I have been asked to share the hour-by-hour schedule and the objectives, for the course in Advanced Cardiac Life Support, that CCNEPal uses when we teach a class of MBBS docs.
here it is, in all it’s glory. First, the Schedule:
“Bringing Critical Care Education to the Himalayas”
Critical Care Assessment and Advanced Cardiac Life Support (ACLS) Training
Program Schedule Day One
|0800 – 0830
||Overview of course. Assessment of class knowledge and demonstration of successful teamwork (expected class outcome)The “six basic rhythms” and the two ABCD surveys for ACLS. (NSR, brady, tachy, asystole, VF, VT)
Review of CPR algorithm.
Discussion of electrical safety issues and ground rules
How to use scenario and how to use algorithm. For this course we will systematically review the “ten core cases” from American Heart Association. Over next days we will go over these group by group.
|rules for good communication during stressful situation. How to be a good team leader and good team member during emergency.Review of CPR (practical) and bag-valve-mask, with sound track.
Short lecture then demonstration by instructors about what successful team will look like after three days.
Break up into groups for
ROUND ONE of guided small group practice with personal feedback and repetition of skills while being videotaped. Use of smartphone video for feedback and critique.
||Break for chiya
||Four possible outcomes of defibrillation, Universal algorithm.
Short lecture then scenarios with feedback.
|TWO monitor/defibrillator units are needed for this. ROUND TWO Scenarios will include universal protocol.
Also will need three bag-valve-mask devices and some airway equipment. (will bring the mannikins for CPR)
||Short review of morning teamwork skills. Bradycardia algorithm; Acute Coronary Syndromes Algorithm (top half). Discussion of 12-lead ekg (bottom half of ACS algorithm.)
||ROUND THREE of small group teamwork skills. “live” manikins for this scenario. Depending on size and skill level of group and number of assistants available, we will break up into groups and rotate between stations.
||Specific supervised practice with defibrillator, for this we will break up into two groups, one goes to ER the other to ICU to familiarize with actual defibrillator.
||One-to-one supervised practice. Emphasis on safety. Both sync and unsynch.
|Use effective teamwork and communication skills for successful intervention in critical situations
|ROUND FOUR of small group teamwork
Including respiratory arrest with pulse; airway scenarios.
Using tables in classroom or stretchers.
IV pole with no-longer-sterile IV bag and tubing, other props as needed. (see equipment list)
||Description of next days training
|0800 – 0805
|0805 to 1030
Then small group scenarios.
Rhythm review using AT-35 simulator. (two groups)
|ROUND FIVE as above, skills will be reviewed in groups with detailed performance feedback given Small group practice. Handout.
|1030 – 1100
|1100 to 1300
||Special scenarios related to unusual conditions. Review of second ABCD survey to determine less-frequently occurring scenarios ( hypothermia, drug overdose, renal failure, weedkiller overdose therapy, etc.) focus on MD role in 5H and 4T
||ROUND SIX special scenario, also learning to go flexibly from one page of protocol to “put it all together” in megacode
|1300 to 1330
|1330 to 1400
||Large group scenario with debriefing
||Ethical issues regarding resuscitation
|1400 to 1445
||Work with group members for final review
|1445 to 1545
||Final exam, group by group
|1545 to 1600
Prior to class – students will be given large electronic file on ecg rhythms for study, also protocol handouts.
Notes about classroom setup – we need a classroom that can hold about thirty people, preferably with flat floor ( not a sloping auditorium) and no carpeting. Ability to sit at tables so as to work with handouts and sample strips. Whiteboard or blackboard with colored marker pens and or colored chalk. A computer monitor for powerpoint is ideal but not necessary. When we break out into small groups, it is preferable to use adjacent spaces so as to keep noise level down. We are flexible about this. Screens can be used.
