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ACLS

PRE

A

30 to 60 Days Before Course

Your Role

•  Determine course specifics

— Target audience

— Number of students

— Special needs or equipment

•  Reserve equipment •  Schedule room •  Schedule additional instructors if needed

Reference

ACLS Instructor Manual/CD

ACLS

PRE

B

ACLS Precourse Preparation (Optional)

ACLS Precourse Preparation (Optional)

Program

Instructors or Training Centers may consider offering an ACLS preparation program days or weeks before the ACLS course to ensure that students understand

•  ECGs

•  Pharmacology

•  ACLS algorithms

•  Airway management

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ACLS

PRE

C

At Least 3 Weeks Before Course

Your Role

•  Ensure that students are sent precourse letters with student materials •  Ensure that students understand that precourse preparation is necessary for successful participation in the ACLS course •  Ensure that students are aware of Precourse Self-Assessment •  Confirm additional instructors

Reference

ACLS Instructor Manual/CD

ACLS

PRE

D

Day Before Course

Your Role

•  Confirm room reservations and setups •  Coordinate plan with additional instructors if needed for class size •  Make sure that all equipment is available and working •  Ensure that all course paperwork is in order

Reference

ACLS Instructor Manual/CD

ACLS

PRE

E

Day of Course

Your Role

•  Greet students as they arrive to help make them feel at ease •  Pass out supplies •  Have student fill out course roster

( www.ahainstructornetwork.org )

•  Strongly recommended: Collect students’ Precourse Self- Assessment score and Precourse Preparation Checklist

Reference

ACLS Instructor Manual/CD

ACLS

START

Welcome, Introductions, and Course Administration

0:00

0:00 5:00

5:00

Introductions, and Course Administration 0:00 5:00 Resources •  Course roster •  Course agenda
Introductions, and Course Administration 0:00 5:00 Resources •  Course roster •  Course agenda

Resources

•  Course roster •  Course agenda

Student Role

•  Introduce themselves •  Listen to you

Student Objectives

•  Get acquainted with you and with other students

Large group, all students

Your Role

•  Introduce instructors •  Invite students to introduce themselves •  Explain housekeeping issues, including paperwork and facilities •  Explain that parts of the course are somewhat strenuous •  Ask that anyone with a medical concern, such as knee or back problems, speak with one of the instructors •  Tell the students, “We are scheduled to end at

Reference

None

ACLS

1A

ACLS Course Overview and Organization

0:00

0:00 5:00

5:00

ACLS 1A ACLS Course Overview and Organization 0:00 5:00 Resources •  ACLS Instructor Manual/CD • 
ACLS 1A ACLS Course Overview and Organization 0:00 5:00 Resources •  ACLS Instructor Manual/CD • 

Resources

•  ACLS Instructor Manual/CD •  Course agenda •  Listing of student groups

Student Role

•  Listen to you •  Ask questions

Student Objectives

•  Understand the course design •  Understand how the course is organized •  Understand the purpose and function of the group rotations •  Understand the course com- pletion requirements

Large group, all students

Your Role

•  Present course overview — Additional details about the course overview can be found in the next Lesson Map •  Explain the learning stations and rotations through stations •  Assign students to small groups for learning stations •  Tell students that they will be using their ACLS Provider Manuals throughout the course •  Clarify course completion requirements

Reference

ACLS Instructor Manual/CD ACLS Provider Manual Part 1

ACLS

1B

ACLS Course Overview and Organization

Details

1B ACLS Course Overview and Organization Details Present Course Overview • 
1B ACLS Course Overview and Organization Details Present Course Overview • 

Present Course Overview •  Discuss course agenda, design, and completion requirements

•   Be certain that students understand major course concepts

  —  Importance of high-quality CPR to patient survival

  —  Integration of effective BLS with ACLS interventions

  —   Importance of effective team interaction and communication during  resuscitation attempt

•  Answer students’ questions

ACLS

2A

BLS and ACLS Surveys

0:00

0:00 20:00

20:00

ACLS 2A BLS and ACLS Surveys 0:00 20:00 Resources •  BLS and ACLS Surveys video • 

Resources

•  BLS and ACLS Surveys video •  AV equipment

Student Role

•  Watch the video •  Participate in discussion

Student Objectives

•  Describe the BLS and ACLS Surveys and critical interventions •  Describe specific assessment and management of each step of the systematic ACLS approach •  Describe how this approach can be applied to almost all cardiopulmonary emergencies

Large group, all students

Your Role

•  Introduce video on BLS and ACLS Surveys •  Show video •  Answer questions (use table on the next Lesson Map) •  Have students follow along in their ACLS Provider Manuals

Reference

ACLS Provider Manual Part 2

ACLS

2B

BLS and ACLS Surveys

Review

ACLS 2B BLS and ACLS Surveys Review Answer students’ questions. Use the table below to guide
ACLS 2B BLS and ACLS Surveys Review Answer students’ questions. Use the table below to guide

Answer students’ questions. Use the table below to guide your answers. Review the new steps of the BLS Survey.

 

BLS Survey

 

ACLS Survey

1

Check for responsiveness

A

 

Airway

Tap and shout, “Are you all right?”

Maintain airway patency by using OPA or NPA or an advanced airway (supraglottic airway or endotracheal tube)

 

Scan the chest for movement

 

If inserting an advanced airway such as an endotracheal tube, verify correct placement with waveform capnography

2

Activate the emergency response system/get the AED

B

Breathing

Give O 2 , use bag-mask with or without an advanced airway to provide adequate ventilation

Avoid excessive ventilation

3

Circulation

C

Circulation

Check carotid pulse (5-10 seconds)

Attach leads and monitor

 

If no pulse, start chest compressions immediately

 

Obtain IV/IO access

Push hard, push fast

Give appropriate drugs

Allow complete chest recoil between compressions

Monitor CPR quality with waveform capnography and intra-arterial relaxation pressure

Minimize interruptions in compressions (10 seconds or less)

Switch providers about every 2 minutes

 

Avoid excessive ventilation

4

Defibrillation

D

Differential diagnosis

Attach AED/defibrillator, analyze, and defibrillate if needed

Search for and treat reversible causes

Learning/Testing 0:00 ACLS Station: Mgmt. of Respiratory Arrest 3 4 3A 45:00 Resources •  AV
Learning/Testing 0:00 ACLS Station: Mgmt. of Respiratory Arrest 3 4 3A 45:00
Learning/Testing
0:00
ACLS
Station:
Mgmt. of
Respiratory
Arrest
3
4
3A
45:00
Station: Mgmt. of Respiratory Arrest 3 4 3A 45:00 Resources •  AV equipment •  Airway Management
Station: Mgmt. of Respiratory Arrest 3 4 3A 45:00 Resources •  AV equipment •  Airway Management
Station: Mgmt. of Respiratory Arrest 3 4 3A 45:00 Resources •  AV equipment •  Airway Management

Resources

•  AV equipment •  Airway Management video •  Airway manikins •  OPAs, NPAs, bag-masks •  Case Scenarios (in Appendix A of ACLS Instructor Manual or on Instructor CD) •  Management of Respiratory Arrest Bag-Mask Ventilation Testing Checklist

Student Role

•  Watch the video •  Demonstrate the use of NPA or OPA, oxygen, and adult bag-mask ventilation

Student Objectives

•  Demonstrate insertion of NPA or OPA •  Demonstrate oxygen delivery and effective bag-mask ventilation •  Demonstrate effective management of a simulated respiratory arrest case, includ- ing a bag-mask ventilation skills test

