So emergency medicine is one of the few medical specialties that still requires oral exams prior to board certification. The board states that the written exam, which I took (and passed) last fall, is just a screening tool to see who can take the oral exams. Regardless of it’s justification, I have to do it if I want to get board certified.
So I took this review course by an un-named state board group, and during the Q&A, I raised my hand and asked, “Will we be expected to know the new Advanced Cardiac Life Support Protocols?” (Just published in December of 2005, and teaching materials are not even available yet…some ACLS courses have not begun to use the new guidelines yet). The course director emphatically stated, “YES, of course!”.
So later that morning, I am doing a case scenario with the same gentleman. Naturally, my patient crashes, goes in to pulseless vfib. I start CPR, then deliver a single shock at 360. No response, so I continue CPR, give epi, shock again and she comes back to life. During the critique, he tells me, “We still use 3 stacked shocks of defibrillation at escalating doses.” I figure he’s right, since I had just asked him, only an hour before, about the ACLS guidelines. I figured I must have read the information wrong.
So TONIGHT, I’m reading section 7.2 of Circulation’s 2005 ACLS guidelines on pulseless algorithms. Guess how many shocks you give on teh first attempt? ONE. At 360 Joules. I was right. When he takes his ACLS recertification (if he ever does), I guess he’ll feel pretty silly. Or maybe it will never even cross his mind.
Anyway, wish me luck this weekend!