Thursday, September 08, 2005

Bring Out Your Dead

Do I look smarter? Do I? Because, boy, I feel ready to bring back the dead.

Yes! It was time for the biennial shake-out-the-cobwebs, dust-off-the-paddles, get-down-and-get-me-an-amp-of epi-STAT! ACLS recertification show.

So, here's the scoop: As many know, I work in a usually low stress same day care type of clinic, sharing space with the occupational medicine clinic and the World's Best Physical Therapy team. We are located in a very unglamorous strip mall, where the Quizno's is within easy trotting distance. Our head nurse (our only nurse, if you must know) is adept at turfing those who call and want to be seen for, oh, crushing chest pain accompanied by shortness of breath, or Large Amounts of Blood Ushering From Orifices, or similar scary, stressful life-threatening thingies to the ER. The place where the competent professionals await to save them. People other than us. They are the people who have all sorts of drugs, syringes and tubes, not to mention all the machines that go "bing".

Sadly, sometimes the terribly sick get through our nurse's snares and either just show up or call wanting to be seen for a sore throat, neglecting to mention the above crushing chest pain and all the not breathing so well stuff. This is not an uncommon occurrence, either. And, oddly, many of them become quite irate that now we are sending them via ambulance to the place that they should have gone to in the first place. We shake our heads a lot.

Thusly, it really is a good idea that I know what the hell to do before the lovely, nice people with the ambulance come. This knowledge is encompassed in the certification for Advanced Cardiac Life Support (ACLS).

Certification lasts for 2 years, during which, if you pass re-certification, you don't have to take the class over again, you just get re-tested. The last time I actually was involved in a full-fledged patient-down-no-pulse-actively-trying-to-die code was in 1994, and I was a flinty-eyed senior resident, endotrachial tube in one hand, MacIntosh blade in the other, barking out orders like I knew what the hell I was doing. Now days, out of code shape as I am, I always opt to go through the whole class, as I clearly don't know what the hell I'm doing any more. Aw, hell, who am I kidding, the critical care nurses basically ran the codes then, anyway, although I did do the tubing and the ordering. "How about some lidocaine, there, Diana?" "Yes! Great idea! An amp of lidocaine! STAT!"

This year's class was a bit different for me. Always in the past, I have taken it with a bunch of other docs. When you do this, unless it is your first time through with all of the other interns during orientation, they usually compress the 2 day didactic stuff into one morning, letting you do the testing in the afternoon, and getting you out of there at light speed. If you are really lucky, they will even let you eat your lunch in the room while you take the written portion of the test. This time, I was with 20 nurses and one of the cardiologists, who had apparently let his certification lapse. As he runs these things in his sleep, he was basically sleeping in the back. It was also really interesting to note how the class was taught differently to the nurses. Much time was spent on how to actually give the drugs, how much to flush through the lines, how to turn up the volume of the maching that goes "bing" so that, if you are transporting the patient alone, you can hear what the heart is doing, rather than having to stop every 10 seconds to check the monitor to see what the rhythm is. They don't teach you any of this stuff in doctorland. We learn how to order and how to read and what the differential diagnosis is, but not how to do the nuts and bolts. Very odd how medicine has evolved. Very hierarchal.

And, boy did I feel sorry for most of nurses. They were almost to a person from obstetrics or the GI lab or other places where they just weren't familiar with this stuff and had really not had any in-depth classes in, say, ECG reading or what most of these drugs did, and had never intubated anyone, ever. You could smell the stress. You could hear the panic. At least for me, the 500 page book assigned for "review" truly was review.

R, the nurse-educator in charge of all teaching programs at the hospital, kept shaking her head. After the morning session, she pulled me aside, as I sat munching my sandwich, going over the protocols, and offered to test the cardiologist and I after the afternoon sessions were done. We both leapt at it and, about 45 minutes after everyone else had cleared out, we were re-certified. Gotta say, it sure was less of a stress having your "mega-code" partner be a cardiologist. Damned if we didn't even bring that Resusi-Andy back to life, twice! Well, to such a life as one can have as a plastic torso without even your plumbing system intact.