6 students, 1 instructor

Your Role

•  Tell students to open ACLS Provider Manual to appropriate pages •  Optional: Show Airway Management video: basic airway adjuncts video segment (Practice Session Part 1) •  Show Airway Management video: introduction and bag-mask ventilation (PWW) •  Present cases •  Each student manages a complete airway case (Testing Session Part 2) •  Show Airway Management video: confirmation of advanced airway devices •  Optional: Show advanced airway video segment (Practice Session Part 3)

Reference

ACLS Instructor Manual/CD ACLS Provider Manual Part 5

ACLS

3B

Learning/Testing Station:

Management of Respiratory Arrest

Student Practice Details

Management of Respiratory Arrest Student Practice Details Practice Session Part 1 • 
Management of Respiratory Arrest Student Practice Details Practice Session Part 1 • 
Management of Respiratory Arrest Student Practice Details Practice Session Part 1 • 

Practice Session Part 1

•  Show Airway Management video: basic airway adjuncts segment

•    Pause video segment while each student practices insertion of NPA and OPA,  practices suctioning and administering oxygen on an airway manikin

•   Continue Airway Management video

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ACLS 3C Learning/Testing Station: Management of Respiratory Arrest Student Practice Details

ACLS

3C

Learning/Testing Station:

Management of Respiratory Arrest

Student Practice Details

Management of Respiratory Arrest Student Practice Details Practice-While-Watching (PWW) Session • 
Management of Respiratory Arrest Student Practice Details Practice-While-Watching (PWW) Session • 
Management of Respiratory Arrest Student Practice Details Practice-While-Watching (PWW) Session • 

Practice-While-Watching (PWW) Session

•  Show Airway Management video: introduction and bag-mask ventilation •  Pause video segment •  Arrange students: 3:1 student-to-manikin ratio (or 2:1, 1:1) •   Each student practices bag-mask ventilation while watching (PWW) for 1 minute  with the video •   Pairs practice 2-person bag-mask ventilation (1 sealing mask, 1 squeezing bag) 

for 1 minute with video (PWW), then switch roles

•   Use the following student rotation for the 2-person bag-mask practice for a 

3:1 student-to-manikin ratio:

Person squeezing the bag

Person holding the mask

1

2

2

3

3

1

ACLS

3D

3D

Learning/Testing Station:

Management of Respiratory Arrest

Student Testing Details

Management of Respiratory Arrest Student Testing Details Testing Session Part 2 •  Present airway case

Testing Session Part 2 •  Present airway case •   Each student practices through the airway case (respiratory arrest with a pulse).  Student must

  —   Perform full assessment, activate the emergency response system, and do a  pulse check

  —    Begin ventilations without delay

  —   Insert NPA or OPA 

  —   Connect bag-mask to oxygen and adjust flow rate to appropriate level

  —   Give bag-mask ventilations for 1 minute (skills test) •   Critique by using the Skills Station Checklist from ACLS Provider Manual or  Instructor Manual/CD •   Check off student’s Skills Station Checklist as each student demonstrates  adequate management of the airway case (Case Scenarios can be found in  Appendix A of ACLS Instructor Manual or on Instructor CD)

ACLS

3E

3E

Learning/Testing Station:

Management of Respiratory Arrest

Video

Station: Management of Respiratory Arrest Video Show Airway Management Video • 

Show Airway Management Video •  Show video: Confirmation of advanced airway devices

ACLS

3F

Learning/Testing Station:

Management of Respiratory Arrest

Student Practice Details

Management of Respiratory Arrest Student Practice Details Practice Session Part 3 Show the Airway Management video:
Management of Respiratory Arrest Student Practice Details Practice Session Part 3 Show the Airway Management video:

Practice Session Part 3

Show the Airway Management video: advanced airway segment

After the video, students practice performing ventilations with a simulated advanced airway in place (on the basis of manikin limitations, instructors may use a standard manikin with a bag-mask rather than a bag connected to a simulated airway tube)

•   Students perform 2-rescuer CPR, one student doing continuous compressions  and the other student ventilating

•   Students perform 1 minute of CPR, switch roles, do 1 minute of CPR,  and then stop

•   Rotate through all students performing ventilations

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CPR and 0:00 ACLS AED 4 3 4A Practice and Testing 45:00
CPR and
0:00
ACLS
AED
4
3
4A
Practice
and Testing
45:00
and 0:00 ACLS AED 4 3 4A Practice and Testing 45:00 Resources •  Adult manikins (at
and 0:00 ACLS AED 4 3 4A Practice and Testing 45:00 Resources •  Adult manikins (at
and 0:00 ACLS AED 4 3 4A Practice and Testing 45:00 Resources •  Adult manikins (at

Resources

•  Adult manikins (at least 2) •  Pocket masks (1 per manikin) •  One-way valves (1 per student) •  AED trainers (2) •  AV equipment •  CPR and AED Skills video •  CPR and AED Testing Checklist •  Stopwatch •  Step stools

Student Role

•  Practice CPR with the video •  Rotate through the testing station for 1-rescuer adult CPR and AED skills

Student Objectives

•  Do chest compressions and ventilation practice (PWW) •  Demonstrate competency in 1-rescuer adult CPR and AED skills

6 students, 1 instructor

Your Role

•  Facilitate CPR practice (PWW)

•  Show video and give feedback during the practice part of the station

— Additional details about CPR practice are included in Lesson Map 4B •  Conduct CPR and AED testing

— Additional details about CPR and AED competency testing are included in Lesson Map 4C

Reference

ACLS Instructor Manual/CD ACLS Provider Manual Part 5 ECC Handbook, pocket reference cards, or crash cart cards

ACLS

4B

Testing Station:

CPR and AED Practice and Testing

Practice Details

CPR and AED Practice and Testing Practice Details CPR Practice • 
CPR and AED Practice and Testing Practice Details CPR Practice • 

CPR Practice

•  Arrange students in groups with manikins

  —  3 or fewer students per manikin

•  Show CPR and AED Skills video

•  Give feedback during PWW

•   Be sure that students continue correct chest compressions throughout the  practice session

•   Video shows a 1-rescuer CPR and AED scenario and gives an introduction to the  CPR and AED test

ACLS

4C

Testing Station:

CPR and AED Practice and Testing

Testing Details

CPR and AED Practice and Testing Testing Details Test students one at a time •  Students

Test students one at a time •  Students not testing should practice on another manikin •  Test each student in a reasonably private environment

— Each student must demonstrate entire sequence of 1-rescuer CPR and AED (with pocket mask) without instructor prompting

— Fill out the CPR and AED Testing Checklist for each student •  Carefully observe the student being tested •  If a student is unsuccessful, refer him or her for immediate remediation

— Each student may retest 1 additional time during this station

— If a student remains unsuccessful, refer for remediation at the end of the course

•  Summarize the importance of high-quality CPR to patient survival Describe the following testing scenario:

“This is a test of the 1-rescuer adult CPR and AED skills. The scene is safe and you are wearing protective gloves. A man has collapsed in front of you, and there is no risk of a head or spinal cord injury. You are the only healthcare provider on the scene. The emergency plan at the site is to activate the emergency response system. You have a pocket mask, and an AED is available. No one else knows how to use the AED.”

