MBBS? Medical Officers?
CCNEPal will be available to train MBBS students in Cardiac Life Support, and is working to schedule this with some hospitals (I will announce more when dates are confirmed).
When we teach this to nurses, we spend more time reviewing basic science, and three days seems to be a good allocation of time.
The doctors have studied more science courses already, so we don’t need the anatomy lab, for example. We can deliver the content in two days’ time if we move along rapidly.
this course uses the latest algorithms from the American Heart Association (AHA) , and relies heavily on teaching techniques used in AHA’s course titled Advanced Cardiac Life Support (ACLS), but it is NOT an “official” ACLS class leading to an “ACLS card” from the AHA. please read previous blog entries on this issue if you need clarification. An “official” course would be too expensive to offer in Nepal.
If you are ever thinking of someday taking an “official” ACLS course, you may wish to enroll in this one now, so you get an idea of what it involves. In USA, most people spend six weeks doing a prep course of some kind, before their first ACLS course.
and now, the course outline for the 2-day course
“Bringing Critical Care Education to the Himalayas”
Critical Care Assessment and Advanced Cardiac Life Support (ACLS) Training
Program Schedule Day One
|0800 – 0830||Inauguration:Welcome speech||dignitaries|
|0830 0915||Overview of course. Assessment of class knowledge and demonstration of successful teamwork (expected class outcome)The “six basic rhythms” and the twoABCD 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.
|1030 –||Break for chiya|
|1100- 1230||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)|
|1315 -1400||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.|
|1400- 1500||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.|
|1500- 1545||Use effective teamwork and communication skills for successful intervention in critical situations||ROUND FOUR of small group teamworkIncluding 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)
|1545- 1600||Description of next days training|
|0800 – 0805||Introduction|
|0805 to 1030||Tachycardia algorithm.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||chiya|
|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||lunch|
|1330 to 1400||Large group scenario with debriefing||Ethical issues regarding resuscitation|
|1400 to 1445||Group study||Work with group members for final review|
|1445 to 1545||Final exam, group by group|
|1545 to 1600||closing|
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.