Logan Gregory James Polkinghorne - Pacific Medical Training

Submitted 2022-10-01

Providing safe and effective care to patients is paramount in the healthcare setting. As a student Respiratory Therapist I have learned that compassion is one of the most important factors contributing to the best possible care for your patients. Another very important, but far less recognized trait imperative to success is that of confidence. As a healthcare provider it is necessary to have confidence in your own abilities, as well as the abilities of your colleagues. Confident competence is the perfect term to describe the mindset required for a healthcare provider. In addition to competence in profession specific skills, it is mandatory that healthcare providers understand the process for BLS; ACLS and PALS are also recommended. Having a familiarity with how these potentially lifesaving procedures are carried out, and the confidence to carry them out without hesitation will result in the best possible care for the patient. As a Student Respiratory Therapist, someone who is only just beginning their journey in the field of healthcare; I have not had very much experience practicing BLS, ACLS and PALS on real patient populations. Although my experience in our simulation lab has given me a taste of the skills and composure required to be successful, I feel as though the real experience will be gained during my third year clinical placement.

I remember the first time that I ever practiced compressions; I was in the ninth grade. A component of our fitness class was to be able to properly demonstrate the process of finding someone in need of CPR, and then performing adequate compressions. Thirty compressions, two breaths; that was it, the test was over. I thought to myself in that moment, “ok, that wasn’t so bad.” Fast forward five years, I am at my one day clinical placement at Ouellette Campus, one of the hospitals in my home town Windsor, Ontario Canada. Our very first patient of the day, a patient with COPD who is air rapping so severely the fellow RT’s are having an extremely hard time ventilating the patient. After a few minutes of pushing meds, and gaining IV access the patient goes into cardiac arrest. The full time RT I am accompanying on my placement tells me to “hop on the chest”, I do. This patient is already intubated, so that means continuous compressions; no break at all. I still remember the feeling, the movement of ribs around my hands as I compress this old man’s chest. After about two minutes, I switch with another RT student and begin bagging for the patient instead, one breath every 5 seconds; don’t forget, don’t go too fast. This went on for about ten minutes before the Doctor decided to call the code, unfortunately we couldn’t save this patient. I sat there sweaty, tired and disappointed; was there something more I could have done, were my compressions good enough? My first real experience with providing basic life support was a failure, this is something that up to this point we have never really talked about, you can’t always save the patient.

Looking back at my experience providing BLS, I have discovered some ways I can further prepare myself for future situations. Physical preparation is quite important when preparing for life support, compressions are hard, and I say this as a 20 year old that is quite active. I recommend training the muscles of the upper body, specifically the shoulders as well as the triceps, training these muscles for endurance rather than strength is the way to do; so low weight, high repetitions is what I recommend. Cardiovascular endurance is also integral to effective compressions, especially when compressions must be carried out for a lengthy periods of time. Perhaps more important than physical preparation is mental preparation, in these very situations it is of upmost importance to maintain your composure. You need to take a deep breath and walk through the steps in your head, this mental recollection is important as it helps keep you focused even when your body begins to tire.

In terms of preparation for ACLS, the physical aspects remain quite similar as BLS; good physical fitness can only serve to help you in these situations. In terms of mental preparation, I recommend further preparation. So something that I recommend is to study the ACLS algorithm until it becomes second nature, in my experience the better you know how to do something the more confident and composed you will be when you have to perform life preserving measures. ACLS can be very hectic, there are often many people in the room, it can be loud and very stressful; in these moments it is important to try and stay calm and remember what you have practiced, over time the more you perform these actions the more comfortable you will be. Once you have performed these life saving techniques enough, mental preparation will be less important, as you already have the confidence and ability required to perform effectively.

For me PALS requires very different preparation when compared to BLS and ACLS. Because PALS deals only with the paediatric population, I feel as though mental preparation is much more important than physical preparation. In PALS life saving manoeuvres are being performed on children, this can be very hard to mentally cope with, especially if you are a father, mother or guardian of a child yourself. It is important to be confident in your ability, to not second guess what you are doing. It all comes down to familiarity and experience, the more experience the more confidence and the less mental preparation needed. Until you receive this real experience reviewing algorithms and scenarios is a good alternative to prepare yourself for the real thing.

As someone that has only begun their career as a healthcare professional I hope I was able to provide some insight to readers, and I was happy to share my experiences. I look forward to what is to come, and I hope to enhance my knowledge as time goes on.