If you’re a student nearing graduation, or a new grad then you’re likely looking at taking ACLS. First of all…reeeelaaaaax. I guarantee you will not be the only student or new grad in the room, and I guarantee you will not be the most clueless person there. So let that sink in as you take a few deep breaths in and out.

Every ACLS class I’ve been in has been about 1/3 to 1/2 students and new grads. So you will be in excellent company! The rest of the group is a mix of experienced medics and nurses from all clinical areas…ED, ICU, dialysis, PACU…mainly the places where ACLS is required. In the last class I took, one of the nurses worked at a Medi-Spa and just wanted to keep her skills sharp. We even had one physician in the group…and, not to toot my own horn or anything, but when a question came up about the compression to ventilation ratio …he was wrong and I was right (just goes to show that just because you perceive someone as being “smarter” than you, doesn’t mean they always have all the answers!). If you’re lucky, there will be a good number of paramedics in the group…these guys run codes all the time. Like All The Time…so they usually know ACLS from front to back (SLCA?).

If you’re new to the whole ACLS thing, take the class with a buddy or two, and get together a few days before the class to run mock codes. As you go through the ACLS code algorithms, you’ll notice that the heart can really only do one of four things…go too slow, go too fast, not go at all, or spaz out. If you can keep that kind of simplicity in your head and refuse to freak out…you’ll be fine! The thing about codes is that it’s rarely the heart doing just one thing the whole time. It will switch around, for example, from v-fib to astystole, from asystole to bradycardia, from bradycardia to something else…it likes to keep you on your toes, that’s for sure! When the rhythm switches around like this we call it a Mega-Code, and that’s what you’ll be signed off on in your ACLS check off. Here’s how the Mega-Code works:

You will be placed in a group of usually 5-6 people, and the instructor will have a Mega-Code scenario for each of you (oh joy!). What this means is that each of you will take the roll of Team Leader and run the code…you basically get to tell everyone in the group what to do…how fun is that? If  you’ve never taken the class before, try not to be the first one running a code as the Team Leader…watch a few and then step up to the plate. You’ll learn a lot just from those few scenarios, and also see that it’s not as scary as you thought after all.

For starters, the patient isn’t going to die if you take a little extra time to ponder the situation (in real life, this may not be the case…but we’re in a Safe Place here!). Next, your team mates will help you, and some instructors even allow  you to use the notes you took in class if you need a little memory boost.

Depending on the simulation capabilities of your facility, you may have the opportunity to actually practice hands-on skills such as placing your patient on the monitor, putting on the oxygen, applying the patches and listening to lung sounds. In other cases, your data will come through the instructor who is running the scenario. Whatever the situation may be, always start your code off with getting some data…get the patient on the monitor right away, then get a blood pressure and an O2 sat. If the scenario involves a homeless person in the winter, get a temp. Order a tox screen so that later on you can go through your differential diagnosis.

The code will usually start with your patient presenting with some kind of complaint or abnormal heart rhythm. Grab a set of vitals, get ’em on the monitor and figure out what the heart is doing (too fast, too slow, not at all, or wackadoo). As you perform interventions based on each algorithm, you’ll notice the heart will change rhythms so that you eventually go through most (if not all) of the algorithms. And that’s it! You (and your patient) survived!

So, if you’ve been nervous about ACLS, I hope you feel a lot better and go in there and have fun 🙂


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