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

LilgirlRN, ADN, RN · Jul 12, 2008

You know every few years something changes about ACLS. I've been taking it since 1987 too. Most of the changes have been to medications, the order in which we gave them etc. I too can see the importance in the compressions but to compress without as much oxygen as we're used to seems rather dumb. We've all been taught that once you reach adulthood there can never really be such a thing as too much O2. When watching TV shows an they're having a code and someone is in the background counting... 1 1000, 2 1000, 3 1000... I'll comment and say that I've never been to a code where there was a rhythym counted out. If you were arming the ambu bag you squeezed as hard and as often as you could. We wanted there to be a brain for this person to come back to. In the end it seems no matter what we do, how we redo ACLS, the only people who are helped by this process at all are the ones who have an arrythmia and we shock them out of it, send them off to the cathlab where their arteries can be rewired. We feel obligated to do something, even when we know something won't likely help the person who is about to die. All of you with years of experience think back to how many people you have saved with ACLS protocol, people who went back to their normal life without any detriments. How many patients can you call a "save" If you're like me, not many. The patients I tend to remember that coded are the ones who died and it was such a shame that they died. The one that stand out the most is a 26 year old who'd had a baby a few days before. How do you tella young husband that his newborn son has no mother? Luckily, I am "just a nurse" and so don't have to tell people terrible news like that (most of the time). Perhaps th new protocols will help, more likely they won't. more likely what will help is the number of AED's in places where they didn't use to be and the fact that anyone can use them now.

allnurses Guide · Jul 12, 2008

The guidelines are reviewed and revised every 5 years to allow for progress in medicine and intergration of any new research that has been done.

At the end of the day I am not sure they have been dumbed down, I have said in previous posts that there is very little within resuscitation that we know and have good evidence to prove that it works. What we do know is that compressions work and defibrillation works the rest is just best guesses.

The best resuscitations are those that you don't have to think about and one way to achieve this is by simplyfying the guidelines.

Personally I don't think that this is a bad thing, the simpler the better.

hypocaffeinemia, BSN, RN · Jul 12, 2008

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

Six years in the ER and you've never witnessed a successful code?

I'd say about 50% of our codes in the unit/throughout the house survive the first code. I don't doubt their outcomes are poor, but we at least buy them a bit more time.

GilaRRT · Jul 12, 2008

A few thoughts if I may?

First, ACLS is not a certification. AHA does not certify you to do anything. Other than to say this card certifies that you have completed our class. I think people really need to undergo a paradigm change. ACLS is not a real certification, and ACLS does not teach you advanced knowledge such as advanced airway management and the finer points of reading 12 leads. Your provider card simply says, you went through our class.

ACLS is more about understanding the basics of the AHA guidelines in emergency cardiac care. BLS is emphasized, becoause it seems that BLS is the only concept the really seems to be of much help in the setting of cardiac arrest.

In addition, two forms of ACLS do exist. For people who want a little more meat, you can take ACLS Experienced Provider. Special situations, electrolyte imbalances, etc are covered in more depth.

Finally, people and hospitals need to wake up. An 8-16 hour class cannot teach people how to run a code. Hospitals are failing their staff and their patients if they think sending nurse Betty to ACLS every two years is adequate education for a code situation. Additional in house courses must be developed to address these areas. Telemetry courses, advanced cardiac courses, and actual code blue parctice scenarios need to occur. Code blue scenarios should be a regular occurence much like a fire drill.

It is about time we recognize ACLS for what it really is. Simply a review of the current recommendations. Even in the "old hard days" of ACLS, I do not think nurses really learned anything. You cannot teach advanced concepts in a one to two day class. Back then, intimidation was widespread and nurses would wear the ACLS title like a congressional medal of honor. I am not sure the providers were any more well versed in ACLS because the course was not considered "dumbed down;" however, there were many people who thought they knew everything about ACLS partly do to the elite culture. I am happy we are taking a more pragmatic approach to ACLS; however, we need to push hospitals to provide better education.

penguin2 · Jul 13, 2008

The first time I took ACLS (21 yrs ago) it was 4 days of classes spread over 2 wks b/f the actual testing/mega code which took place on day 5 on a Saturday. You had to pass, not just complete it & no one got a chance to re-test. One nurse in our ED was suspended until she could retake the class (she was given the option to work Med-Surg since ACLS was not required there yet). We learned it well, and working in the ED we got to practice what we'd learned firsthand- not just go thru the motions. I felt I gained a greater understanding of the way codes were run, as well as the rationale behind the drugs we were given, the drips, etc. We were also required to take EKG & other classes prior to ACLS. Of course I'm talking "the good old days" here! :) ACLS is easier now, that's a fact, but where I work it's the same course the MDs take & we're all in there together, so it's very much a learning experience.

MassED, BSN, RN · Jul 13, 2008

Six years in the ER and you've never witnessed a successful code?
I'd say about 50% of our codes in the unit/throughout the house survive the first code. I don't doubt their outcomes are poor, but we at least buy them a bit more time.

nope.

