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Life Support Certifications

ACLS & BLS Certification
for GCC Nurses

Required for almost every GCC nursing job — get certified before you arrive or within 3 months of joining. Algorithms, drug doses, where to certify and exam tips all in one guide.

Required at 95% of GCC hospitals
AHA / RCUK accepted
Valid 2 years
Cost AED 800–1,500
Find Certification Centres View Algorithms
Why It Matters

Certifications Are Non-Negotiable in GCC

GCC hospitals operate under strict JCI and national accreditation frameworks — BLS and ACLS are mandatory, not optional extras.

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JCI Accreditation Requirement
JCI standards require ALL nursing staff to hold a valid, current BLS certification. This is audited during accreditation surveys and cannot be waived.
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Required at Onboarding
Most GCC hospitals will not complete your onboarding or assign you to clinical duties without a valid certificate in hand. Bring your original certificate on Day 1.
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Licensing Body Requirement
DHA (Dubai), SCHS (Saudi Arabia) and QCHP (Qatar) all require BLS at minimum for nursing registration. Without it, your licence application stalls.
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Renew Every 2 Years
Certificates expire every 2 years. GCC hospitals track expiry dates — an expired certification can trigger a performance notice or remove you from clinical rosters.
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ACLS for Specialist Areas
ACLS is mandatory for ICU, CCU, HDU, ER, PACU, OR, NICU and paediatric settings. It is routinely asked at interview — not having it closes many GCC doors.
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Interview Credential Check
GCC recruiters and hiring managers verify your BLS/ACLS before extending a formal offer. Listing it on your CV without having it is immediately caught at credential screening.
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Pro tip: Get your BLS (and ACLS if applicable) in your home country before departure — it is cheaper, faster, and removes one stressor from your first weeks. AHA and RCUK certificates are accepted across all GCC countries.
Certification Hierarchy

Which Certification Do You Need?

Build up from BLS — the foundation every GCC nurse must have — through specialty certifications for your clinical area.

1
BLS — Basic Life Support
ALL nurses — mandatory for every clinical area
Adult CPR, infant/child CPR, AED use, choking management
Prerequisite for all higher certifications
2
ACLS — Advanced Cardiovascular Life Support
ICU, CCU, ER, HDU, PACU, theatre nurses
Cardiac arrest algorithms, arrhythmia management, post-ROSC care, ACS, stroke
3
PALS — Paediatric Advanced Life Support
NICU, PICU, paediatric wards, paediatric ER
Weight-based dosing, paediatric arrest algorithms, respiratory failure management
4
NRP — Neonatal Resuscitation Program
NICU, L&D, neonatal transport teams
Newborn resuscitation, positive pressure ventilation, chest compressions in neonate
5
Advanced Trauma — ATLS / PHTLS / ITLS
Trauma units, ER, flight nursing, critical care transport
Primary/secondary survey, haemorrhage control, traumatic arrest
Specialty Certifications
Obstetrics
ALSO
Advanced Life Support in Obstetrics — L&D, maternity units
Obstetrics
MOET
Managing Obstetric Emergencies and Trauma — OB wards, L&D
Trauma
TNCC
Trauma Nursing Core Course — trauma centres, ER
Paediatric Emergency
ENPC
Emergency Nursing Paediatric Course — paediatric ER, PICU
BLS Guide

Basic Life Support — Everything You Need to Know

Master the 2020 AHA guidelines for CPR and AED use — the foundation of all resuscitation practice in GCC hospitals.

100–120
Compressions / min
≥5 cm
Adult compression depth
30:2
Single rescuer ratio
15:2
2-rescuer paediatric ratio
<10 s
Max rhythm check pause
2 min
CPR cycles before recheck
  • Adult CPR: recognition of cardiac arrest, chest compression technique, ventilation with BVM
  • Infant and child CPR: 2-finger technique for infants, 1 or 2-hand heel of hand for children
  • AED use: safe operation, pad placement (anterolateral), peri-shock pause minimisation
  • Choking — Heimlich manoeuvre: conscious adult/child; back blows + chest thrusts for infant; pregnant/obese patient modifications
  • Foreign body airway obstruction (FBAO): recognition of complete vs partial obstruction and appropriate response
  • Team dynamics: clear roles, closed-loop communication, team leader vs team member
4–6 hours duration AED + manikin practical Renews every 2 years

Both the American Heart Association (AHA) and the Resuscitation Council UK (RCUK) certifications are fully accepted across all GCC countries and by all major licensing bodies (DHA, SCHS, QCHP).