ACLS

5A

The Megacode and Resuscitation Team Concept

0:00

0:00 25:00

25:00

The Megacode and Resuscitation Team Concept 0:00 25:00 Resources •  AV equipment •  Megacode video

Resources

•  AV equipment •  Megacode video

Student Role

•  Watch the video •  Ask questions

Student Objectives

•  Identify the roles of the resuscitation team leader and team members •  List elements of team dynamics

Large group, all students, 1 instructor (or may be done in 2 smaller groups, 2 instructors)

Your Role

•  Ask students to open the ACLS Provider Manual to appropriate pages •  Show video •  Answer questions (use points on the next Lesson Map to guide your answers) •  Remind students that they will be functioning as team leader and different team members in the learning and testing stations

Reference

ACLS Provider Manual Part 3

ACLS

The Megacode and Resuscitation Team Concept

Review

5B

The Megacode and Resuscitation Team Concept Review 5B Elements of Effective Team Dynamics • 
The Megacode and Resuscitation Team Concept Review 5B Elements of Effective Team Dynamics • 

Elements of Effective Team Dynamics •   Closed-loop communication

•  Clear messages

•  Clear roles and responsibilities

•  Knowing one’s limitations

•  Knowledge sharing

•  Constructive intervention

•  Reevaluation and summarizing

•  Mutual respect

ACLS

6A

Learning Station:

Cardiac Arrest (VF/Pulseless VT)

0:00

0:00 90:00

90:00

Station: Cardiac Arrest (VF/Pulseless VT) 0:00 90:00 Resources •  Code cart or code kit • 
Station: Cardiac Arrest (VF/Pulseless VT) 0:00 90:00 Resources •  Code cart or code kit • 

Resources

•  Code cart or code kit •  Algorithms •  Monitor/manual defibrillator and simulator •  Manikins for CPR and intubation/ ventilation •  Stopwatch and countdown timer •  Case Scenarios (in Appendix A of ACLS Instructor Manual or on Instructor CD) •  Step stools

Student Role

•  Practice in the role as team leader in a VF/pulseless VT case •  Practice all team roles if possible •  Apply Immediate Post–Cardiac Arrest Care Algorithm after ROSC

Student Objectives

•  Implement the Cardiac Arrest Algorithm (VF/Pulseless VT) for a shockable rhythm •  Show proper management of a simulat- ed VF/pulseless VT case as team leader •  Rotate through all team roles

6 students, 1 instructor

Your Role

•  Monitor/defibrillator technology review •  Review algorithms

— Cardiac Arrest Algorithm (VF/Pulseless VT)

— Immediate Post–Cardiac Arrest Care Algorithm

•  Review team roles, responsibilities, and assignments for each case (see Lesson Maps 6B and 6C) •  Students may use ECC Handbook, pocket reference cards, or crash cart cards

•  Present cases for each student to demonstrate appropriate management •  Perform debriefing

Reference

ACLS Instructor Manual/CD ACLS Provider Manual Part 5 ECC Handbook, pocket reference cards, or crash cart cards

ACLS

6B

6B

Learning Station:

Cardiac Arrest (VF/Pulseless VT)

Review Algorithms and Roles

Arrest (VF/Pulseless VT) Review Algorithms and Roles Review algorithms (5 minutes) Student Rotations in Learning
Arrest (VF/Pulseless VT) Review Algorithms and Roles Review algorithms (5 minutes) Student Rotations in Learning

Review algorithms (5 minutes)

Student Rotations in Learning Station Cases According to Resuscitation Team Roles

The team leader will direct the actions of the other team members. (For example, the team leader will coach the airway management team member if performance of bag-mask ventilation is not making the chest rise.) Team members will perform interventions as directed by the team leader. This is an opportunity for students to practice skills and receive feedback from the team leader. Students will demonstrate effective team behaviors (eg, closed-loop communication, clear messages). The timer/recorder will use a stopwatch to time 2-minute intervals for case man- agement, announce each 2-minute interval for CPR switching, and record critical action times on the ACLS Code Timer/Recorder Sheet (in Appendix B of ACLS Instructor Manual or on Instructor CD) or a whiteboard.

ACLS

6C

6C

Learning Station:

Cardiac Arrest (VF/Pulseless VT)

Rotations

Station: Cardiac Arrest (VF/Pulseless VT) Rotations 14 minutes per case Case Case Case Case Case
Station: Cardiac Arrest (VF/Pulseless VT) Rotations 14 minutes per case Case Case Case Case Case

14 minutes per case

Case

Case

Case

Case

Case

Case

Team Role

1

2

3

4

5

6

Team leader

S1

S2

S3

S4

S5

S6

Airway

S2

S3

S4

S5

S6

S1

IV/meds

S3

S4

S5

S6

S1

S2

Defibrillator/airway #2

S4

S5

S6

S1

S2

S3

Compressions

S5

S6

S1

S2

S3

S4

Timer/recorder

S6

S1

S2

S3

S4

S5

It is important that every student have a role in each case. Student role assignments may vary depending on the number of students at the station. However, every student must function as the team leader for 1 case. Cases may be run in a different order, but ensure that no single student always goes first in subsequent learning stations. Any additional students may be given roles as additional recorders.

ACLS

6D

6D

Learning Station:

Cardiac Arrest (VF/Pulseless VT)

Details for Case Rotations

Arrest (VF/Pulseless VT) Details for Case Rotations Directions for Case Rotations (6 rotations, 14 minutes each)
Arrest (VF/Pulseless VT) Details for Case Rotations Directions for Case Rotations (6 rotations, 14 minutes each)

Directions for Case Rotations (6 rotations, 14 minutes each)

(Instructors must conduct the scenario in real time)

 

•  Review assigned team roles from the rotation chart for this case

Start Case Scenario (10 minutes)

Ensure that students understand expectations of assigned roles (eg, “Your role is to use the bag-mask to give ventilations that cause the chest to rise”) •  Introduce the case by reading the Case Scenario •  Set the timer to 10 minutes •  Ask the team leader to begin managing the case •  Observe and coach

— Effective team performance

— Appropriate case management

High-quality skill performance, including high-quality CPR throughout the scenario •  Guide the team leader through management of the case •  Stop the case after 10 minutes

Case 1 Debriefing (4 minutes)

•  Set the timer to 4 minutes •  Conduct a team debriefing at the end of the case

Total time for case:

14 minutes

Repeat for each of the remaining 5 cases

ACLS

7A

Learning Station:

Acute Coronary Syndromes

0:00

0:00 45:00

45:00

Learning Station: Acute Coronary Syndromes 0:00 45:00 Resources •  AV equipment •  ACS video Student
Learning Station: Acute Coronary Syndromes 0:00 45:00 Resources •  AV equipment •  ACS video Student

Resources

•  AV equipment •  ACS video

Student Role

•  Watch the video •  Participate in a discussion about ACS and ACS management

Student Objectives

•  Explain and apply the ACS Algorithm •  Discuss ACS management

Large group, all students

Your Role

•  Show ACS video •  Pause video for discussion points •  Lead the discussion with the group

Reference

ACLS Instructor Manual/CD ACLS Provider Manual Part 5 ECC Handbook, pocket reference cards, or crash cart cards

ACLS

7B

7B

Learning Station:

Acute Coronary Syndromes

Video Discussion 1

Station: Acute Coronary Syndromes Video Discussion 1 Pause 1 1. What is the difference between stable
Station: Acute Coronary Syndromes Video Discussion 1 Pause 1 1. What is the difference between stable

Pause 1

1. What is the difference between stable angina, unstable angina, and myocardial infarction?

Angina is a tightness or discomfort (not a sharp pain) in the center of the chest and/or the surrounding area. The onset of discomfort associated with stable angina is often predictable; in many cases, it begins during exertion or with strong emotions. It is a symptom, not a diagnosis of coronary artery disease or acute ischemic symptoms. While often associated with myocardial ischemia, angina may have other causes. In the presence of coronary disease, the most common cause of angina is an obstructing or disrupted coronary plaque.

Angina may be stable and predictably produced by exertion or emotion. At rest, a fixed coronary plaque generally allows enough blood supply—but blood flow is insufficient during stress. When a plaque becomes unstable, ACS occurs. With minimal exertion or at rest, blood flow is insufficient, causing unstable angina and prolonged discomfort. Death of the heart muscle eventually occurs, which often correlates with angina episodes of 15 minutes or longer.

