Working in nearly any capacity in healthcare can be a highly demanding, stressful, and traumatic endeavor at times. Movies and television programs usually depict the drama and the heroics, but very few capture what it is like in reality, the impact that it can have on both the patient and the provider. For many people, being in the hospital must be like an episode of Grey’s Anatomy. That’s what they see. However, for those who are caring for patients in real life, it is a much different portrayal. I personally see the differences in my capacity as a registered nurse working in the intensive care setting.
When the situation arises where ACLS is needed, it can be either extremely chaotic or it can play out like the textbook. One can become familiar with the necessary algorithms, medications to be administered, actions to take, their sequence, and gain a sense of knowledge simply by completing the required training modules. One can even practice with a mannequin and be checked off with one hundred percent satisfaction. Then comes the first time that knowledge and those skills have to be used. When that situation occurs and for every time afterward, there are two choices. One can panic and hope that someone else knows what to do, or take charge utilize the knowledge that he or she possesses from being proficient with BLS and ACLS.
The first time I witnessed someone go into cardiac arrest, I was terrified. A man came in through the emergency department complaining of chest pain and was vomiting blood. Shortly after being placed on a hospital bed, he fell over and stopped moving. I yelled for help. Before I knew it, the room was full of people. Someone shouted, “Get a back board!” Another shouted, “Put the pads on!” I was told to begin doing chest compressions in the midst of what I perceived to be chaos. People were moving all about, someone with IV medications, someone trying to secure an airway, someone asking about minutes that have passed since this or that.
In the middle of this, I remembered that I had taken the courses and I had been checked off. But then I began questioning myself. How many chest compressions should I be doing per minute? Am I going to fast? Am I going to slow? How can I tell what rhythm this guy is in? Should epinephrine be given or was it the other drug? Once he is intubated, how many breaths per minute is he supposed to receive? How far apart are the IV medications supposed to be given? Does he have a pulse? How can I really tell if I feel a pulse? This was so easy when I took my class. I had all of the answers when the mannequin was in front of me.
Unfortunately, the man did not survive. He was shocked multiple times, was given many doses of epinephrine, and had received CPR from the moment he fell down until the physician pronounced him deceased. I had just watched a man die in front of me. There was blood covering his face and chest from where he had vomited. There was blood on the bed, the floor, and room equipment. Then the questions came flooding through my mind. Did I do something wrong? What should I have done? What would I have done if the doctor and nurses had not been in the room? Could I have saved him if I had been in charge? I felt paralyzed.
The reality of working in healthcare is that you really do hold another person’s life in your hands at times. There are times when you are the one that others look to for answers. By taking BLS and ACLS courses, you have the answers to the important questions if you pay attention and approach learning with the attitude that others may die if I do not get this right. By simply learning the algorithms and remaining calm, the rest will follow. Sometimes you will save a life. Other times people will die regardless of your best efforts. The reality can be a lot to take in. It can be a lot to process.
People go into healthcare fields for a number of different reasons and pursue a wide array of career paths. The one commonality shared among all healthcare workers is the desire to help others. Some accomplish this by becoming doctors, others nurses, and some by working in labs, hospital cafeterias, housekeeping services, and even law. Some have greater knowledge and training to save lives than others. Some are better positioned. Regardless of where one may fall in the huge gambit that is healthcare, being dedicated to becoming proficient in both BLS and ACLS can be the determining factor in the outcome of someone in need of life-saving care.