1. Bordelon, Sandra J. BSN, RN

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To the Editor,


Recently, the nursing staff of the Endoscopy Department of the Michael E. DeBakey Veterans Affairs Medical Center in Houston, Texas renewed our certifications in Advanced Cardiac Life Support (ACLS). This is a mandatory requirement along with a yearly training in Basic Life Support (BLS). Many of the class participants expressed their fears concerning their ability to remain proficient or competent in ACLS during the long periods between the classes. Several of us were searching for ways in which many of the standards of care in ACLS can be reviewed. We all want to be ready in every respect to care for patients in life threatening situations.


One of our instructors suggested that on a monthly basis, we select some aspect of care in ACLS and review it in detail. An example would be Pulseless Electrical Activity (PEA). We should define the process or, in other words, know that PEA is a heart rhythm on the monitor without a detectable pulse. Reviewing and learning the algorithm for each process is important.


PEA Algorithm


* P = problem solving, search for probable cause and intervene appropriately


* E = epinephrine


* A = atropine


To review the entire process, we would reinforce the basics of Cardio Pulmonary Resuscitation (CPR) and defibrillation:


* Check responsiveness


* Activate emergency response team


* Call for defibrillator or automated external defibrillator (AED)


* A Airway: open the airway


* B Breathing: provide positive pressure ventilations


* C Circulation: give chest compressions


* D Defibrillation: assess for and shock if needed



The principle behind this lesson is that practice makes perfect. The more we review, practice, and demonstrate the principles of ACLS, the more comfortable and proficient we become in this area of care. Endoscopy is such a specialized area and has many things unique to this specialty. Specialization is wonderful and does support excellent care, but we must remain aware that our patients sometimes have multiple problems or disease processes. We must be equipped to care for patients in emergency situations, providing quality care and maintaining the standards of the American Heart Association.


The idea of monthly reviewing a different aspect of ACLS in order to improve upon the competence and security of the staff providing patient care in emergency situations was something I wanted to share with fellow nurses around the country. I look forward to hearing from other nurses with their suggestions of things they have done that really work in their practice setting.


Sandra J. Bordelon, BSN, RN


Michael E. DeBakey Veterans Affairs Medical Center Houston, Texas