ACLS

7C

7C

Learning Station:

Acute Coronary Syndromes

Video Discussion 1

Station: Acute Coronary Syndromes Video Discussion 1 2. This patient is having chest discomfort. What are
Station: Acute Coronary Syndromes Video Discussion 1 2. This patient is having chest discomfort. What are

2. This patient is having chest discomfort. What are the possible causes of chest discom- fort that may be life-threatening?

Although most life-threatening chest discomfort is due to ACS, the initial emergency diagnosis may include several other disorders. When a diagnosis of ACS is uncertain, the following possible diagnoses should be considered in the initial evaluation as well as continuing assessment:

•  Aortic dissection

•  Pulmonary embolism

•  Acute pericarditis with effusion and tamponade

•  Spontaneous pneumothorax

•  Esophageal rupture

ACLS

7D

7D

Learning Station:

Acute Coronary Syndromes

Video Discussion 1

Station: Acute Coronary Syndromes Video Discussion 1 3. What are the classic symptoms of acute ischemic
Station: Acute Coronary Syndromes Video Discussion 1 3. What are the classic symptoms of acute ischemic

3. What are the classic symptoms of acute ischemic chest discomfort?

The predominant symptom in most patients with ischemic syndromes is chest discomfort. This discomfort is often not described as a pain. Brief episodes of chest discomfort may be due to ischemia and may or may not progress to infarction. However, when symptoms are constant (ie, last for more than 15 to 20 minutes), myocardial infarction may be present. Symptoms suggestive of ACS include

•   Uncomfortable pressure, fullness, squeezing, or pain in the center of the chest lasting several minutes (infarction: usually more than 15 minutes)

•   Pain spreading to the shoulders, neck, arms, or jaw, or pain in the back or between the  shoulder blades

•  Chest discomfort with lightheadedness, fainting, sweating, or nausea

•  Shortness of breath with or without chest discomfort

ACLS

7E

7E

Learning Station:

Acute Coronary Syndromes

Video Discussion 2

Station: Acute Coronary Syndromes Video Discussion 2 Pause 2 1. Half of ACS patients do not
Station: Acute Coronary Syndromes Video Discussion 2 Pause 2 1. Half of ACS patients do not

Pause 2

1. Half of ACS patients do not arrive at the hospital by EMS. Why is early EMS dispatch important for patients with ACS? What are the most important components of a community ACS recognition program?

Patients arriving with ST-segment elevation MI (STEMI) have a complete occlusion of a coronary artery. Early opening of the artery reduces mortality and the size of infarction. Patients arriving by EMS receive earlier reperfusion.

ACS is the most common cause of cardiac arrest in adults. Every community should develop a program to respond to cardiac arrest and identify patients with possible ACS. Components of this program include •   Recognizing symptoms of ACS •   Activating the EMS system •   Providing early CPR •   Providing defibrillation with AEDs available through lay rescuer CPR and  defibrillation programs

ACLS

7F

7F

Learning Station:

Acute Coronary Syndromes

Video Discussion 2

Station: Acute Coronary Syndromes Video Discussion 2 2. What are the goals of therapy for patients
Station: Acute Coronary Syndromes Video Discussion 2 2. What are the goals of therapy for patients

2. What are the goals of therapy for patients with ACS?

Improving systems of care enables early initiation of therapy for patients with possible ACS and increases the likelihood of target goal achievement. These goals (discussed in detail in the ACS video) are

•  Relief of ischemic chest discomfort

•  Prevention of major adverse cardiac events (MACE), such as death, nonfatal MI, and the need for postinfarction urgent revascularization

•  Treatment of acute, life-threatening complications of ACS, such as VF/pulseless VT, symptomatic bradycardias, and unstable tachycardias

Reperfusion therapy opens an occluded coronary artery with either drugs or mechanical means. “Clot buster” drugs are called fibrinolytics—a more accurate term than thrombolytics. PCI, performed in the heart catheterization suite following coronary angiography, allows balloon dilation and/or stent placement for an occluded coronary artery. PCI performed as the initial reperfusion method is called primary PCI.

ACLS

7G

7G

Learning Station:

Acute Coronary Syndromes

Video Discussion 2

Station: Acute Coronary Syndromes Video Discussion 2 3. What role does aspirin play in ACS? What
Station: Acute Coronary Syndromes Video Discussion 2 3. What role does aspirin play in ACS? What

3. What role does aspirin play in ACS? What are the indications and contraindications?

The most common cause of ACS is the rupture of a lipid-laden plaque with a thin cap. After rup- ture, a monolayer of platelets covers the surface of the ruptured plaque (platelet adhesion). Ad- ditional platelets are recruited (platelet aggregation) and activated. Aspirin irreversibly binds to platelets and partially inhibits platelet function.

Studies have shown that aspirin reduces mortality during MI. The recommended dose is 160 to 325 mg. Aspirin is indicated in all patients with possible ACS.

Contraindications include true aspirin allergy and recent or active GI bleeding.

ACLS

7H

7H

Learning Station:

Acute Coronary Syndromes

Video Discussion 3

Station: Acute Coronary Syndromes Video Discussion 3 Pause 3 1. Let’s review. What is the initial
Station: Acute Coronary Syndromes Video Discussion 3 Pause 3 1. Let’s review. What is the initial

Pause 3

1. Let’s review. What is the initial drug therapy for ACS? We have already discussed aspirin. Other initial agents are oxygen (to keep the saturation greater than or equal to 94%), nitroglycerin, and morphine. What are the doses and indications/contraindications/cautions for nitroglycerin? Nitroglycerin is administered by sublingual or spray dosing. Three doses may be administered after repeating assessments of blood pressure and heart rate. Conditions complicating nitroglycerin administration in patients with ACS include

•  Inferior MI and RV infarction: Use nitroglycerin with caution in patients with known inferior wall STEMI. For these patients, perform a right-sided ECG to assess the degree of RV involvement. If RV infarction is confirmed by right sided precordial leads or clinical findings by an experienced provid- er, nitroglycerin and other vasodilators (morphine) or volume depleting drugs (diuretics) are contra- indicated. Patients with acute RV infarction are very dependent on RV filling pressures to maintain cardiac output and blood pressure. •  Hypotension, bradycardia, or tachycardia: Avoid use of nitroglycerin in patients with hypotension (systolic BP <90 mm Hg), extreme bradycardia (<50/min), or tachycardia. •  Recent use of phosphodiesterase inhibitor for erectile dysfunction: If the patient has recently taken a phosphodiesterase inhibitor (eg, sildenafil or vardenafil within 24 hours; tadalafil within 48 hours), nitrates may cause severe hypotension refractory to vasopressor agents.

ACLS

7I

7I

Learning Station:

Acute Coronary Syndromes

Video Discussion 3

Station: Acute Coronary Syndromes Video Discussion 3 2. What are the possible ECG groups that help
Station: Acute Coronary Syndromes Video Discussion 3 2. What are the possible ECG groups that help

2. What are the possible ECG groups that help triage initial ACS? What are they called, and why is it recommended that EMS send advance notification of the ECG to the receiving facility?

Analysis of the ECG ST segment allows triage of ACS patients into 1 of 3 diagnostic and treatment groups: STEMI; ST-segment depression (high-risk unstable angina/non–ST-segment elevation MI); and normal or nondiagnostic ECG. (Refer to boxes 5, 9, and 13 in the ACS Algorithm.)

Time is a critical factor in producing a positive outcome for an ACS patient, especially for STEMI patients. The American Heart Association recommends that EMS systems implement 12-lead ECG programs to assist in the early recognition of those patients who could benefit most from treatment at a specialty cardiac center. EMS providers who lack training in advanced ECG interpretation can still acquire and transmit the 12-lead ECG to the emergency department for interpretation there. With an ECG diagnostic for STEMI, EMS providers should activate the local STEMI response plan.

