ACLS Megacode 2010 Guildlines Treating V-Fib

[TheBrewingMedic]

@jordanld, sorry man but you made yourself look ridiculous with your "when is the last time a medic pushed epi or amiodirone" comment. We carry anywhere from 30 to 50+ emergency medications depending on the agency you work for. Cardiac meds are a huge part of that, Epi, Vasopressin, Amiodirone, Lidocaine, Atropine (recently removed from ACLS protocol) are the heart of our "Code" drugs, next you'll say we dont intubate, stop now we carry a full array of ET tubes, combitubes and the new I-gels

[TheBrewingMedic]

@903629338, starting a peripheral line in a "clinical" setting aka, moving ambulance is not that difficult, and doing so during compressions is actually helpful as you only get flash if blood is moving. As an ACLS instructor I could list a half dozen errors in their near "flawless" performance, although it was done well enough to pass

[903629338]

In real clinical situation, it's really hard to put on an IV line during chest compression!

[tweakz20]

what's the point of using a device to set the beat if the dude completely ignores it

[JasonYoungMD]

Interesting videos on ACLS - complements the videos I uploaded.

[BUD22able]

@Jordanld, have you ever been in the back of an ambulance?

[led3excelnsgstud]

Great cudos to Master Train for producing great instructors to train all students attending their diverse programs! Some of these You Tube guys don't know what time it is. I participated in the ACLS Provider Course this weekend, and the classes were very organized and informative. Thanks Master Train!!!! I see you guys in a few years. :-)

[rn87mom94]

they said he was a diabetic. why didn't anyone check a bs after the first shock? all our known diabetic arrests get a bs!

[jakesGOTstyyle]

Also, a good SAMPLE HISTORY could be beneficial.

[jakesGOTstyyle]

First off, you have eight people there. Think about intubating. Capnography would people ideal especially when seeing quality of compressions.

First Epi in at 4:03

Amiodarone in at 6:08

Second Epi in at 7:14

Thats a no-no

[zaxterry]

this video is so damn slow going. poor quality i could not a grasp out the video because it was so slow running

[LucidExposure]

Get the ACLS manual for cheap here:

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[L2b1serval]

Those who are complaining about them not placing an advanced airway, taking too little time to check pulse or doing compressions before rescue breathing obviously haven't seen the new guidelines. There is much less emphasis on airway and much more on CPR

[oldscout28041]

six mins. without placing an advanced airway? FAIL!! If you think it's hard to run a code stationary with 8 people then try doing it solo doing 60 mph... backwards!

[oldscout28041]

@oldscout28041 And she has the algorithm in her hand!

[AWAYTOCHANGE]

Is it 30-to-2 for two man CPR or 15-to-2. With 15BPM to two vent. = 30 BPM to 4 vent.  instead of 30 to 2.

[Tindamayor]

should have 1 compression in half a second. the compression here as i can see is slow, you should push harder and push faster.Communication should be emphasized because its vital to work as 1 team.the leader should communicate well with his team. like stop compression,lets analyze rhythm the patient is in VFib, defib pt at 200 joules. then continue venti and compression lets give meds.

[mexguy411]

I hope to god I never encouter these people for a mega code

[Jordanld]

To giffstyle...You "medics" may be "superior" in code management but the reason why so many RNs and MDs are involved in codes in the ER is because they are the ones calling out orders and pushing the drugs. Since when has a paramedic pushed epi or amiodarone?You obviously have no understanding of what goes on in a code if since you say you would rather code in an ambulance.

[captmercer]

@Jordanld Ok well apparently you dont know what the hell your talking about either. I have pushed so many damn code drugs without a "special" "MD, DO, RN, or any other Advanced care provider" that I have lost count. Who gives a damn what they want. Last time I checked the "DR" was not out in the freezing cold working his ass off trying to revive some one in their home. Oh and BTW, EPI and AMI, would be the first line drug pushes in certain codes! Stupid Idiot!! From all my fellow MEDICS and FF.

[gmacdono]

@captmercer Any medic worth their salt should care what the "DR" wants, because they want the same thing any good medic should want: a patient that is able to walk out of the hospital healthier than when they came in.