MassED, BSN, RN · Jul 13, 2008

The first time I took ACLS (21 yrs ago) it was 4 days of classes spread over 2 wks b/f the actual testing/mega code which took place on day 5 on a Saturday. You had to pass, not just complete it & no one got a chance to re-test. One nurse in our ED was suspended until she could retake the class (she was given the option to work Med-Surg since ACLS was not required there yet). We learned it well, and working in the ED we got to practice what we'd learned firsthand- not just go thru the motions. I felt I gained a greater understanding of the way codes were run, as well as the rationale behind the drugs we were given, the drips, etc. We were also required to take EKG & other classes prior to ACLS. Of course I'm talking "the good old days" here! :) ACLS is easier now, that's a fact, but where I work it's the same course the MDs take & we're all in there together, so it's very much a learning experience.

that's another thing - It would be nice for everyone to be on the same sheet of music. We assume the docs are up to date being that they are board certified in emergency medicine... but... I'd like some consistency.

MassED, BSN, RN · Jul 13, 2008

Six years in the ER and you've never witnessed a successful code?
I'd say about 50% of our codes in the unit/throughout the house survive the first code. I don't doubt their outcomes are poor, but we at least buy them a bit more time.

I wasn't referring to codes in other units, as I'm in the ER - I'm sure there are statistics out there for those that are inpatient codes versus those that come into the ER coding, those inpatients would likely have a better shot at survival. I'm puzzled - how many of you have had successful codes in the ER? How many? Once an individual is in the position of being coded, it's not a good situation, so I'm surprised anyone is surprised that I haven't witnessed a successful code. I'm baffled that anyone has witnessed any - even one would be amazing. To experience more than one, well, maybe I need to question where I'm working and the docs running the codes!

MassED, BSN, RN · Jul 13, 2008

you know every few years something changes about acls. i've been taking it since 1987 too. most of the changes have been to medications, the order in which we gave them etc. i too can see the importance in the compressions but to compress without as much oxygen as we're used to seems rather dumb. we've all been taught that once you reach adulthood there can never really be such a thing as too much o2. when watching tv shows an they're having a code and someone is in the background counting... 1 1000, 2 1000, 3 1000... i'll comment and say that i've never been to a code where there was a rhythym counted out. if you were arming the ambu bag you squeezed as hard and as often as you could. we wanted there to be a brain for this person to come back to. in the end it seems no matter what we do, how we redo acls, the only people who are helped by this process at all are the ones who have an arrythmia and we shock them out of it, send them off to the cathlab where their arteries can be rewired. we feel obligated to do something, even when we know something won't likely help the person who is about to die. all of you with years of experience think back to how many people you have saved with acls protocol, people who went back to their normal life without any detriments. how many patients can you call a "save" if you're like me, not many. the patients i tend to remember that coded are the ones who died and it was such a shame that they died. the one that stand out the most is a 26 year old who'd had a baby a few days before. how do you tella young husband that his newborn son has no mother? luckily, i am "just a nurse" and so don't have to tell people terrible news like that (most of the time). perhaps th new protocols will help, more likely they won't. more likely what will help is the number of aed's in places where they didn't use to be and the fact that anyone can use them now.

that is what i just posted about... how many successful codes have people actually witnessed, 1, 3, 5? in what time frame, working over a 10 year time frame, 20 years? this kindof points off topic, but hey, i'm interested to hear the answers!

hypocaffeinemia, BSN, RN · Jul 13, 2008

I wasn't referring to codes in other units, as I'm in the ER - I'm sure there are statistics out there for those that are inpatient codes versus those that come into the ER coding, those inpatients would likely have a better shot at survival. I'm puzzled - how many of you have had successful codes in the ER? Once you're in the position of being coded, it's not a good situation, so I'm surprised anyone is surprised that I haven't witnessed a successful code. I'm baffled that anyone has witnessed any - even one would be amazing.

It's been a few years since I've worked ER (background: I'm an EMT currently working as a monitor tech as I finish up my ADN), but we had plenty of successful codes in the small community hospital I worked at.

Granted, most if not all of the code-on-arrival patients didn't make it, but we had plenty of unstable patients who coded after arrival and were successfully revived.

And when I say plenty, I-- the ER tech-- personally ran over and thumped at least a half-dozen witnessed arrests in my 3 years in the ER.

This was just a plain jane community ER without any trauma service.

hypocaffeinemia, BSN, RN · Jul 13, 2008

that is what I just posted about... how many successful codes have people actually witnessed, 1, 3, 5? In what time frame, working over a 10 year time frame, 20 years? This kindof points off topic, but hey, I'm interested to hear the answers!

Define success.

From an ER standpoint a successful code is revival and stabilizing enough to transfer to ICU. I've seen hundreds of these.

If we are defining success as the patient returning to the same quality of life as prior to the arrest, of course the success rate will be

MassED, BSN, RN · Jul 13, 2008

It's been a few years since I've worked ER (background: I'm an EMT currently working as a monitor tech as I finish up my ADN), but we had plenty of successful codes in the small community hospital I worked at.
Granted, most if not all of the code-on-arrival patients didn't make it, but we had plenty of unstable patients who coded after arrival and were successfully revived.
And when I say plenty, I-- the ER tech-- personally ran over and thumped at least a half-dozen witnessed arrests in my 3 years in the ER.
This was just a plain jane community ER without any trauma service.

well I guess you were in the right place at the right time. I still think that is quite unusual. To witness arrests and have that occur in the ER is quite fortunate for patients! To have that defibrillator would make their chances that much greater for survival. I'll probably get hit with something like this tomorrow at work.... :uhoh21: