Over the weekend, I completed my certification in CPR and advanced cardiac life support (ACLS) through the emergency medicine interest group at Baylor Med.
In conventional CPR, you follow the C-A-B protocol: chest compressions, maintaining airway integrity, and breathing. It can be done virtually anywhere by a trained individual without any sophisticated equipment. ACLS, on the other hand, is more like “CPR for the hospital environment.” You utilize defibrillators, oxygen, monitors, IV drugs, and work as a team to successfully resuscitate patients.
As part of the ACLS training, we learned how to recognize heart rhythms (like Vfib and PEA) by checking pulses and analyzing the monitor readout. Based on the readout, consciousness of the patient, and presence of a pulse, we learned which drugs and dosages to administer, when to administer them, how often to administer them, and whether or not electrical cardioversion is necessary. *Whew*, in retrospect, it was a lot of new info! Two minute intervals (5 cycles) of CPR beginning with compressions serves as the framework for the entire process. In fact, without high quality CPR, electrical cardioversion and IV drugs are pretty useless.
We also took turns being the “leader” who is responsible for assigning roles, maintaining a clear line of communication with members, and preparing for the next step. It’s easy to learn drug dosages and match readouts to heart rhythms on paper, but when you’re actually simulating a code, being the leader can be pretty strenuous. On the bright side, the other members of the code team are also trained in ACLS and can contribute their suggestions during the resuscitation process.
So this brings up an interesting scenario. If I notice one of the code members or code leader doing something which doesn’t reflect the current ACLS protocol, how can I intervene as a medical student (aka, the peon of a code team)? One of the upperclassmen offered a great piece of advice. It’s important to understand your role as the medical student, but also important that you do whatever you can to aid the patient. How can you do this without offending an attending? Offer to do chest compressions! High quality CPR is the most important part of both basic and advanced cardiac life support. According to protocol, the person administering the compressions is supposed to switch off after they complete five cycles. You should be the person waiting! And when you do compressions, you do them to the best of your ability. 🙂
By the way, if you’re wondering why I have the Bee Gees’ “Stayin’ Alive” video in this post, you’ve obviously not taken a CPR course. 😉 The chorus is roughly at the rate you administer compressions (~100/min).