AHA (American Heart Association)

  • Most common in GCC — strongly preferred in US-affiliated hospitals (Cleveland Clinic AD, Johns Hopkins Aramco)
  • Uses HeartCode platform for online component — very popular for nurses completing pre-departure
  • Certification card issued immediately upon completion
  • AHA Training Centres widely available across UAE, KSA, Qatar

RCUK (Resuscitation Council UK)

  • Preferred in UK-influenced hospital networks — common in Oman, Bahrain, some UAE hospitals (SEHA, Imperial College London Diabetes Centre)
  • ILS (Immediate Life Support) is the RCUK equivalent of ACLS
  • BLS training often delivered by UK-trained educators using RCUK materials
Both accepted by DHA / SCHS / QCHP Check your hospital's preference at offer stage

Compression Quality

  • Rate: 100–120 compressions per minute (a metronome or feedback device is recommended)
  • Depth: ≥5 cm adult (avoid >6 cm), ≥4 cm child, ≥1.5 cm infant
  • Allow full chest recoil between compressions — do not lean on the chest
  • Minimise interruptions: pre-shock and post-shock pauses <10 seconds
  • Switch compressor every 2 minutes to maintain quality

Ventilation

  • Ratio: 30:2 single rescuer (adult and child); 15:2 two-rescuer paediatric
  • Each breath over 1 second — visible chest rise only
  • Avoid hyperventilation — causes increased intrathoracic pressure and reduced coronary perfusion
  • Advanced airway in place: 1 breath every 6 seconds (10/min) asynchronous with continuous compressions

AED Use

  • Attach pads as soon as available — do not delay CPR to wait for AED
  • Continue CPR while AED is powering on and pads applied
  • Clear everyone before analysing and shocking
  • Resume CPR immediately after shock — do not check pulse first
  • Paediatric pads for children <8 years / <25 kg; adult pads if paediatric unavailable

BLS Algorithm (In-Hospital)

→
Patient unresponsive — shout "Are you alright?" and tap shoulders
→
Shout for help — activate emergency response / call code blue
→
Check breathing and pulse simultaneously (≤10 seconds) — no normal breathing / no pulse: start CPR
→
30 compressions : 2 breaths — minimise interruptions
→
Attach AED as soon as available — analyse rhythm
→
Shockable: deliver shock → immediately resume CPR
→
Continue until ROSC, advanced help arrives, or decision to stop made by team leader
ACLS Guide

Advanced Cardiovascular Life Support — Algorithms & Drug Doses

The core algorithms every ICU, CCU and ER nurse in GCC needs to know by heart — and the drugs to back them up.

  • VF/VT cardiac arrest algorithm — shockable rhythms, defibrillation, drug timing
  • PEA/asystole algorithm — non-shockable rhythms, reversible causes
  • Symptomatic bradycardia — atropine, pacing, second-line options
  • Stable and unstable tachycardia — SVT, AF, VT with pulse, cardioversion
  • Post-cardiac arrest care — 12-lead ECG, TTM, oxygen targeting, PCI pathway
  • Acute coronary syndrome (ACS) — STEMI, NSTEMI recognition, MONA/BATMAN
  • Stroke — FAST recognition, NIH Stroke Scale, thrombolysis window
  • Megacode simulation — team leader role, communication, closed-loop handover
2-day course (AHA) Written exam + megacode practical 70% pass mark BLS prerequisite
VF / Pulseless VT Algorithm
1
Start CPR — high quality, 100–120/min, minimise interruptions
2
Rhythm check → VF or pVT confirmed: Defibrillate 200J biphasic
3
Immediately resume CPR 2 minutes — obtain IV/IO access, attach monitoring
4
Rhythm check → if still shockable: defibrillate → resume CPR
5
Adrenaline (epinephrine) 1 mg IV/IO — give after 2nd shock, then every 3–5 min
6
Rhythm check → if still shockable: Amiodarone 300 mg IV/IO bolus (or lidocaine 1–1.5 mg/kg)
7
Second dose amiodarone 150 mg if VF/VT persists after 5th shock
✓
ROSC? → Post-arrest care pathway (12-lead ECG, TTM, SpO2 target)
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Key point: Give adrenaline as soon as IV/IO access is established — do not delay compressions for drug administration. The compressor should never stop for drug delivery.
PEA / Asystole Algorithm
1
Start CPR immediately — high quality compressions
2
Adrenaline 1 mg IV/IO as soon as access established — repeat every 3–5 minutes
3
Identify and treat reversible causes — 4Hs & 4Ts (see below)
4
Rhythm check every 2 minutes — if becomes shockable, switch to VF algorithm
5
Continue until ROSC or decision to stop

