Sunday, 1 July 2007

ALS in Inverness

Ventricular fibrillation on lead II or the munros of the Scottish Highlands?

June has been a busy month of re-certifying. Last week I moseyed over to Inverness for my Advanced Life Support Course (ALS) for a refresher since the last time I did it I remembered 3 distinct treatment algorithms for cardiac arrest situations (now it’s 2)…but times have moved swiftly on. Management have been pared down to essentials…chest compressions have assumed a more prominent role in relation to rescue breaths…amiodarone is now a more active drug…and there is a greater emphasis on teaching management of peri-arrest situations (I remembered in my more junior days thinking ironically that managing a cadiac arrest patient was sooooo much more easier than the complicated lingering moribund patient with a peri-arrest arrhythmia).

The rest remained pretty much the same – 2 long days of last minute cram reading of the deceptively thin but information dense manual, the quickie power-point lectures, the straight forward skill stations since it’s clinical stuff I engage in on a regular basis, CASTeach scenarios (ooooh what adrenaline rushing fun!)…and the enthusiastic and friendly instructors galore. It was held at the Marriott where in our own groups of about 6, we were shepherded throughout the day in between various function rooms where we got the chance to sharpen our skills and embarrass ourselves in private with mannequins (uhmm, somehow that came out wrong).

My abiding memory though was the evening out – starting first at the civilised Waterside Restaurant by the River Ness where bland menu descriptions turned out to be surprisingly anything but. Like the unimaginatively titled “Turnip soup”. Yes, just “turnip soup” but that turned out to be a highly praised appetiser by many of those who were brave enough to order it (moi!). There was a zucchini/cheese combo that sounded hideous on paper but was simply mouth-watering heaven and extremely rich. That gut bursting main meal however did not dampen the ice-cream/mud cake/fruit dessert. It was all served very slowly and we got to gradually know each other. Most disappeared later back to their rooms for some last minute swotting before the examination the next day.

The instructors and I (the only candidate out for more fun???) went on to the local rustic watering hole, Johnny Foxes, for what turned out to be a surprisingly great night out exchanging stories, hearing and dancing to great music by the live band, drinking and some things that I swore should never, ever, ever be revealed. Ahem: inflatable sheep. I think it was somewhere north of 2:00am before we staggered back for a bright and early bleary-eyed long day that began in just a few hours. I figured the night out was more fun and that I would erm “wing it” on the assessment the next day….and glad I did! Waiting in the wings for your turn in the assessment brought back pleasant memories of coffee-filled bladder instability and sympathetic overdrive of hand sweat glands in professional exams but I got a reasonable 96% on the MCQ and a middle aged man in the coronary care unit with complete heart block and ventricular fibrillation in my simulation scenario (help! airway! atropine! help! airway! CPR! shock! adrenaline! shock! CPR! shock! adrenaline! shock! amiodarone! he lives! now my sinus tachycardia can slow down!).

I really enjoyed the well-organised course and was glad of all the lovely nurses, wonderful doctors and engaging instructors I met and bantered with. Confidence does not necessarily equate to competence and it’s only through practice and critiquing that one can improve. European Paediatric Life Support (EPLS) next!


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