Early ECG interpretation and notification of the receiving hospital speeds the time to reperfusion therapy, saves heart muscle, and may reduce mortality.

ACLS

7J

7J

Learning Station:

Acute Coronary Syndromes

Video Discussion 3

Station: Acute Coronary Syndromes Video Discussion 3 3. Why is STEMI special and the focus of
Station: Acute Coronary Syndromes Video Discussion 3 3. Why is STEMI special and the focus of

3. Why is STEMI special and the focus of this case?

Reperfusion therapy for STEMI is perhaps the most important advance in the treatment of cardiovascular disease in recent cardiovascular therapy. Early fibrinolytic therapy or direct catheter-based reperfusion has been established as a standard of care for patients with AMI who present within 12 hours of onset of symptoms with no contraindications.

Reperfusion therapy reduces mortality and saves heart muscle. The shorter the time to reperfusion, the greater the benefit. For example, a 47% reduction in mortality was noted when fibrinolytic therapy was provided in the first hour after onset of symptoms.

Guidelines have set goals for door-to-drug (fibrinolytic) administration time of 30 minutes and PCI door-to-balloon time of 90 minutes. STEMI systems of care (EMS systems and emergency department initial triage) have a major impact on these goals.

0:00 ACLS Learning Station: 8A Stroke 45:00
0:00
ACLS
Learning Station:
8A
Stroke
45:00

Resources

•  AV equipment •  Stroke video

Student Role

•  Watch the video •  Participate in a discussion about stroke and stroke management

Student Objectives

•  Explain and apply the Suspected Stroke Algorithm •  Discuss the 8 D’s of Stroke Care and explain why timely action is crucial

Large group, all students

Your Role

•  Show Stroke video •  Pause video for discussion points •  Lead the discussion with the group

Reference

ACLS Instructor Manual/CD ACLS Provider Manual Part 5 ECC Handbook, pocket reference cards, or crash cart cards

ACLS

8B

8B

Learning Station:

Stroke Discussion

Video Discussion 1

Station: Stroke Discussion Video Discussion 1 Pause 1 1. What signs and symptoms is this patient
Station: Stroke Discussion Video Discussion 1 Pause 1 1. What signs and symptoms is this patient

Pause 1

1. What signs and symptoms is this patient having? How are they typical of stroke?

Students should recognize that the patient is having difficulty speaking and moving. These are some of the warning signs of stroke. Ask students what some other warning signs or symptoms of stroke are.

The signs and symptoms of a stroke may be subtle. They can include

•  Sudden weakness or numbness of the face, arm, or leg, especially on one side of the body •  Sudden confusion •  Trouble speaking or understanding •  Sudden trouble seeing in one or both eyes •  Sudden trouble walking •  Dizziness or loss of balance or coordination •  Sudden severe headache with no known cause

ACLS

8C

8C

Learning Station:

Stroke Discussion

Video Discussion 1

Station: Stroke Discussion Video Discussion 1 2. What are the major types of stroke? Is there
Station: Stroke Discussion Video Discussion 1 2. What are the major types of stroke? Is there

2. What are the major types of stroke? Is there any treatment that can reduce disability?

Stroke is a general term. It refers to acute neurologic impairment that follows interruption in blood supply to a specific area of the brain. Although expeditious care for stroke is important for all patients, this case emphasizes reperfusion therapy for acute ischemic stroke because rapid therapy with a fibrinolytic agent can reduce the disability from stroke. The major types of stroke are

•  Ischemic stroke: Accounts for 87% of all strokes and is usually caused by an occlusion of an artery to a region of the brain.

•  Hemorrhagic stroke: Accounts for 13% of all strokes and occurs when a blood vessel in the brain suddenly ruptures into the surrounding tissue. Fibrinolytics are contraindicated in this type of stroke.

A transient ischemic attack refers to any focal neurologic deficit that resolves spontaneously and completely within 1 hour.

ACLS

8D

8D

Learning Station:

Stroke Discussion

Video Discussion 1

Station: Stroke Discussion Video Discussion 1 3. If this patient is having a stroke, what are
Station: Stroke Discussion Video Discussion 1 3. If this patient is having a stroke, what are

3. If this patient is having a stroke, what are some goals for stroke care?

The goal of stroke care is to minimize brain injury and maximize the patient’s recovery. The Stroke Chain of Survival described by the AHA and the American Stroke Association is similar to the Chain of Survival for sudden cardiac arrest. It links actions to be taken by patients, family members, and healthcare providers to maximize stroke recovery. These links are

•  Rapid recognition and reaction to stroke warning signs

•  Rapid activation of the EMS system

•  Rapid EMS-system transport and prearrival notification to the receiving hospital

•  Rapid diagnosis and treatment in the hospital

ACLS

8E

8E

Learning Station:

Stroke Discussion

Video Discussion 2

Station: Stroke Discussion Video Discussion 2 Pause 2 1. What are the critical EMS assessments and
Station: Stroke Discussion Video Discussion 2 Pause 2 1. What are the critical EMS assessments and

Pause 2

1. What are the critical EMS assessments and actions to provide the best outcome for this patient with a potential stroke? •  Identify signs: Define and recognize the signs of TIA and stroke. •  Support ABCs: Administer oxygen if the oxygen saturation is <94% or the oxygen saturation is unknown. •  Do stroke assessment: Perform a rapid out-of-hospital stroke assessment. •  Establish time: Determine when the patient was last known to be at neurologic baseline. This represents time zero. If the patient wakes from sleep and is found with symptoms of stroke, time zero is the last time the patient was seen to be normal. •  Transport: Transport the patient and consider triage to a stroke center. Consider bringing a witness, family member, or caregiver with the patient to confirm time of onset of stroke symptoms. •  Alert hospital: Provide prearrival notification to the receiving hospital. •  Check glucose: During transport, support cardiopulmonary function, monitor neurologic status, and if authorized by medical control, check blood glucose.

ACLS

8F

8F

Learning Station:

Stroke Discussion

Video Discussion 2

Station: Stroke Discussion Video Discussion 2 2. What type of hospital is appropriate for this patient?
Station: Stroke Discussion Video Discussion 2 2. What type of hospital is appropriate for this patient?

2. What type of hospital is appropriate for this patient? Why is advance notification so important?

A stroke center has the capability to rapidly triage and treat patients by using a multidisciplinary approach.

Evidence indicates a favorable benefit when stroke patients are triaged directly to designated stroke prepared centers (primary/comprehensive centers) (Class I).

Advance notification allows activation of the facility stroke plan and team, minimizing delay in evaluation and treatment.

ACLS

8G

8G

Learning Station:

Stroke Discussion

Video Discussion 2

Station: Stroke Discussion Video Discussion 2 3. What stroke screen was used in the video? What
Station: Stroke Discussion Video Discussion 2 3. What stroke screen was used in the video? What

3. What stroke screen was used in the video? What are the 3 important physical findings?

Cincinnati Prehospital Stroke Scale (CPSS) The CPSS identifies stroke on the basis of 3 physical findings:

•  Facial droop (have the patient smile or try to show teeth) •  Arm drift (have the patient close eyes and hold both arms out) •  Abnormal speech (have the patient say, “You can’t teach an old dog new tricks”) Using the CPSS, medical personnel can evaluate the patient in less than 1 minute. The presence of 1 finding on the CPSS indicates a 72% probability of stroke. The presence of all 3 findings indicates that the probability of stroke is greater than 85%.

