Bullocks to BLS!

Bullocks! Bullocks! I proclaim.

I just finished my ACLS training; Advanced Cardiovascular Life Support. I like that stuff. I had my “mega-code” simulation in which a fake code blue was performed. My fake patient was a 57 y/o female who was diaphoretic, weak, pre-syncopal with chest pain and shortness of breath. Her initial rhythm on the monitor was a sinus bradycardia.

“Okay, check the ABC’s,” I explained to my team. “Give her supplemental oxygen at two liters nasal canula and start an IV please. Draw up 0.5 mg atropine and place the pacer pads and get ready for pacing.”

She remained in symptomatic sinus brady after the atropine, so I ordered to start pacing. The pacer captured, but shortly after this she went into ventricular fibrillation.

“Okay, start CPR and hook-up the defibrillator please. Charge to 200 Joules please. Everyone clear? I’m clear. Clear. Deliver the shock please. Still in v fib. Resume CPR for 5 cycles please.” After 5 cycles my “patient” was still in v fib.

“Okay, shock at 200 please. Could you please draw up 1 mg epi? We’ll give it after this shock. Clear. Shock. Still v fib, could you push the epi please and then continue that every three to five minutes with 1 mg epi. Also could you please draw up 300 amio? Thanks.”

And thus the code continued until my “patient went into pulseless electrical activity (PEA). “Now we’re in PEA. Please resume CPR. Push 1 mg epi. Draw 1 mg atropine.” After 5 cycles of CPR (30 and 2 are the new guidelines) the “patient” was still in PEA. “Push the atropine and draw another 1 mg. Keep with the epi every 3 to 5 minutes, 1 mg please.”

Still in PEA. “Second dose of atropine given? Okay draw one more please. 1 mg. We’ll give it after this next cycle of CPR. Epi still going in? Good.” After the next cycle, the “patient” developed a weak pulse and another sinus brady.

And the code was over. She lived! The next step would be to consult electrophysiology, ship her to the cardiac ICU and have a pacemaker placed.

So that was my Friday morning. That and a written test covering essentially the same stuff. Now why the hell do I have to take the Basic Life Support (BLS) class on Monday? I obviously know CPR and how to run a code. I know the guidelines for child CPR (15 and 2 now) and everyone can do the Heimlich maneuver. I don’t want to spend four hours on Monday doing this crap, and without the fun of giving drugs and running a code. BLS….argh….

I don’t know what irks me more: having to pay the $50 for the BLS training (ACLS was $230) or giving up four hours on my last week of vacation.

Bullocks! Absolute bullocks!