The 4Hs and 4Ts — Reversible Causes

4 Hs
  • Hypoxia — ensure adequate ventilation, 100% O2
  • Hypovolaemia — IV fluid bolus, consider haemorrhage
  • Hypothermia — rewarm; drugs/defibrillation less effective below 30°C
  • Hyper/hypokalaemia — electrolyte disturbance, metabolic cause
4 Ts
  • Tension pneumothorax — needle decompression, then chest drain
  • Tamponade — pericardiocentesis, bedside echo if available
  • Toxins/poisons — antidote if known (naloxone, flumazenil)
  • Thrombosis — PE (consider fibrinolysis) or coronary (STEMI)

Symptomatic Bradycardia (HR <60 with haemodynamic compromise)

1
Identify and treat reversible causes (hypoxia, hypothermia, drug toxicity, heart block)
2
Atropine 500 mcg IV — repeat every 3–5 min up to maximum 3 mg total
3
If atropine ineffective: Transcutaneous pacing — set rate 60–80/min, increase current until capture
4
Alternative: Adrenaline infusion 2–10 mcg/min or dopamine 5–20 mcg/kg/min
5
Cardiology consult — may require transvenous pacing or permanent pacemaker

Stable Tachycardia (HR >100, haemodynamically stable)

  • Narrow complex (SVT): vagal manoeuvres → adenosine 6 mg IV rapid push → if no conversion: adenosine 12 mg (repeat once)
  • AF/flutter — rate control: metoprolol, diltiazem (not verapamil + beta-blocker)
  • AF/flutter — rhythm control: amiodarone IV if haemodynamically borderline
  • Wide complex VT with pulse (stable): amiodarone 150 mg IV over 10 min, repeat up to 2.2 g/24h

Unstable Tachycardia (HR >150, haemodynamic compromise)

→
Immediate synchronised DC cardioversion — do not delay for medications
→
Energy: narrow complex 50–100J → SVT/AF 120–200J biphasic → VT with pulse 100J biphasic
→
Sedate/analgese patient if conscious before cardioversion (midazolam + fentanyl)
→
Confirm synchronise mode selected — prevents R-on-T phenomenon
  • 12-lead ECG immediately — identify STEMI or LBBB → activate cath lab if present
  • SpO2 target 94–98% — avoid hyperoxia (reduces FiO2 once stable; 100% O2 initially)
  • Target normocapnia — PaCO2 35–45 mmHg; avoid hypocapnia (causes cerebral vasoconstriction)
  • MAP target ≥65 mmHg — vasopressors (noradrenaline) if needed; avoid hypotension
  • TTM (Targeted Temperature Management) — if comatose after ROSC: target 32–36°C for minimum 24 hours; active prevention of fever ≥37.7°C for at least 72 hours
  • Blood glucose target 140–180 mg/dL — avoid hypoglycaemia and severe hyperglycaemia
  • Neurological assessment — GCS, pupillary response, prognostication at ≥72h after normothermia
  • PCI pathway — STEMI post-arrest: go to cath lab regardless of GCS; non-STEMI: discuss timing with cardiology
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Remember: Avoid hyperventilation post-ROSC. Each unnecessary breath drops PaCO2, causing cerebral vasoconstriction and worse neurological outcomes.
ACLS Drug Reference

Key ACLS Medications — Doses & Indications

Memorise these before your ACLS exam. Confirm with current local formulary and BNF/PDR before clinical use.