Today I sit, heady with all this skill. No fear. I know just what the fuck to do if any of you were to collapse right in front of me.

Oh, yeah!

I KNOW how to call 911. As long as I have my trusty cardiologist by my side.

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9 Comments:

Blogger The Lioness said...

Oooh, a medical post, she wrote a medical post, yey!!! YEY!!!

Those poor nurses. Believe me, my heart bleeds just thinking abt it, poor poor things.

2:58 PM  
Anonymous Anonymous said...

Hey, I just signed up to renew my ACLS class in December! I live in fear of forgetting to renew and having to take the WHOLE DAMN CLASS over.

I find it odd that your class included non-critical care staff. Our hospital makes sure that everyone knows CPR and how to bag and how to work the AED but only the ICUs, PACU, OR, and cath lab nurses need ACLS (I think. There may be one other floor. Endo maybe?). So we breeze through our megacodes because we are those nurses saying, "Hey, it's 3 minutes from the last epi!" and "Um, you guys wanna shock that?" :)

Linda
http://indigogirl.typepad.com

4:08 PM  
Blogger Diana said...

Johnny- Hush, you. Don't you have some studying to do? Hey, come to think of it, I've been wanting to know what vets do for such things. Do they have whole algorithms and standardized "what to dos"? You need to discuss. Also, what about vet post-grad training? What comes next? (Please don't hit me)

Linda- I was thinking about you during it. ER also needs it here. They just started requiring OB nurses and, I think, anyone nursing in a place that sedation is used (hence GI lab). OB and peds nurses also must have to have PALS, of course. Honestly, I think everyone should have it, certainly all nurses and docs in all of the satelite clinics (like moi). The doc ACLS class was dropped as almost none of the docs wanted to take it, according to our nurse-educator. What the hell? If I were you and doing it day and night, I would make a special effort to not have to sit through the whole damn class, too. It is nice that now the mega-code testing is done in small teams, like in real life. Much better than 10 years ago. Stressful but not nearly as bad as it was. And, yeah, let's shock that! Shock, shock, shock, everybody shock!

4:55 PM  
Blogger Teri said...

and I thought CPR re-certification was tough...
(Okay, not really).

9:18 PM  
Blogger CarpeDM said...

Huh. Well, I'm not really sure what you said except that I a)could see you starring in some sort of medical drama and b) laughed out loud at the machine that goes "bing."

But I did enjoy the post because I liked all of your dramatic names for the people that are dying. You are very funny.

4:23 PM  
Blogger Diana said...

Teri- Good for you! CPR very good to know. Thank you, thank you, thank you. It really does make a difference.

Dana- Damn. See, that's why it it hard to incorporate work into blog. I can only write about the technical and it just doesn't translate well. I'd LOVE to write about the people but really don't care to lose my licence and / or job. "Bing!"

4:46 PM  
Blogger Teri said...

Uh, you're welcome, you're welcome, you're welcome. I first was certified when I was 16, and I keep letting the certification lapse, but I remember enough, I think. I have a daughter that choked (really choked, not just gagged)on food about once a week from the time she started eating solid food until she was three. More often than not she was able to cough the food back up, but there were a few times she turned kinda purple (come to think of it, she did that again last week...), and CPR is mighty useful in that situation.

5:40 PM  
Anonymous Anonymous said...

Did I tell you about the time I had a contract to do the display on one of those machines that go "bing"? Yup, I did the display controller for the old Protocol ProPac portable patient monitor, the single color gold display one back in the last century. Closest I ever got to real danger and blood. I'm glad there are very dedicated people like you around who really study and work to understand the stuff that's going to save someone's life someday. Me? I just hit the switch and turn off the electricity when it gets too intense...it'll be there tomorrow to figure out when I have more time to think about it.

MG

1:30 AM  
Anonymous Anonymous said...

I just love it when you talk real doctor stuff. If I ever get in a cardio-pickle, I will call you to rush right home and do me good. And don't even try to recall if you are or are not in my will when you do that voodoo you do so well.

The Ole RF-er

2:08 PM  

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