# ACLS- ACS/Stokre???



## ethomas4 (Jan 28, 2012)

Does anyone know if the 2012 ACLS written and skills tests include ACS and stroke questions/algorithms??

if so how in depth does it get? will we have to runan acs and or stroke scenario?


thanks have a great night!!


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## NYMedic828 (Jan 28, 2012)

ethomas4 said:


> Does anyone know if the 2012 ACLS written and skills tests include ACS and stroke questions/algorithms??
> 
> if so how in depth does it get? will we have to runan acs and or stroke scenario?
> 
> ...



ACLS is like 25 questions... how in depth can it possibly get.

Not to come off as a ****, but I would hope if you are an ALS provider you could run an ACS or Stroke studying or not...

ACLS stands for "Advanced Cardiac Life Support"

A stroke is a BLS call. Atleast in my region there is nothing we can do but Start a lock, give O2 and rapid transport.

Your class will focus on megacodes and antidysrhythmics primarily.


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## ethomas4 (Jan 28, 2012)

thanks nymedic..I am not an ALS provider but I have to take the class for my job. I have not figured out why, but hey good learning opportunity

thanks for the response


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## NYMedic828 (Jan 28, 2012)

ethomas4 said:


> thanks nymedic..I am not an ALS provider but I have to take the class for my job. I have not figured out why, but hey good learning opportunity
> 
> thanks for the response



Many hospitals require it for ER techs and whatnot so they can start IVs and draw blood as well as assist in cardiac arrest situations more readily.


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## NomadicMedic (Jan 28, 2012)

If you're not an ALS provider, it's basically useless for you to take the course. Do you have any experience in interpreting ECGs? Are you familiar with any of the ACLS algorithms and why we do what we do? 

Just taking the class doesn't give you permission to perform any of the skills or interventions. It's just another "merit badge" class, that has no value for anyone who isn't certified to perform the interventions.


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## NYMedic828 (Jan 28, 2012)

n7lxi said:


> If you're not an ALS provider, it's basically useless for you to take the course. Do you have any experience in interpreting ECGs? Are you familiar with any of the ACLS algorithms and why we do what we do?
> 
> Just taking the class doesn't give you permission to perform any of the skills or interventions. It's just another "merit badge" class, that has no value for anyone who isn't certified to perform the interventions.



One of the kids at my volly FD just got hired as an ER tech.

The requirements are being an EMT, and he has to take ACLS through them. He is trained via the hospital staff to start IVs and draw bloods but he has to take ACLS for some reason. 

Didn't even occur to me that he would have 0 knowledge of EKG interpretation. I went over briefly recognition of shockable rhythms in my last AHA CPR course that I taught but AHA doesn't really like deviation from their curriculum -_-


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## Handsome Robb (Jan 29, 2012)

NYMedic828 said:


> ACLS is like 25 questions... how in depth can it possibly get.
> 
> Not to come off as a ****, but I would hope if you are an ALS provider you could run an ACS or Stroke studying or not...
> 
> ...



The new test is like 50 questions but who's counting? 

Agreed about strokes being a ILS/BLS call. Our hospitals like a minimum of 2 lines, 3 if we can get em.

ACS is easy, MONA. Morphine, o2, nitro, aspirin with appropriate indications of course.

Strokes aren't hard either, just know your stroke screening tool. A real, real easy way to remember it is FAST. Face (smile), arm drift, speech, Time (last normal). That's pretty simplified. If a pt is obviously slurring their words already please don't ask them to say a stupid phrase...it's repetitive and frustrating to the pt 

Like NY said, it'll be a megacode for your test.


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## TheGodfather (Jan 29, 2012)

NVRob said:


> The new test is like 50 questions but who's counting?
> 
> Agreed about strokes being a ILS/BLS call. Our hospitals like a minimum of 2 lines, 3 if we can get em.
> 
> ...



that screening tool is in the process of being updated as it is only sensitive to left and right hemisphere strokes and not so much brainstem/cerebellar, or hemorrhagic... 

new criteria (in a nutshell, from memory) from ASLS algorithm

initial questions:
-age
-was there a fall?
-any chance of seizure?
-what is the blood glucose level?
-did they take blood thinners in the past 24 hours?


initial assessment:

1) speech - repeat "you cant teach an old dog new tricks"

2) arm drift

3) facial droop

4) coordination (finger to their nose to your finger and back) both hands
----foot to opposite leg's knee and slide downward and back to starting position. ----both legs
----be sure to note ataxia as this is a sign of strokes affecting the cerebellum.

5) sensory (have patient close their eyes and say yes every time they feel you touch them -- touch them on both sides -- upper and lower extremities)---can you feel it? does it feel the same? any loss of sensory?

