Recert Blues

I have recently taken both my semi-annual PALS and ACLS recertifications for the 15th time (possibly 16th, can't recall).  It has always, ALWAYS been a source of tremendous stress for me.  Nothing strikes fear into my heart more than the word "MEGACODE".  Seriously.  More than "woman in labor".

This stems from the olden days when ACLS was taught by paramedics with one mission: to fail each student.  I was so paranoid about possibly failing this course that I paid a bunch of money to take my initial certification at a Big Town university, many miles away from my tiny hospital so that if I did fail, I could do so in obscurity.  I passed the megacode portion, a one-on-one situation in those days, but I was so traumatized that I promptly failed the written portion and had to return the following evening for a retake.  Thus I suffer from ACLS induced PTSD.

Pseudocity does not run ACLS recert classes.  Oh no.  They offer online review, and then you must make an appointment for Megacode with one of the educators.  I just couldn't fit it in, so I jumped at the chance to take the recert with Best Paramedic on the Planet (BPOP) at a location right near my home.  Piece of cake, right?

Always, more complicated than it seems.  Class consisted of me, another nurse and 10 paramedics.  After the requisite DVD viewing, airway station, CPR run-through (that I just did 2 weeks ago), and a too long break for pizza lunch, it was time for the dreaded Megacode.

For added fun, Best Paramedic set it up as a field experience.  Victims (mannequins) set up, ambulance with equipment on scene, back boards, monitors, med boxes.  The other nurse and I could not have been more out of our element.  Plus, she was wearing a dress.

First scenario, "52 year old man climbed up a flag pole after drinking a bottle of vodka and a couple of energy drinks, felt dizzy and fell.  Complains that his butt hurts" ( the butt hurting thing was a common complaint in these fictional scenarios, I was later to discover).  Group leader  was expected to run the scenario like a regular call, something all the pre-hospital types do 100 times a day.  Other Nurse and I were all,  "which one is the first response bag?", "where do you keep the c-collars?", "how do you get the drug box opened?".  We were useless.  Best Paramedic excused us from that portion of the exercise and just let us do our own (gentle version) of Megacode in the back of the ambulance, but even that was intimidating.  I could feel the internal eye rolls of the medics as I stuttered my way through an easy v-fib to PEA to asystole scenario and had to list all the H's and T's.  Like I said, megacode makes me paranoid.  One year I was so nervous I gave my maiden name although at that point I had been married over 30 years.  But I digress.

BPOP  was anxious for my feedback on including nurses in the megacode portions of the course set up for paramedics as we were the first two guinea pigs.  I had to tell him that, personal nerves aside, it was eye opening for an ER nurse

Ambulances are mysterious things to nurses who have never worked in them, and even in a short handed ER there are always resources.  Not so in the back of a moving ambulance.  Sure, I have been on transfers, but it generally consisted of sit here, don't touch that, push that med, is that IV running type of thing.  Never really had to do too much and spent that time finishing up my charting or whatever.  And I didn't enjoy it, except for that time we did the CPR Marathon back in the 80's.  That was fun.

Observing experienced medics in their natural habitat was an interesting and invaluable experience, and they occupy a spot on my pedestal, just a little higher up now.

As to the PALS recert?  Given by the education department and included 3 office pediatricians who haven't run a code in 20 years, a pediatric office nurse who was essentially a new grad, and me.   I felt like a rock star.