Working for a children’s hospital as a Respiratory Therapist, we see plenty of emergencies from broken bones, seizures, asthma, croup, and unfortunates like crib death syndrome, overdose and drownings. There have been many times when my team has used the ACLS guidelines and for most of the patients we have had been able to stabilize there and eventually go home. Unfortunately, sometimes there are a few who, even with our efforts and following the algorithms, we have not been able to save. Those are the sad stories and shows us how life is a precious thing no matter how old or young they maybe.
During my clinicals, we rotated from the oldest of adults to the tiniest and youngest of children. I remember many of the patients for whom we could use the ACLS procedures to stabilize a patient. I have noticed that because we had a plan in place, we each knew our roles, we each knew what was expected of us, and we each had a guideline to go by, therefore the patient was well taken care of in a coordinated manner while being less hectic for the team method and be less hectic on what to do. This is good for the patient and their family as they watch the team do their best to stabilize the patient. They see a good, coordinated flow and not a jumbled chaotic team yelling at each other or doing things independently that may bring more harm than good to the patient. The ACLS guidelines gives us a method to make sure nothing is missed. The algorithm shows step by step what can be done till the patient is stabilized. In using the guidelines, I have seen patients be stabilized quickly, not overdosed on critical medicines or receive medicines that should not have been given. Also, with this method, much of the guess work on “what to do next” is taken out of the equation.
One young lady comes to mind as a demonstration of how using the ACLS guidelines were beneficial. This teenager had come to us unresponsive and with no pulse due to a drug overdose. The ambulance crew has started ALCS and were currently doing compressions. I took over the airway care, and another Respiratory Therapist took over the compressions doing the 15:2 method. I personally like this method because it allows to me to keep compressions going which in turn keeps blood flowing through the body. Then giving fresh oxygen with the 2 breaths gives the body a way to exhale the carbon dioxide, and is replenished with fresh oxygen. Without this, the patient might get to much air in the stomach and the compressions will not be as effective thus delaying the blood flow we need to keep the brain alive and bringing the vital medicines flowing throughout the body. The Nurses and Doctors started the other part of the algorithm giving epinephrine and atropine as needed in the sequence as suggested on the information sheets. We have been taught in our ACLS classes to switch team members on compressions every 2 minutes to reduce compression fatigue. We followed this guideline religiously. During this time, all of us were communicating our actions and confirming orders between team members while considering the next steps.
Thankfully we did not reach the stage to intubate, the patient started to gain a pulse, thus we stopped compressions when her heart rate reached 80, blood pressure, saturations and pulse became strong and she started to open her eyes. We had revived her and all of us were excited to see her back and stabilizing. The parents of the patient had arrived during our efforts and were crying with happiness and relief. They thanked the team whole heartedly.
This is just one of many stories I have where ACLS training has come in handy. With every emergency patient, we get we use our ACLS guidelines, learning from and supporting from each other while we stabilize the patient. This is an important aspect of our care to our patients, it brings a team together no matter our roles. From the Doctors, to the Nurses, to the Respiratory Therapist and the Technicians, we all have found a way with this program to be stronger as team members efficiently working together to move a patient towards becoming whole and eventually going home with their families.
Thanks to the team effort and the ACLS emergency guidelines we were able to help a teenage recover and hopefully grow into adulthood remembering what drugs did to her and how she had survived it with the help of our team.