Drug Adult Dose Route Indication Key Notes
Adrenaline (Epinephrine) 1 mg every 3–5 min IV / IO All cardiac arrest (VF, PEA, asystole) Give ASAP for non-shockable; after 2nd shock for VF/VT
Amiodarone 300 mg bolus; 150 mg 2nd dose IV / IO VF/pVT after 3rd shock; stable VT with pulse 150 mg over 10 min Dilute in 5% dextrose; hypotension risk with rapid infusion
Atropine 500 mcg IV; max 3 mg total IV Symptomatic bradycardia; vagally mediated bradycardia Not effective in complete heart block or denervated (transplant) heart
Adenosine 6 mg rapid IV push; 12 mg if no response (×2) IV (antecubital or above) Regular narrow complex SVT; diagnostic in wide complex tachycardia Flush rapidly with 20 mL NS; warn patient of transient chest pain/flushing. Contraindicated in asthma, Wolff-Parkinson-White
Lidocaine (Lignocaine) 1–1.5 mg/kg IV bolus; maintenance 1–4 mg/min IV / IO VF/pVT if amiodarone unavailable; VT with pulse Alternative to amiodarone in cardiac arrest
Magnesium Sulphate 2 g IV over 10 min (arrest: 2 g rapid) IV / IO Torsades de pointes; suspected hypomagnesaemia; eclampsia First-line for Torsades — withhold in hypermagnesaemia or renal failure
Calcium Chloride 10% 5–10 mL (500 mg–1 g) IV (central preferred) Hyperkalaemia; hypocalcaemia; calcium channel blocker toxicity Not routinely given in cardiac arrest; extravasation causes tissue necrosis
Sodium Bicarbonate 8.4% 1 mmol/kg (1 mL/kg) IV IV / IO Hyperkalaemia; tricyclic antidepressant toxicity; metabolic acidosis (prolonged arrest) Not recommended routinely in arrest — guide by ABG; inactivates adrenaline/catecholamines if mixed
Dopamine 5–20 mcg/kg/min infusion IV infusion Symptomatic bradycardia (if atropine fails); cardiogenic shock Titrate to effect; higher doses cause peripheral vasoconstriction
Noradrenaline (Norepinephrine) 0.1–0.5 mcg/kg/min infusion IV infusion (central preferred) Post-ROSC hypotension; distributive/vasodilatory shock First-line vasopressor post-arrest for MAP <65

Reference guide only. Always verify doses against current AHA guidelines, local formulary and patient weight/renal function before administration.

PALS Guide

Paediatric Advanced Life Support — Key Differences

Paediatric resuscitation differs significantly from adult — most paediatric arrests are respiratory in origin, not cardiac.

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Airway/Breathing First
Most paediatric arrests are caused by respiratory failure progressing to asphyxia. Oxygenation and ventilation are the priority — unlike adult cardiac arrest where compressions come first.
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Weight-Based Dosing
All medications and defibrillation doses are weight-based. Use the Broselow tape (colour-coded by length) or Handtevy colour-code system to estimate weight and pre-calculate doses rapidly.
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Defibrillation Energy
First shock: 2 J/kg (vs adult 200J fixed). Subsequent shocks: 4 J/kg. Maximum does not exceed adult dose of 200J biphasic. Paediatric pads for <25 kg / <8 years.
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Intraosseous (IO) Access
If IV access cannot be established within 2 attempts or 90 seconds, go straight to IO. EZ-IO drill — proximal tibia (1st choice), distal femur or proximal humerus. Confirm with aspiration and flush.
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Paediatric Chain of Survival
Prevention → recognition and activation → high-quality CPR → rapid activation of EMS/code team → ALS → post-arrest care. Prevention is uniquely emphasised vs the adult chain.
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CPR Ratio Difference
Two-rescuer paediatric CPR uses a 15:2 ratio (vs 30:2 adult). Two-thumb encircling hand technique is preferred for infant chest compressions during 2-rescuer CPR.
ℹ️
Adrenaline dose in paediatric arrest: 0.01 mg/kg IV/IO (0.1 mL/kg of 0.1 mg/mL solution) — every 3–5 minutes. Maximum single dose 1 mg. Always double-check weight-based calculation with a second nurse before administration.
Certification Centres

Where to Get Certified in GCC

AHA Training Centres, RCUK providers and online options across all six GCC countries — including how to complete your theory before you arrive.