6) focal/neuro (have patient look straight at your face - put both of your hands out into their peripheral vision space -- have patient while continuing to look at you say "yes" when they see your fingers wiggle.. wiggle fingers 1 hand at a time at different intervals) ---- also note pupillary status including ROM.


*REPEAT, REPEAT, REPEAT* note changes.

keep patient flat, keep ambulance cool/cold, 2L o2 (too much will cause cerebral vasoconstriction, keep it at 2L) 1 large bore IV in the AC if possible minimum.


pretty sure that covers the jist of the new criteria....




PS---if the patient is slurring their speech, ASK THEM TO SAY THE PHRASE ANYWAY... this is part of the assessment, if they dont like it, tough $hit. hospital will ask this when they recieve the patient if you do not...


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## Handsome Robb (Jan 31, 2012)

TheGodfather said:


> that screening tool is in the process of being updated as it is only sensitive to left and right hemisphere strokes and not so much brainstem/cerebellar, or hemorrhagic...
> 
> new criteria (in a nutshell, from memory) from ASLS algorithm
> 
> ...



I'm not a fan of asking them to repeat a phrase if they are already slurring or using inappropriate words, but to each his own. If during your other assessment they are using inappropriate words rather than slurring (aphasia vs. dysarthria)  that assessment point has already been met, but like I said, to each his own.

I agree with everything else you said, but at the basic level it's a bit much. With the current education standards and with the OP worded his question it doesn't sound like he is ready to go that in depth, he's just trying to get through ACLS. No offense to the OP, that's just how I'm reading it.


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## ethomas4 (Jan 31, 2012)

Thanks for the responses.

The original post was a simple question regarding the content of the acls course. I wanted to know if in class I would be put through a scenario and get to the point of having to decide to give labetalol or nicardipineor go through the steps taken in a hospital. That would benew to me. Im studying it anyway but I just wanted to know.

I am not an als privider, I am an emt b in the usa and an advanced emt II outside of the states, im not fresh out of emt b school. I am confident reading ecgs, I know the meds etc. acls wont really help me in the usa but outside it will thats why im taking it, plus my job. I have a unique background and sometimes I have to fill in thetraining gaps. I got a winter emt job and they want me to takethe course, I was told they want everyone to know it, which is fine by me even though I wont be allowed to use it here.

Thanks for the help


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## TheGodfather (Jan 31, 2012)

NVRob said:


> I'm not a fan of asking them to repeat a phrase if they are already slurring or using inappropriate words, but to each his own. If during your other assessment they are using inappropriate words rather than slurring (aphasia vs. dysarthria)  that assessment point has already been met, but like I said, to each his own.
> 
> I agree with everything else you said, but at the basic level it's a bit much. With the current education standards and with the OP worded his question it doesn't sound like he is ready to go that in depth, he's just trying to get through ACLS. No offense to the OP, that's just how I'm reading it.



Would you not palpate the chest wall after a trauma because the patient states he/she is having pain? Yes, there likely would be an injury, but we cannot pinpoint where this is stemming from without doing our proper assessment.

The reason why you should have the patient repeat that phrase (as stupid as it may sound) is because it better helps you pinpoint where the source of the stroke may be occurring...

example: 

*Left hemisphere:* patient will say things like, "can't truck" "can't tricks" "teach tricks" in a sporadic and aggravated manner.
---these words aren't "inappropriate" (aphasic), they are just unable to be said in the correct way. the patient will be "tongue twisted".. patient may be able to put other strings of sentences together correctly. 
*Right hemisphere:* there will be no deficit
*Brainstem:* pt will be slurring (dysarthric) at a maximal level. words will barely be able to be understood. pt will continue telling you the room is spinning.
---this reflects a cranial nerve abnormality.
*Cerebellum:* there will be no deficit
*Hemorrhagic:* there will be no deficit

bottom line: the doc will ask you what abnormalities you found on the assessment. dont let him catch you say "oh, i saw he was slurring so i skipped that step", not sure about your EDs, but where I'm from, they will burn you for that.

if patient is slurring speech where you would otherwise would suspect he is not, that would be time to get the family involved; any alcohol/drugs - (suspect coagulopathy), history of stroke? past deficits? SAMPLE.


Also, this criteria is designed for basic or advanced providers. Being a paramedic/paramedic student is not the end all be all of patient care. EMT-B's are far from being incapable of performing these steps, and as I stated earlier, ALL components of these steps should be performed on every suspected stroke patient you come in contact with. The entire process should take you no longer than 2-3 minutes, and there is no reason why these steps couldn't be performed as your en route to your destination.


