headache

It feels like the temple of my head is squeezing everybit into my mind.

It is aching pain.. 

Results from getting all tensed up for the ACLS I"m taking on Monday. 

Well, why tense up..? cause it's the second time I'm taking and I don't want to fail it again. 

I think I give lots of 'what if' situations when I'm studying the algorithm, and ends up with ' what if she (examiner) came up this... oh no.. what should I do?' questions. 

I know where I screwed up in last exam. When my friends were taking the exam, I can answer the questions that the lecturer asked them in my heart. I know where I should be going. but when it reaches me... 

I panicked, kept my mind focused on the second part of 'getting the bp set, oxygen mask, iv lines' cause I scared that I might forget. THAT leads me to forget the straight away thing after checking responsiveness and call for help is check pulse.. 

A total wrong right from the start and I lose all the confidence.  

she says no pulse. 

start cpr immediately.
get defib, give oxygen bag mask, set up iv lines, and cardiac monitoring. This is where it should come.
the cardiac monitor shows this:

the second part I get wrong, is I didn't figure out it's a PEA activity. 

the screen shows sinus tachycardia. 

the examiner looked at me saying "are you sure?" when I said 'shock' patient.. then I took a lot at the screen again.. I know I'm not wrong. It shows "sinus tachy." THEN after like 5 seconds of looking, the chart pop into my mind. only VT and VF is shockable. I was like.. 'OH HELL!!' and it's a 'pulseless' and so it's a PEA. should not shock the patient! this is non-shockable rhtyhm. 

continue cpr for 5 cycles and then add in atropine 1mg iv every 3-5 min. 

check rhtyme and pulse.

then she continued saying no use. no use for two times and I repeated my answer with atropine two times.. 

so what should I do? 

yes, investigate the causes..

I listed out the 5T and 6Hs. but took some time again listing cause I was panicking already.. 

I was all 'crap crap' 

then she asked me what's the most possible cause in this patient. 

pt is young asthmatic. 

I said "hypoxia"

what else? 

eh... 

what others in young asthmatic? 

so. then after I paused for awhile i decided to give it a shot since it's the only answer in my mind, so I said "tension pneumothorax"

correct..

so what should I do? 

needle decompression. 

landmarks?

second intercostal space, midclavicular line. 

and you'll hear a hiss sound after poking

then what do you do?

check rhtyhm and assess vital signs. 

take x ray

patient returned normal

pulse present.

yay.. then..? 

what did you do just now?

I think think back.. needle decompression... 

insert chest tube! 

take x ray. 

asssess vital signs. 

patient returned normal

monitor. 

post resuscitation care.


so the most important thing for me is not to panic..  and have confidence. oh well.. I got the most difficult twisted case.

I studied hard for this time.
I must pass this time.
I can be a leader when I want.

best wishes for me.