🇦🇪 UAE — AHA & RCUK Training Centres

BLS Cost
AED 400–600
ACLS Cost
AED 900–1,500
BLS Duration
4–6 hours
ACLS Duration
2 days

UAE has the highest concentration of AHA Training Centres in the GCC. Many large hospital groups (SEHA, Mediclinic, NMC) offer in-house BLS/ACLS as part of new employee orientation.

AHA Training Centres — Dubai & Abu Dhabi
  • ACLS Dubai Hospital Training Centre — one of the largest AHA TCs in the region
  • Cleveland Clinic Abu Dhabi — AHA training for staff and external candidates
  • NMC Healthcare Academy — BLS, ACLS and PALS; multiple Dubai and Abu Dhabi locations
  • Sheikh Khalifa Medical City (SEHA) — in-house for SEHA staff; external courses available
  • Mediclinic Hospital Group — in-house AHA BLS/ACLS for new employees
RCUK Provider
  • British Medical Training Centre Dubai — ILS (RCUK equivalent of ACLS), ALS, BLS
💡
Tip: Check your joining package carefully — most SEHA, Cleveland Clinic and Mediclinic contracts include mandatory BLS/ACLS within the first 3 months at employer expense.

🇸🇦 Saudi Arabia — AHA Training Centres

BLS Cost
SAR 300–800
ACLS Cost
SAR 800–1,800
BLS Duration
4–6 hours
ACLS Duration
2 days

MOH (Ministry of Health) hospitals across Saudi Arabia frequently provide BLS and ACLS as part of employee orientation — confirm with your HR representative before arrival so you don't pay for it yourself.

AHA Training Centres — Riyadh & Major Cities
  • King Faisal Specialist Hospital and Research Centre — accredited AHA TC; staff and external candidates
  • Saudi German Hospital Training Centre — BLS, ACLS, PALS; Riyadh and other cities
  • Saudi Heart Association (SHA) — AHA training network; coordinates TCs across Riyadh, Jeddah, Dammam, Khobar
  • Johns Hopkins Aramco Healthcare — in-house BLS/ACLS for JHAH staff in Eastern Province
  • Security Forces Hospital Riyadh — internal AHA TC; external bookings sometimes available
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SCHS note: Saudi Commission for Health Specialties (SCHS) requires valid BLS for nursing registration. If your certificate was issued more than 2 years before your SCHS application date, you will need renewal before proceeding.

🇶🇦 Qatar — AHA Training Centres

BLS Cost
QAR 400–900
ACLS Cost
QAR 1,000–1,800
BLS Duration
4–6 hours
ACLS Duration
2 days
  • Qatar Red Crescent Society — AHA Training Centre; BLS and Heartsaver courses
  • HMC (Hamad Medical Corporation) Education Institute — in-house BLS/ACLS for HMC staff; external candidates by arrangement
  • Sidra Medicine — in-house training for Sidra staff (one of Qatar's largest employers of international nurses)
  • Primary Health Care Corporation (PHCC) — orientation training includes BLS for all clinical staff
ℹ️
QCHP requirement: Qatar Council for Healthcare Practitioners requires BLS for nursing licensure. Most HMC and Sidra contracts include funded BLS training in the first 90 days.