[andrewsapirate]

@captmercer I love you!

[kingbear3472]

@Jordanld You have NO idea what you are talking about.....Medics do it ALL in a uncontrolled setting!!

[mypawgi]

@Jordanld

have you ever tried doing ASSESSMENT, CPR, INTUBATION, IV INSERTION, and VENTILATION in a MOVING AMBULANCE...i bet NOT...we MEDICS respect the DOCTORS and RN's because we're in the same field...but in terms of the superiority in ACLS...i must agree...EMT/PARAMEDICS can do it ALONE...while our partner is driving...and in a UNCONTROLLED ENVIRONMENT...not like in the HOSPITAL SETTING (which is a CONTROLLED ENVIRONMENT) where u need 8-12 persons

but hats off to EMT, RNs & DOCs

[andrewsapirate]

@Jordanld are you an idiot? Medic's push drugs all of the time, especially the drugs you mentioned in certain codes.  I work in a county ambulance service, and the town hospital will often call medics to do intubation for the because of a medics experience. You have absolutely no idea what you are talking about. You are just another snob in med school excited for the day someone calls you Dr. Dickface. Medics don't do this shit for the money, you do. ASSHOLE

[pureadrenalin9019]

Oh, and let's not mention the fact his pulse check was 3 seconds and nobody checked the airway. No possible way you can call this a perfect code to AHA standards. Had I been testing the team, it would have been a failure. 

[fafinaf]

Thanks for uploading this.

[sandvin4u143]

they are not pausing for ventilation....he is using ambu bag for ventilation

[giffystyle]

i must say id much rather code in an ambulance than an er. No offense to you docs and rn's, but medics are superior in code management. sorry. and there is usually only 2-3 of us compared to a code in hospital when atleast half a dosen people are running around the pt. I see it all the time. its crazy

[TaiChiKnees]

A nice demonstration, and I like that you've got it here with the training dummy so students interested in going into healthcare can see what real compressions are supposed to look like, as well as how orderly a code really goes in the hospital. Thanks.

[alex1919018]

CPR IN BED ?

[edelweissgirl]

@alex1919018 ... you don't see it here in this video, but one of the first steps everyone is trained to do is place the cpr board that is located behind all crash carts under the patient then proceed with CPR. This video probably started filming after this step I would assume.

[Paramedic18791]

@alex1919018

that's possible in hospital... just LOCK the bed up

[mzmedic]

wow we don't check breathing or give breaths before checking the pulse and defibing? Not perfect at all....

[BoscoWillaby]

They don't check the rhythm before giving the second or third shock

[DrSkawman]

You're right... No monitor check before shocking pt. ¿any one knows why? LP 10 has no CPR filter...

Congratulations to the guy on blue shirt. He follows "tic-tac" perfectly to accomplish 100 c.p.m.

[MasterTrainInc]

@BoscoWillaby

They stop CPR, she looks at the monitor over the patient's bed where she sees V-Fib and orders a shock.

[pmcgill54]

But obviously an excellent resus - sorry i should have said that first

[pmcgill54]

I thought the epi should have been followed immediately by the 3 rd shock?

[DrSkawman]

Epi or Vasopresin should be pushed inmediately following the second shock. After third shock, antiarrhythmics (amiodarone, lidocaine) should be used if still VF/pVT.

After drug administration, arm should be lifted for 20 sec. and 20 cc of saline must be pushed in the IV (20/20 technique).

Good code though.

[nursemell2000]

Uh oh! They didn't switch compressors after the first 5 cycles of CPR... Tisk, Tisk...

[MasterTrainInc]

You are correct. However, high-quality chest compressions were started within 20 seconds of the arrest and they were effective. Anthony is going to medical school to become an E.D. doctor. He is a pretty big guy and he does really good CPR. He took us to the first shock. He wasn't winded so he continued to the second assessment. How do we know his compressions are effective? Because we use a high fidelity simulator!

[pureadrenalin9019]

@MasterTrainInc Compressions aren't even in time with the metronome. And, whether he is winded or not, the change still needs to occur, you can watch his compressions become irregular, and less in depth as the code continues.

[cash434]

WOW!!!