Sunday, July 20, 2008

Every Dead Person Deserves Epi

So I finished my ACLS practical and the written exam and passed, so you best hope that I'm not running the code if you go down(don't worry I won't be). To my discredit, I really didn't treat it very seriously coming into Day 1... after all, I'm never going to be running a code and won't even be a member of a code team... I was sent to get ACLS certified a) because Spaulding was paying for it and b) if anyone does have an event in our lab, I will know how to do CPR and use the AED while we wait for the code team to come. All I really need is BLS, but it certainly doesn't hurt to be able to recognize rhythms and to know what is going on when the code is being run. Despite this, I was so lost and afraid that I was going to embarrass myself by failing, that I actually studied pretty hard last night, and thus the review on Day 2 was pretty smooth. It helps that it's really a fascinating field. One thing that was particularly interesting was that they did a good job of going over the evidence of efficacy for all the different procedures, and how strong or weak the evidence was for or against was for each. For example, Amiodarone is recommended as a second line agent after epinephrine in ventricular fibrillation, but it hasn't been shown to be more effective in that regard than Lidocaine and it is more involved to use... so it depends on your personal preference at this point, though that may change. So there's at least some indications of evidence based medicine being applied here.

In addition to getting myself interested in the field, I also managed to get myself on a Super Team with the head of PM&R (my boss's boss) and two other physicians, so I think that might have made it a little easier, as they threw the genuine complicated code at Dr. Zafonte and everyone else was ready to chime in with advice. I was given symptomatic sinus bradycardia as my code to run, and dove right for the atropine (0.5 if alive). The only mistake I (almost) made was giving nitro counter chest pain despite low blood pressure, luckily I asked for a little help from the peanut gallery on that one since I knew there were contraindicators but couldn't remember them.

Thankfully, neither the practical nor the written test required identification of A/V blocks, which are a bitch. However they did require us to go home and watch the YouTube video "Diagnosis Wenckebach" (think Justin Timberlake's Sexyback).

WARNING:
This will probably only qualify as AWESOME if you are a "health care provider"... otherwise it may seem a little stupid, but hey.