Kuwait, Oman & Bahrain

🇰🇼 Kuwait
  • Ministry of Health Kuwait — in-house BLS for MOH staff
  • Dasman Diabetes Institute — AHA TC; external candidates accepted
  • American Hospital Kuwait — BLS and ACLS for staff and community
  • Most private hospital groups offer in-house ACLS as part of employment package
🇴🇲 Oman
  • Royal Hospital Muscat — in-house resuscitation training (RCUK-based)
  • Sultan Qaboos University Hospital — BLS/ACLS for staff; RCUK and AHA both used
  • Oman Medical Specialty Board — coordinates CPD including resuscitation training
  • RCUK certificates more commonly accepted given UK nursing influence in Oman
🇧🇭 Bahrain
  • Bahrain Defence Force Hospital — in-house resuscitation training
  • King Hamad University Hospital — BLS/ACLS; both AHA and RCUK accepted
  • American Mission Hospital — AHA TC; community BLS courses
  • Bahrain Nurses Society — CPD events periodically include BLS update sessions

Online ACLS & BLS — Complete Before Arriving in GCC

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Recommended strategy: Complete your BLS (and ACLS theory if applicable) in your home country before departure. This removes a logistical burden in your first weeks and demonstrates commitment to GCC employers.
AHA HeartCode ACLS
Online theory component + in-person skills check at a local AHA TC. Complete theory at home, do skills check in GCC on arrival. Cost: USD 120–175 online component.
AHA HeartCode BLS
Same blended learning model for BLS. Online portion available globally. Very widely accepted for GCC hospital onboarding. Pairs with any AHA TC for skills check.
Preparation & Practice Resources
  • ACLS-PALS.com — comprehensive AHA-equivalent study materials, algorithm guides and practice tests; widely used by GCC-bound nurses
  • ProACLS.com — ACLS preparation content with algorithm summaries and drug dose quizzes
  • AHA eLearning portal (heart.org) — official HeartCode platform for online ACLS/BLS/PALS components
  • RCUK eLearning — resus.org.uk for UK-trained nurses; ILS online component available
  • YouTube: Resuscitation Council UK and AHA channels — free algorithm walk-through videos
⚠️
Important: Online-only ACLS certificates (without an in-person skills check) are generally NOT accepted by GCC hospitals. You must complete the hands-on megacode/practical component at a registered Training Centre.
Simulation Scenarios

5 Resuscitation Scenarios — Step-by-Step

Practice these clinical scenarios to prepare for your ACLS megacode and real-world emergencies on GCC hospital wards.

