ACLS is actually doable, but not like on TV
I’m in the midst of a two day Advanced Cardiac Life Support course. I only got the provider manual yesterday, so I did my best to cram before today. So much detail, but a lot is fluff too.
All the algorithms for ACLS protocols would be hard to memorize, if it wasn’t just logical. The instructors have been great, expecting us to learn patterns rather than by rote. ACLS, broken down, is about stable, unstable, and dead patients with hearts going too fast or too slow (or not at all). Chemicals and electricity can be used to try and fix these aberrations. Framing it like this was much less daunting than seeing box after box on a flowchart of decisions.
I fear I’m going to draw a blank on drug doses at the critical moment, but that’s why they invented pocket ACLS guides and PDA programs. Phew! Other than that, the process of resuscitation, although low-yield, can be highly satisfying and exhilarating. And that’s why it’s on TV.
Whenever I have done CPR courses or trauma sessions or mock codes, I am always impressed that CPR/ACLS instructors and ALS paramedics can quote the statistics of resuscitation on TV. They cited the fact that 60% of asystolic patients (on television) are ‘defibrillated.‘ But we all know defibrillation is not to start the heart, but rather to stop it when it is in a fast, wonky rhythm. At least, we all know that now!
Other TV medical myths about resuss?
- 75% of TV patients in cardiac arrest survive resuscitation, a much greater figure than even the most optimistic of real world figures, according to a popular paper on the subject, “Cardiopulmonary Resuscitation on Television — Miracles and Misinformation“
- Cardiothoracic surgeons manage arrhythmias intra-op – find more ‘things I learned on Grey’s Anatomy that I didn’t learn in medical school‘ from Med Blogger,Schrödinger’s Cat
Every time I watch House, I yell at the TV and get laughed at for offering my diagnosis, or getting mad that the residents are doing the lab tests themselves or that a neurologist is doing surgery.
But there are real life myths too. Now, lets just stop giving the epi already, shall we? (i.e. no evidence of survival benefit with giving it)
- “We were unable to establish a significant survival benefit with the introduction of intravenous epinephrine to an EMS system. More research is needed to determine the effectiveness of drugs such as epinephrine in resuscitation.” (Survival Outcomes With the Introduction of Intravenous Epinephrine in the Management of Out-of-Hospital Cardiac Arrest)
- “We found no association between standard ACLS medications and improved resuscitation from in-hospital cardiac arrest” (Do advanced cardiac life support drugs increase resuscitation rates from in-hospital cardiac arrest)
- “Animal data indicate that, in comparison with epinephrine (adrenaline), vasopressin produces better vital organ blood flow during cardiopulmonary resuscitation (CPR). These apparent advantages have yet to be converted into improved survival in large-scale trials of cardiac arrest in humans.” (Advanced life support drugs – Do they really work?)