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## TheGodfather (Jan 31, 2012)

^^ i guess the point im really trying to make here (without sounding like too much of an a-hole) is don't skip part of an assessment (no matter how small), if all it takes is 3 extra seconds...


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## NomadicMedic (Jan 31, 2012)

ethomas4 said:


> Thanks for the responses.
> 
> The original post was a simple question regarding the content of the acls course. I wanted to know if in class I would be put through a scenario and get to the point of having to decide to give labetalol or nicardipineor go through the steps taken in a hospital. That would benew to me. Im studying it anyway but I just wanted to know.
> 
> ...



In short, no. You'll be expected to know how to work a cardiac arrest and assess a stroke.


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## NYMedic828 (Jan 31, 2012)

ACLS is not really meant to teach you about the heart or the body, its assumed you already have this knowledge in your background. ACLS is meant to teach you to work as part of, or lead a team in a hospital or per-hospital setting and provide the appropriate care in the most efficient manor possible.

The skills groups will basically just be megacode after megacode. 

When I took ACLS like 6 months ago, the drugs that pertained to the program were.

Lidocaine
Procainamide
Epinephrine
Atropine
Amiodarone
Vasopressin
Magnesium Sulfate

Did I miss any?


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## DPM (Jan 31, 2012)

NYMedic828 said:


> When I took ACLS like 6 months ago, the drugs that pertained to the program were.
> 
> Lidocaine
> Procainamide
> ...



Dopamine and MONA for the ACS side of things. 

And there's rTpa and all that other fun stuff but nothing that we would use.


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## Handsome Robb (Jan 31, 2012)

DPM said:


> And there's rTpa and all that other fun stuff but nothing that we would use.



Depending on where you are in the country and if you're working in a rural setting, some services have paramedics administering fibrinolytic therapies in the field. 

We spent time on it in class. 

TheGodfather: last time I checked aphasia was a clinical symptom of a stroke. Confused, "tongue twisted" speech would meet that category being that the words are inappropriately placed, that's how a neurologist explained it to me in the ICU the other day. He was the one that told me not to ask pts to repeat such phrases if I already observed deficits and could communicate aphasia vs. dysarthria to the receiving hospital. Again I'll say it, to each his own.

There's no reason to be rude about it.


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## BandageBrigade (Feb 1, 2012)

NYMedic828 said:


> ACLS is like 25 questions... how in depth can it possibly get.
> 
> Not to come off as a ****, but I would hope if you are an ALS provider you could run an ACS or Stroke studying or not...
> 
> ...



A stroke a bls call? Really? Ever had a stroke patient start to seize? Posture? Need airway support? How about checking a bgl(some places basics cannot) what if hes hypoglycemic?, 12 lead? IV? Just because its "easy" or not alot for you to do, that does not make it basic.


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## DPM (Feb 1, 2012)

I'm sure we can all think of a situation where any call would deserve / require ALS so I don't think that's a valid argument. 

I agree with you on blood glucose (which should be a BLS skill anyway...) but there are a lot of stroke PT who fall outside the 3/4 hours window and have no other serious "issues". As long as the dispatch criteria are robust enough to determine whether or not ALS is required then I don't see a problem there.


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## TheGodfather (Feb 1, 2012)

EDIT: beating a dead horse, content deleted.



for everyone else, u may want to print this out and review it.
http://www.asls.net/MEND Checklist.Prehospital.V10.pdf


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## BandageBrigade (Feb 1, 2012)

DPM said:


> I'm sure we can all think of a situation where any call would deserve / require ALS so I don't think that's a valid argument.
> 
> I agree with you on blood glucose (which should be a BLS skill anyway...) but there are a lot of stroke PT who fall outside the 3/4 hours window and have no other serious "issues". As long as the dispatch criteria are robust enough to determine whether or not ALS is required then I don't see a problem there.



But does the condition not warrent ALS monitoring in case of deterioration? It is not about the amount of interventions that need done.


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## NYMedic828 (Feb 1, 2012)

BandageBrigade said:


> A stroke a bls call? Really? Ever had a stroke patient start to seize? Posture? Need airway support? How about checking a bgl(some places basics cannot) what if hes hypoglycemic?, 12 lead? IV? Just because its "easy" or not alot for you to do, that does not make it basic.



I can turn any patient into a "what if" for just about anything.

What if your arm fracture patient has a history of epilepsy and starts seizing? 

No one is gonna argue that any of the above aren't a possibility, but honestly you still have only one definitive cure to it and thats to transport them. You cannot fix a stroke in the field. 

Studies for stroke/trauma patients have shown that having ALS on scene, actually tends to delay rapid transport because people sit on scene playing doctor when the patient needs a hospital more than any other patient category.


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