Notes about equipment: we need two monitor-defibrillator units to which we will attach the AT-35 rhythm simulators. If you have CPR manikins those would also be good but not mandatory. Also, three or four IV poles with IV bag and tubing (these can be nonsterile ones that would be otherwise discarded) and bag-valve-masks and airway equipment. If you can bring two or three patient stretchers that would be good but if not we can use tables instead.
Students bring a smartphone if they have one with video capability. Their own pen and notebook. Pen drive. Wear clothes suitable for activity including kneeling on floor and bending. Bring a small blanket to lay on floor if worried about getting dust on clothes. See above list of special supplies for day two.
Next, the course objectives and teaching methods:
Course Objectives for 2-day course in ACLS
CCNepal “Bringing Critical Care Nursing Education to the Himalayas”
Joe Niemczura, RN, MS CCNEPal2013@gmail.com Joe.niemczura1 (Skype) 9801096822
This is a training course in Advanced Cardiac Life Support (ACLS) skills adapted from the American Heart Association specifically for MBBS doctors and interns in Nepal. It is two consecutive days in length, eight hours each day, but could be conducted over three days of about six hours each. I taught this at CMC, CMS and LMC in 2014. Note; it is NOT the “Official” AHA ACLS course.
Objectives At the completion of this course, the participant will:
Identify the lethal cardiac rhythms on a monitor, and use the “Six Rhythms” method of ecg interpretation.
List the correct dosage and administration for the most commonly used pharmacotherapeutic interventions in Emergency Cardiac Care.
Learn and apply the BLS and ACLS Survey.
Describe elements of initiative and decisionmaking in critical care that apply to the medical leader of a team, and examine personal goals related to this role in medical practice.
Apply the treatment protocols consistent with the American Heart Association guidelines for Emergency Cardiac Care, in typically recurring scenarios, especially the “ten core cases”
Use effective teamwork and communication skills for successful intervention in critical situations
Students must attend all sessions of the course. Part of each day will be devoted to lecture, small group work, and discussion. A key feature of this course is “Megacode” – a simulated emergency situation in which small groups of participants are assembled and expected to respond in teams, then given personalized feedback about skills performance. The afternoon session of each day is devoted to megacode practice so that all participants are given time to get feedback.
There will be a final exam at the end of this course, which will consist of a team response to a simulated “Megacode” scenario.
Handouts are provided by CCNEPal free of charge. Participants will be given course materials on pen drive. CCNEPal and Joe Niemczura do not accept compensation for this course.
A session of the 2011 course was videotaped and edited for use on YouTube. This is the best description of the teaching style and the focus on Megacode. The URL for this is:
Teachers of this course
The Principal Faculty for this course is Joe Niemczura, RN, MS who holds licenses as a Registered Nurse in both USA and Nepal. During the academic year he is a faculty member in the School of Nursing at the University of Hawaii in Manoa, (part of Honolulu). He has made seven trips to Nepal. In 2007, 2008 and 2009 he taught at Tansen Nursing School. In 2011 and 2013 he was based in Kathmandu and taught critical care nursing skills. He is on leave from the University for the academic year 2014-2015. He has a Bachelor’s degree in nursing from the University of Massachusetts at Amherst (1977) and a Master’s degree in nursing from the University of California at San Francisco. (1981).
Mrs. Radha Bangdel, Campus Chief of Lalitpur Nursing Campus
Mrs. Shakuntala Thanju, Principal of Tansen Nursing School
Rachel Karrach, MD, administrator of UMN Hospital, Tansen Palpa.
Niranjan Sharma, MD, Medical Director of UMN Hospital
Mrs. Sita Parajuli, Matron of Purano Medical College, Bharatpur
Dr. Gautam Bajracharya, Chief of Anesthesia at Nepal Medical College, Jorpati
Dr. Manohar Pradhan, Chief of Emergency Services at College of Medical Sciences, Bharatpur
Dr. Rano Piryani of Chitwan Medical College
Mr. Gopal Pokharel, Lumbini Medical College
Dr. Rajendra Khoju, KUMC in Dulikhel.