ACLS

8H

8H

Learning Station:

Stroke Discussion

Video Discussion 3

Station: Stroke Discussion Video Discussion 3 Pause 3 1. Let’s review. What is the initial emergency
Station: Stroke Discussion Video Discussion 3 Pause 3 1. Let’s review. What is the initial emergency

Pause 3

1. Let’s review. What is the initial emergency department assessment and stabilization?

•  Assess ABCDs: Assess the ABCDs and evaluate baseline vital signs. •  Provide oxygen: Provide supplemental oxygen if the patient is hypoxemic, ie, oxygen saturation <94% (Class I) or in patients with an unknown oxygen saturation value. •  Establish IV access and obtain blood samples: Establish IV access and obtain blood samples

for baseline blood count, coagulation studies, and blood glucose, but do not let this delay obtaining

a CT scan of the brain.

•  Check glucose: Promptly treat hypoglycemia. •  Perform neurologic screening: NIH Stroke Scale or Canadian Neurological Scale.

•  Activate stroke team: Activate the stroke team or arrange consultation with a stroke expert. •  Order CT brain scan: Order an emergent CT scan of the brain and have it read promptly by

a radiologist.

•  Obtain 12-lead ECG: Obtain a 12-lead ECG, which may identify a recent AMI or arrhythmias (eg, atrial fibrillation) as a cause of embolic stroke. Life-threatening arrhythmias can follow or accompany stroke, particularly intracerebral hemorrhage. If the patient is hemodynamically stable,

treatment of non–life-threatening arrhythmias (bradycardia, VT, and atrioventricular conduction

blocks) may not be necessary. This should not delay getting the CT scan of the brain.

ACLS

8I

8I

Learning Station:

Stroke Discussion

Video Discussion 3

Station: Stroke Discussion Video Discussion 3 2. What are the possible outcomes of the CT scan?
Station: Stroke Discussion Video Discussion 3 2. What are the possible outcomes of the CT scan?

2. What are the possible outcomes of the CT scan? Which test result makes the patient a candidate for fibrinolytic therapy?

Emergent CT or MRI scans of patients with suspected stroke should be promptly interpreted by an expert. The presence of hemorrhage versus no hemorrhage determines the next steps in treatment and whether the patient is a candidate for fibrinolytic therapy.

No, hemorrhage is not present.

If the CT scan shows no evidence of hemorrhage, the patient may be a candidate for fibrinolytic therapy.

Yes, hemorrhage is present.

If hemorrhage is noted on the CT scan, the patient is NOT a candidate for fibrinolytics. Consult

a neurologist or neurosurgeon and consider transfer for appropriate care.

ACLS

8J

8J

Learning Station:

Stroke Discussion

Video Discussion 3

Station: Stroke Discussion Video Discussion 3 3. What does fibrinolytic therapy do for patients with
Station: Stroke Discussion Video Discussion 3 3. What does fibrinolytic therapy do for patients with

3. What does fibrinolytic therapy do for patients with ischemic stroke?

Several studies have demonstrated a higher likelihood of good to excellent functional outcome when rtPA was given to adults with acute ischemic stroke within 3 hours of symptom onset. These results occurred only when rtPA was given by physicians in hospitals with a stroke protocol that rigorously adhered to the eligibility criteria and therapeutic regimen of the NINDS protocol. Evidence from prospective randomized studies in adults also documents a greater likelihood of benefit when treatment begins earlier.

Studies have also shown improved clinical outcome in carefully selected patients when fibrinolytic administration occurred between 3 and 4.5 hours after symptom onset, although the degree of benefit was smaller than seen in the group receiving treatment at ≤3 hours.

ACLS

8K

8K

Learning Station:

Stroke Discussion

Review of 8 D’s

Station: Stroke Discussion Review of 8 D’s •  Detection: Rapid recognition of stroke symptoms
Station: Stroke Discussion Review of 8 D’s •  Detection: Rapid recognition of stroke symptoms

•  Detection: Rapid recognition of stroke symptoms •  Dispatch: Early activation and dispatch of EMS by calling 911 •  Delivery: Rapid EMS identification, management, and transport •  Door: Appropriate triage to stroke center •  Data: Rapid triage, evaluation, and management within the emergency department •  Decision: Stroke expertise and therapy selection •  Drug: Fibrinolytic therapy, intra-arterial strategies •  Disposition: Rapid admission to stroke unit, critical care unit

0:00 ACLS Learning Station: 9 10 9A Bradycardia/PEA/Asystole 45:00
0:00
ACLS
Learning Station:
9
10
9A
Bradycardia/PEA/Asystole
45:00
Station: 9 10 9A Bradycardia/PEA/Asystole 45:00 Resources •  Code cart or code kit • 
Station: 9 10 9A Bradycardia/PEA/Asystole 45:00 Resources •  Code cart or code kit • 

Resources

•  Code cart or code kit •  Algorithms •  Monitor/manual defibrillator and simulator •  Manikins for CPR and intubation/ ventilation •  Stopwatch and countdown timer •  Case Scenarios (in Appendix A of ACLS Instructor Manual or on Instructor CD) •  Step stools

Student Role

•  Discuss algorithm •  Demonstrate appropriate patient management

Student Objectives

•  Show proper management of a simu- lated bradycardia/PEA/asystole case •  Rotate through team roles

6 students, 1 instructor

Your Role

•  Monitor/defibrillator technology review •  Review algorithms

— Bradycardia Algorithm

— Cardiac Arrest Algorithm (PEA/Asystole) •  Discuss bradycardias •  Discuss H’s and T’s

•  Review team roles, responsibilities, and assignments for each case (see Lesson Maps 9D and 9E) •  Present cases for each student team to manage

— Additional details about the student cases are presented in Lesson Map 9C •  Perform debriefing

Reference

ACLS Instructor Manual/CD ACLS Provider Manual Part 5 ECC Handbook, pocket reference cards, or crash cart cards

ACLS

9B

9B

Learning Station:

Bradycardia/PEA/Asystole

Algorithm, Bradycardia, and H’s and T’s Review

Algorithm, Bradycardia, and H’s and T’s Review •  Review algorithms (5 minutes) •  Discuss
Algorithm, Bradycardia, and H’s and T’s Review •  Review algorithms (5 minutes) •  Discuss

•  Review algorithms (5 minutes)

•  Discuss bradycardias: sinus, first-, second-, and third-degree AV blocks (5 minutes)

•  Discuss H’s and T’s (5 minutes)

ACLS

9C

9C

Learning Station:

Bradycardia/PEA/Asystole

Roles

Learning Station: Bradycardia/PEA/Asystole Roles Student Rotations in Learning Station Cases According to
Learning Station: Bradycardia/PEA/Asystole Roles Student Rotations in Learning Station Cases According to

Student Rotations in Learning Station Cases According to Resuscitation Team Roles The team leader will direct the actions of the other team members. (For example, the team leader will coach the airway management team member if performance of bag-mask ventilation is not making the chest rise.) Team members will perform interventions as directed by the team leader. This is an opportunity for students to practice skills and receive feedback from the team leader. Students will demonstrate effective team behaviors (eg, closed-loop communication, clear messages). For Bradycardia: The timer/recorder will check off critical action boxes on the Bradycardia Learning Station Checklist. For PEA/Asystole case management: The timer/recorder will use a stopwatch to time 2-minute intervals for case management, announce each 2-minute interval for CPR switching, and record critical action times on the ACLS Code Timer/Recorder Sheet (in Appendix B of ACLS Instructor Manual or on Instructor CD) or a whiteboard.

