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just now i realized what the ACLS Megacode is.
if you’ve seen Grey’s Anatomy or House, it’s the part where a patient goes cardiac arrest all of a sudden, on cue slight panic music, the cardiac monitor makes this eerie beep sounds along with all other equipment in the room, the code team rushes in seemingly good at what they do, then one does the CPR and provides the meds, then they defibrillate the patient, give the meds again and keep doing it until patient is restored.
soon, i’m going to try being in that situation. maybe become part of the code if I’m good. :)
ACLS/BLS Part II
Ventricular fibrillation/Ventricular tachycardia (VF/VT) - Ugly hills/Tombstone rhythm. These are treated with high-energy unsynchronized shocks - 120 to 360joules. Shocks are often done in conjunction with Epinephrine/Vasopressin —> Antiarrhythmics
- CPR until AED arrives——> Defibrillation ——> CPR ——> Vasopressor/Shock/CPR ——> Antiarrhythmic/Shock/CPR
Pulseless Electrical Activity (PEA) - Any organized rhythm without a pulse (besides VF/VT/asystole) is defined as PEA. This is the most common rhythm present following defibrillation. Sometimes people look like they have a normal rhythm but have no pulse associated with it. It is still PEA. This is treated first with Epinephrine/Vasopressin. If the rate is slow you can use Atropine.
- CPR ——> Defibrillation if deemed able ——> CPR/Vasopressor ——> CPR/Atropine
Asystole - Flat line. Not good. CPR and figuring out the cause is going to be important and in fact IV/IO access is more important than advanced respiratory with this. Start CPR as always. Medications that are used - Epinephrine, Vasopressin, Atropine. Routine shock administration is not indicated and studies have demonstrated groups that received shocks had a trend toward worse outcome.
- CPR ——> Defibrillation if able (if it’s a fine vfib) ——> CPR/Vasopressor ——> CPR/Atropine
Part III will address Acute Coronary Syndrome, Bradycardia, Tachycardia (Unstable/Stable). If you have any specific questions, feel free to let me know - I am more than willing to go into something with more specifics!
Done with ACLS! Finally! Thank heavens I passed [A-] i think. Damn that ECG tracing interpretation! But the real test here is if I can rightly apply it to my bedside care once (God forbid) I have a patient who is on an actual code. As much as I want to be able to do it, I don’t want any of my patient to need CPR, compressions, vasopressins, antiarrhythmics etc. anytime soon. But if the inevitable does happen, (given that I work on one of the world’s best hospitals), I hope I can perform the ACLS algorithm as taught. And hopefully, revive the patient long enough to be transferred to intensive care or much better if the patient can even come out of it, even if the actual success rate of code is only 10%.
I am on my 3rd year of being a nurse (the 1st year was unpaid service), but I haven’t had (thankfully!) a patient who died or went critical on my care. Hopefully, I won’t have to. I assisted on some codes but I didn’t fully grasped it before. Life! So precious, so fragile, yet it can survive compressions and electric currents and jumpstart again. Also, after the ACLS I now have a new found respect and higher admiration for cardiologists. Man! Don’t they have brains that can tweak the amazing heart- not beating, galloping, skipping, hyperactive, slow and tired beating hearts!