Close One...

Well, it seems that I have now had two close calls in testing. Yesterday, we had our ACLS test. The test consists of two parts: a Practical and Written examination. The written exam was all textbook material, and was fairly simple. However, the bread and butter of ACLS is reading EKG's (squiggly lines) and assessing your overall patient; that was where the practical exam came in. For this part of the test, it was me and my "Zoll" manual defibrillator and the dummy patient. The Zoll we train with is a $20,000 piece of equipment and is capable of not only defibrillating, but getting a pulse oximetry, blood pressure, 12 lead EKG, and comes several other neat things which are too many to list. The dummy we train on is also capable of simulated breathing, pulses, verbal responses, and can even exhibit signs of various pulmonary and cardiac life threats. It's a great training tool, and the Zoll is a life saver. So, all week I studied the sequence, the various EKG's, and the various cardiac drugs (indications, doses, contraindications, and mechanisms of action), I thought I was ready, but I missed a critical criteria. I misinterpreted one of my EKG's as a 2nd degree Type I heart block, and in reality it was a 3rd degree heart block. This makes a huge difference when administering drugs, and I unfortunately administered a contraindicated drug. There were about 5 different heart rhythms for test day, and when I had finished the run I had no idea I had made a mistake, I was utterly confident I was a "go". My instructor let me go all the way through, and then we sat down for the second half of the practical exam which consisted of simply reading strips. There were 4 strips in all, and I, of course, got all of them right, but when I finished up, my instructor asked me to take a look at the 3rd degree heart block strip (which I had just interpreted) and compare it with the one I printed out during my run on the dummy. My jaw dropped, and once again, I was with the retesting crew today. 18 guys in all had to retest, and I just got out of there with a "go", but I'm still not sure how everyone else did. Anyhow, another target down. On to Combat Trauma Management!