ACLS

9D

9D

Learning Station:

Bradycardia/PEA/Asystole

Rotations

Learning Station: Bradycardia/PEA/Asystole Rotations 10 minutes per case Case Case Case Team Role
Learning Station: Bradycardia/PEA/Asystole Rotations 10 minutes per case Case Case Case Team Role

10 minutes per case

Case

Case

Case

Team Role

1

2

3

Team leader

S6

S1

S2

Airway

S1

S2

S3

IV/meds

S2

S3

S4

Defibrillator

S3

S4

S5

Compressions (if needed)

S4

S5

S6

Timer/recorder

S5

S6

S1

This station is designed to allow 3 of the 6 students to be a team leader in this station and 3 to be a team leader in Lesson 10 (Tachycardia). Other assigned student roles may vary depending on the number of students at the station. Any additional students may be given roles as additional recorders. Cases may be run in a different order, but assigned student roles should not be changed.

ACLS

9E

9E

Learning Station:

Bradycardia/PEA/Asystole

Details for Case Rotations

Bradycardia/PEA/Asystole Details for Case Rotations Directions for Case Rotations (3 rotations, 10 minutes each)
Bradycardia/PEA/Asystole Details for Case Rotations Directions for Case Rotations (3 rotations, 10 minutes each)

Directions for Case Rotations (3 rotations, 10 minutes each)

(Instructors must conduct the scenario in real time)

 

•  Review assigned team roles from the rotation chart for this case

Start Case Scenario (6 minutes)

Ensure that students understand expectations of assigned roles (eg, “Your role is to use the bag-mask to give ventilations that cause the chest to rise”) •  Introduce the case by reading the Case Scenario •  Set the timer to 6 minutes •  Ask the team leader to begin managing the case •  Observe and coach

— Effective team performance

— Appropriate case management

High-quality skill performance, including high-quality CPR throughout the scenario •  Guide the team leader through management of the case •  Stop the case after 6 minutes

Case debriefing (4 minutes)

•  Set the timer to 4 minutes •  Conduct a debriefing at the end of the case •  Ask the team leader to summarize the case, roles of team members, and areas for improvement •  Ask the timer/recorder to critique the case •  Give a summary of key concepts of the case

Total time for case:

10 minutes

Repeat for each of the remaining cases (Bradycardia/PEA/Asystole)

0:00 ACLS Learning Station: 10 9 10A Tachycardia, Stable and Unstable 45:00
0:00
ACLS
Learning Station:
10
9
10A
Tachycardia,
Stable and Unstable
45:00
10 9 10A Tachycardia, Stable and Unstable 45:00 Resources •  Code cart or code kit • 
10 9 10A Tachycardia, Stable and Unstable 45:00 Resources •  Code cart or code kit • 

Resources

•  Code cart or code kit •  Algorithms •  Monitor/manual defibrillator and simulator •  Manikins for CPR and intubation/ ventilation •  Stopwatch and countdown timer •  Case Scenarios (in Appendix A of ACLS Instructor Manual or on Instructor CD)

Student Role

•  Participate in the case •  Learn to assess and manage tachycardia

Student Objectives

•  Explain and apply the Tachycardia Algorithm •  Understand wide and narrow QRS complex •  Demonstrate safe and effective cardioversion •  Practice team roles

6 students, 1 instructor

Your Role

•  Monitor/defibrillator technology review •  Review Tachycardia Algorithm •  Discuss tachycardias •  Review team roles, responsibilities, and assignments for each case (see Lesson Maps 10D and 10E) •  Present cases for each student to manage — Additional details about student cases can be found on Lesson Map 10C •  Perform debriefing

Reference

ACLS Instructor Manual/CD ACLS Provider Manual Part 5 ECC Handbook, pocket reference cards, or crash cart cards

ACLS

10B

10B

Learning Station:

Tachycardia, Stable and Unstable

Algorithm and Tachycardia Review

Stable and Unstable Algorithm and Tachycardia Review •  Review the Tachycardia Algorithm (5 minutes) • 
Stable and Unstable Algorithm and Tachycardia Review •  Review the Tachycardia Algorithm (5 minutes) • 

•  Review the Tachycardia Algorithm (5 minutes) •  Review tachycardias (10 minutes)

— Sinus

— Atrial fibrillation

— Atrial flutter

— Reentry supraventricular tachycardia

— Monomorphic VT

— Polymorphic VT

— Wide-complex tachycardia of uncertain type

ACLS

10C

10C

Learning Station:

Tachycardia, Stable and Unstable

Roles

Station: Tachycardia, Stable and Unstable Roles Student Rotations in Learning Station Cases According to
Station: Tachycardia, Stable and Unstable Roles Student Rotations in Learning Station Cases According to

Student Rotations in Learning Station Cases According to Resuscitation Team Roles

The team leader will direct the actions of the other team members. (For example, the team leader will coach the airway management team member if performance of bag-mask ventilation is not making the chest rise.)

Team members will perform interventions as directed by the team leader. This is an opportunity for students to practice skills and receive feedback from the team leader. Students will demonstrate effective team behaviors (eg, closed-loop communication, clear messages).

The timer/recorder will check off critical action boxes on the Tachycardia Learning Station Checklist.

ACLS

10D

10D

Learning Station:

Tachycardia, Stable and Unstable

Rotations

Station: Tachycardia, Stable and Unstable Rotations 10 minutes per case Case Case Case Team Role
Station: Tachycardia, Stable and Unstable Rotations 10 minutes per case Case Case Case Team Role

10 minutes per case

Case

Case

Case

Team Role

1

2

3

Team leader

S3

S4

S5

Airway

S4

S5

S6

IV/meds

S5

S6

S1

Defibrillator

S6

S1

S2

Compressions (if needed)

S1

S2

S3

Timer/recorder

S2

S3

S4

This station is designed to allow 3 of the 6 students to be a team leader in this station and 3 to be a team leader in Lesson 9 (Bradycardia). Other assigned student roles may vary depending on the number of students at the station. Any additional students may be given roles as additional recorders. Cases may be run in a different order, but assigned student roles should not be changed.

ACLS

10E

10E

Learning Station:

Tachycardia, Stable and Unstable

Details for Case Rotations

Stable and Unstable Details for Case Rotations Directions for Case Rotations (3 rotations, 10 minutes each)
Stable and Unstable Details for Case Rotations Directions for Case Rotations (3 rotations, 10 minutes each)

Directions for Case Rotations (3 rotations, 10 minutes each)

(Instructors must conduct the scenario in real time)

 

•  Review assigned team roles from the rotation chart for this case

Start Case Scenario (6 minutes)

Ensure that students understand expectations of assigned roles (eg, “Your role is to use the bag-mask to give ventilations that cause the chest to rise”) •  Introduce the case by reading the Case Scenario •  Set the timer to 6 minutes •  Ask the team leader to begin managing the case •  Observe and coach

— Effective team performance

— Appropriate case management

— High-quality skill performance

•  Guide the team leader through management of the case

•  Stop the case after 6 minutes

Case debriefing (4 minutes)

•  Set the timer to 4 minutes •  Conduct a debriefing at the end of the case •  Ask the team leader to summarize the case, roles of team members, and areas for improvement •  Ask the timer/recorder to critique the case •  Give a summary of key concepts of the case

Total time for case:

10 minutes

Repeat for each of the remaining cases (Stable and Unstable Tachycardia)

ACLS

11A

Putting It All Together

0:00

0:00 95:00

95:00

ACLS 11A Putting It All Together 0:00 95:00 Resources •  AV equipment •  Megacode video • 
ACLS 11A Putting It All Together 0:00 95:00 Resources •  AV equipment •  Megacode video • 

Resources

•  AV equipment •  Megacode video •  Code cart or code kit •  Algorithms •  Monitor/manual defibrillator and simulator •  Manikins for CPR and intubation/ ventilation •  Stopwatch and countdown timer •  Megacode Case Scenarios (in Appendix A of ACLS Instructor Manual or on Instructor CD) •  Step stools