1
Unresponsive Patient in Hospital Room
BLS — In-Hospital Response
1
Approach safely — check for hazards. Tap shoulders, shout "Are you alright?"
2
No response — activate Code Blue/emergency response loudly. Assign someone to call.
3
Check breathing and pulse simultaneously ≤10 seconds. No pulse/no normal breathing: start CPR immediately
4
30 compressions (hard, fast, full recoil) : 2 breaths with BVM. Switch compressor every 2 min
5
AED/defibrillator arrives — attach pads without stopping CPR. Analyse rhythm.
6
Follow AED/defibrillator prompts. If shockable: clear, shock, resume CPR immediately.
7
ACLS team arrives — hand over: patient found, time of call, CPR started, shocks delivered, ROSC status.
2
Patient Develops VF on Monitor
ACLS — Shockable Cardiac Arrest
1
Alarm sounds — confirm VF on monitor. Check patient: unresponsive, no pulse. Call Code Blue.
2
Start CPR immediately — assign clear roles (compressor, airway, medications, recorder, team leader)
3
Charge defibrillator to 200J biphasic while CPR continues. Apply conductive gel / confirm pad placement.
4
"Clear!" × 3 — confirm all clear visually. Deliver shock. Resume CPR immediately — no pulse check.
5
After 2nd shock: adrenaline 1 mg IV. Continue CPR 2 min cycles.
6
After 3rd shock: amiodarone 300 mg IV bolus. Continue CPR.
7
ROSC → post-arrest care: 12-lead ECG, SpO2 94–98%, normocapnia, MAP ≥65, TTM if comatose.
3
Sinus Tachycardia HR 170, BP 70/40
ACLS — Unstable Tachycardia
1
Patient diaphoretic, confused. HR 170, BP 70/40, SpO2 93%. Identify as unstable tachycardia
2
Apply O2, IV access, continuous monitoring. Call for senior/ACLS-trained support and crash trolley.
3
Do NOT delay for medications — proceed directly to synchronised DC cardioversion
4
Sedate if conscious: midazolam 1–2 mg IV + fentanyl 25–50 mcg IV (physician to prescribe)
5
Select SYNC mode on defibrillator — confirm marker appears on R-waves on the display
6
Energy: 120–200J biphasic (narrow complex); 100J if VT with pulse. Charge, clear, shock.
7
Reassess rhythm and vital signs. Repeat if unsuccessful. Document, escalate, monitor for recurrence.
4
Post-Op Patient Develops PEA Arrest
ACLS — PEA & 4Hs/4Ts Reasoning
1
Post-abdominal surgery, 2h post-op. Monitor alarm — organised rhythm, no pulse. PEA confirmed
2
Start CPR immediately. Call Code Blue. Adrenaline 1 mg IV ASAP, every 3–5 min.
3
Systematically work through 4Hs & 4Ts: most likely post-op causes...
4
Hypovolaemia — surgical haemorrhage most likely; give IV fluid bolus, alert surgical team stat
5
Tension pneumothorax — absent breath sounds? Tracheal deviation? Needle decompression 2nd ICS MCL
6
PE (Thrombosis) — consider if no other cause; discuss fibrinolysis with team leader
7
Continue CPR, reassess every 2 min, treat identified cause, document all interventions with timestamps.
5
Paediatric Patient: Respiratory Distress → Arrest
PALS — Paediatric Approach
1
8-year-old, weight 25 kg. Severe respiratory distress: RR 42, SpO2 78%, subcostal retractions, altered.
2
Immediate high-flow O2 via NRM, position of comfort, call PICU/paediatric team, prepare BVM.
3
Fails to improve → apnoeic. Start paediatric BLS: 30:2 (single rescuer) or 15:2 (two rescuers)
4
BVM ventilation with 100% O2 — airway and breathing are priority in paediatric arrest
5
IV access: 2 attempts. Fails → EZ-IO proximal tibia immediately. Confirm with aspiration and flush.
6
Adrenaline 0.01 mg/kg IO (= 0.25 mg for 25 kg) — every 3–5 min. Use Broselow tape to confirm.
7
If VF/pVT: defibrillate 2 J/kg (50J) → resume CPR → 4 J/kg (100J) subsequent shocks.
Crash Trolley

Resuscitation Equipment — What Every GCC Nurse Must Know

Crash trolley knowledge is assessed in GCC hospital orientation and ACLS training. Know where everything is before you need it.

