asked to have the moniters back on the crash carts and I was told that the we 'wouldn't know what we are looking at' so the moniter comes with the Rapid Response or Code Blue Teams.

Personally, after 22 years of nursing, this seemed to me lilke a major insult.

These decisions are made by managers who can't read monitors. What a slap in the face- it's like saying "you have to be certified in ACLS -- even tho you can't recognize rhythms" !!!

[CABG patch kid, BSN, RN]

I just got ACLS certified recently, and it did feel quite a bit easier than I was expecting... from all the stories I've heard about the mega code and such, I think we are spoon fed this stuff now. Luckily I work in tele, I am confident in my rhythm recognition, and I won't be running a code anytime soon, but if I was in the ER or ICU I'd feel a bit underprepared.

BTW I can't believe the nurse manager who refused having a regular monitor on the floor. What a joke.....

[JBudd, MSN]

amen on that one. Personally, I've never witnessed a successful code.

Oh, I have. Sometimes a blessing, sometimes not. Even if all you have bought is a few more days, those days can be extremely precious to the family. If it is really time to go, they go; buying time to say goodbye is as important as the ones that recover and go home again.

When the time came that I had to sign the DNR papers for my husband, it was really hard. But, I knew CPR & a code wouldn't do anything, even for a few days.

To the OP: yes, ACLS is really dumbed down. Taking out so much of the stress is good, but I think they went too far in not having to really know the drugs, and the administration of them. As far as reading strips, well, VT & VF are pretty darned obvious!

[mwboswell]

I'd like to see two versions of ACLS classes - one which is "just the basics", designed to get the monitor applied, turned on and maybe a first round intervention for each leathal scenario; then a second level ACLS class for more experienced folks (ER, ICU, CCU, CVICU, EMS etc) which includes the basic level plus all the "traditional" ACLS content. The basic class would just be those first steps to "get things going" while the code team is enroute to the unit, build a "comfort" level amongst non-experienced folks so they feel more of the "team" themselves.....