Student Role

•  Practice as team leader for a complete Megacode case

Student Objectives

•  Demonstrate team leader role for a complete Megacode case •  Clarify team roles and responsibilities

2 stations of 6 students each,

1 instructor per station

Your Role

•  Show Putting It All Together video (first part of Megacode video) — Highlight effective patient management through several algorithms •  Present a Megacode practice case for each student to manage (see Lesson Map 11C) •  Students may use ECC Handbook, pocket reference cards, or crash cart cards •  Perform structured debriefing

Reference

ACLS Instructor Manual/CD ACLS Provider Manual Parts 1-5 ECC Handbook, pocket reference cards, or crash cart cards

ACLS

11B

Putting It All Together

Video

ACLS 11B Putting It All Together Video 1. Show Putting It All Together video (first part

1. Show Putting It All Together video (first part of Megacode video) •  Highlight effective patient management through several algorithms

ACLS

11C

Putting It All Together

Practice Cases

ACLS 11C Putting It All Together Practice Cases 3. Present Megacode practice case for each student
ACLS 11C Putting It All Together Practice Cases 3. Present Megacode practice case for each student

3. Present Megacode practice case for each student (each case will be one of the following):

•  Bradycardia VF Asystole ROSC (Immediate Post–Cardiac Arrest Care) •  Tachycardia VF PEA ROSC (Immediate Post–Cardiac Arrest Care)

Present 6 Megacode practice cases, one at a time, 14 minutes each (10-minute case, 4-minute debriefing):

•  Determine team leader for first case (see rotations on next Lesson Map) •  Team leader organizes other students into team roles •  Present case •  Students may use the ECC Handbook, pocket reference cards, or emergency crash cart cards •  Team leader practices through entire Megacode case •  Give feedback, answer questions •  Rotate through all students practicing as team leader for remaining 5 cases •  Timer/recorder announces 2-minute intervals and checks off critical actions on Megacode Testing Checklist

Make sure students understand their roles and responsibilities in managing a Megacode case.

ACLS

11D

Putting It All Together

Rotations

ACLS 11D Putting It All Together Rotations   Case Case Case Case Case Case Team Role
ACLS 11D Putting It All Together Rotations   Case Case Case Case Case Case Team Role
 

Case

Case

Case

Case

Case

Case

Team Role

1

2

3

4

5

6

Team leader

S2

S3

S4

S5

S6

S1

Airway

 

IV/meds

Defibrillator

 

Team leader assigns other students to each team role.

 

Compressions

 

Timer/recorder

Cases may be run in a different order, but assigned team leader roles should not be changed. Each student must have the opportunity to run a complete Megacode case as a team leader.

ACLS

T1

Testing Details

ACLS T1 Testing Details
ACLS T1 Testing Details Resources •  Course groups list •  ACLS Provider Manual Student Role • 

Resources

•  Course groups list •  ACLS Provider Manual

Student Role

•  Prepare for competency testing

Student Objectives

•  Learn the competency testing for the Megacode and written tests

Large group, all students

Your Role

•  Explain the testing rotation for the Megacode and written tests •  Remind students that the passing grade for the written test is 84% •  Organize students into 2 groups of 6 for the Megacode testing stations

Reference

ACLS Instructor Manual/CD ACLS Provider Manual Parts 1-5

ACLS

T2

Testing Station Setups

ACLS T2 Testing Station Setups Recommended testing station setup: •  2 Megacode stations, 2 instructors, 6

Recommended testing station setup:

•  2 Megacode stations, 2 instructors, 6 students each •  Other testing setups are permissible as long as

— All students are given the opportunity to be tested as a team leader 1 time in Megacode

— The written test is proctored and secure

— The written test is not interrupted to move a student to the Megacode test

ACLS

T3

Megacode Test

0:00

0:00 60:00

60:00

ACLS T3 Megacode Test 0:00 60:00 Resources •  Code cart or code kit •  ECG simulator

Resources

•  Code cart or code kit •  ECG simulator and manikins •  Case Scenario (in Appendix A of ACLS Instructor Manual or on Instructor CD) •  Megacode Testing Checklist •  Step stools

Student Role

•  As team leader, direct a team in the simulated Case Scenario

Student Objectives

•  Successfully demonstrate competency as a team leader managing a simulated patient

Your Role

•  Provide Megacode Case Scenario — Additional details on Megacode test can be found in Lesson Maps T4 and T5

Reference

ACLS Instructor Manual/CD ACLS Provider Manual Parts 1-5

ACLS

T4

Megacode Test

Details

ACLS T4 Megacode Test Details •  Present Megacode Case Scenario: Bradycardia ➔ VF/Pulseless VT ➔

•  Present Megacode Case Scenario:

Bradycardia VF/Pulseless VT Asystole ROSC (Immediate Post–Cardiac Arrest Care) or Tachycardia VF/Pulseless VT PEA ROSC (Immediate Post–Cardiac Arrest Care) •  Using the Megacode Testing Checklist, test each student one at a time as he or she functions as team leader •  You must conduct the scenario in real time •  Students not being evaluated may function as team members •  Students may use the ECC Handbook, pocket reference cards, or emergency crash cart cards with restrictions (see ACLS Instructor Manual) •  Timer/recorder announces 2-minute intervals •  Take no longer than 10 minutes to test and give students feedback on their performance (pass/fail) •  Do not give hints or coaching during the test •  Deliver test results in a reasonably private environment for each student after completion of the Megacode test •  Rotate among all students •  Refer students who need remediation to remediation lesson

ACLS

T5

Megacode Test

Rotations

ACLS T5 Megacode Test Rotations   Case Case Case Case Case Case Team Role 1 2
 

Case

Case

Case

Case

Case

Case

Team Role

1

2

3

4

5

6

Team leader

S5

S6

S1

S2

S3

S4

Airway

 

IV/meds

Defibrillator

 

Team leader assigns other students to each team role.

 

Compressions

 

Timer/recorder

Students may be tested in any order, but each student must have the opportunity to run a complete case as a team leader.

ACLS

T6

Written Test

0:00

0:00 45:00

45:00

ACLS T6 Written Test 0:00 45:00 Resources •  Written tests •  Answer sheets •  Answer key

Resources

•  Written tests •  Answer sheets •  Answer key •  Annotated answer key

Student Role

•  Take the written test

Student Objectives

•  Successfully complete the written test with a score of 84% or higher

Your Role

•  Distribute the written test •  Proctor the test •  Collect and score each test •  Review the answers with the students •  Additional information about the written examination can be found in the next Lesson Map

Reference

ACLS Instructor Manual/CD ACLS Provider Manual Parts 1-5

ACLS

T7

Written Test

Details

ACLS T7 Written Test Details •  The written test is a closed-book test •  Students may

•  The written test is a closed-book test •  Students may not cooperate or talk to each other during the test •  When the student completes the test, grade the test •  Refer to the annotated answer key to discuss questions answered incorrectly •  Answer any questions •  Students who scored <84% need immediate remediation

— Make sure the student understands the errors and corrects the answers

— Give a second test or have the student verbally go over each item that he or she got incorrect, showing understanding of incorrect items

Do not interrupt the test to have a student go to the Megacode testing station

ACLS

REM

Remediation

ACLS REM Remediation Resources •  Written tests •  Answer sheets •  Answer key •  Megacode

Resources

•  Written tests •  Answer sheets •  Answer key •  Megacode Testing Checklist

Student Role

•  Undergo remediation as needed •  Retake tests as needed

Student Objectives

•  Successfully complete the written test with a score of 84% or higher after remediation •  Successfully complete the Megacode testing after remediation

Your Role

•  Review course material for each student who needs remediation •  Retest students as necessary •  Give feedback •  Evaluate competency •  For Megacode retesting, instructor may play multiple team member roles, or other available students may be team members