⚡
Defibrillator / Monitor
  • Manual biphasic defibrillator (200J default energy)
  • Synchronised cardioversion mode (SYNC)
  • External pacing function (transcutaneous)
  • Common brands: Zoll R Series, Philips HeartStart MRx, Lifepak 15/20
  • Paediatric pads and adult pads — stored separately
  • Anterolateral pad placement (standard); anteroposterior alternative
  • Daily test/print-out required — document in crash trolley check log
🫁
Airway Equipment
  • Bag-valve mask (BVM) — adult and paediatric sizes
  • Endotracheal tubes (ETT): 6.0, 6.5, 7.0, 7.5, 8.0 cuffed
  • Laryngoscope — direct and video; curved (Macintosh) and straight (Miller) blades
  • Laryngeal mask airway (LMA) — sizes 3, 4, 5
  • Oral airways (Guedel): sizes 1–5
  • Nasopharyngeal airways + lubricant
  • End-tidal CO2 detector / capnography
  • Stylet, 10 mL syringe for cuff inflation, tape/ties
💉
Vascular Access
  • Large bore IV cannulas: 14G, 16G, 18G
  • Intraosseous (IO) kit — EZ-IO drill + needles (25 mm adult, 15 mm obese, 45 mm)
  • IO sites: proximal tibia (1st choice), distal femur, proximal humerus
  • Central venous access kit (for post-arrest use)
  • IV giving sets, normal saline flushes, 500 mL NS bags
  • 3-way stopcocks, extension sets
💊
Emergency Drugs
  • Adrenaline (epinephrine) 1:10,000 — 1 mg/10 mL prefilled syringes
  • Amiodarone 150 mg/3 mL ampoules (also 300 mg)
  • Atropine 600 mcg/mL
  • Adenosine 6 mg/2 mL
  • Sodium bicarbonate 8.4% — 50 mL pre-filled
  • Calcium chloride 10% — 10 mL
  • Magnesium sulphate 50% — 10 mL
  • 50% glucose (dextrose) — 50 mL
  • Naloxone 400 mcg/mL
  • Midazolam + fentanyl (for cardioversion)
🔧
Other Equipment
  • Suction unit — Yankauer catheters, suction tubing
  • ECG leads — 4-limb leads + 6 precordial; 12-lead capable
  • SpO2 probe, NIBP cuff
  • Sharps container, gloves (multiple sizes), aprons
  • Crash trolley checklist — completed daily by designated nurse
  • Tamper-evident seal — if broken without resus event, document and report
  • Torch (for pupillary assessment), glucometer
📋
Daily Check Responsibilities
  • Assigned nurse checks and signs crash trolley log every shift change
  • Verify defibrillator self-test complete and battery charged
  • Check seal intact — replace and document if broken
  • Confirm drug expiry dates monthly (designated lead nurse role)
  • After any resus event: full restock before the trolley goes back to position
  • JCI auditors will check crash trolley logs — gaps = non-conformance
⚠️
GCC hospital brands: The most common defibrillator brands across GCC hospitals are the Zoll R Series, Philips HeartStart MRx, and Lifepak 15/20. If your previous hospital used a different model, ask for a hands-on orientation to the crash trolley defibrillator on your first day. Never use a defibrillator you haven't been shown how to operate.
Exam Preparation

ACLS & PALS Exam Tips — Pass First Time

The AHA ACLS course has a written exam and a megacode practical — here's how to prepare and avoid the most common fails.

Written Exam
What to Expect
  • 50 multiple choice questions — 70% passing score (35/50 minimum)
  • Questions focus on algorithm decision-making, drug doses and sequences
  • Most questions are scenario-based: "What is your next action?"
  • Memorise: adrenaline 1 mg IV every 3–5 min; amiodarone 300 mg after 3rd shock; atropine 500 mcg max 3 mg; adenosine 6 → 12 mg
  • Know defibrillation energy: 200J biphasic adult; 2 J/kg then 4 J/kg paediatric
  • Pre-study: complete HeartCode online module fully before attending the in-person day
Megacode Practical
Running the Simulation
  • You will be assessed as team leader AND team member during separate scenarios
  • Team leader: stand back, direct the team, call rhythm checks, time adrenaline doses
  • Verbally assign roles: "You — start compressions. You — get the defibrillator. You — IV access."
  • Use closed-loop communication: give the order → receive read-back → confirm execution
  • Time adrenaline: give after 2nd shock for VF; every 3–5 min; don't miss a dose
  • Always state post-ROSC care steps at the end — many candidates forget this
Common Fails
Avoid These Mistakes
  • Not calling for help loudly and early — shout, do not mumble
  • Poor CPR quality: rate too slow (<100), too shallow (<5 cm), not allowing full recoil
  • Forgetting to switch compressor every 2 minutes
  • Missing adrenaline dose timing or giving wrong dose
  • Checking pulse after every shock (don't — resume CPR immediately)
  • Not selecting SYNC mode for cardioversion of VT with pulse
  • Not calling post-ROSC care steps (12-lead ECG, TTM, SpO2, MAP targets)
  • Pausing CPR for too long during rhythm checks or drug delivery
Renewal & GCC Compliance
Keeping Your Certification Active
  • Renew every 2 years — mark your expiry date in your phone and hospital CPD tracker
  • Do not let it lapse — JCI auditors review staff certification compliance and expired certs = a deficiency finding
  • Some GCC hospitals run annual BLS refreshers for all staff regardless of expiry — attend them
  • Keep a digital copy of your certificate in cloud storage — you will be asked for it at interviews, licensing applications and internal audits
  • AHA certificates can be verified online via the AHA Training Network — GCC hospitals use this
  • If your cert expires while in GCC: most hospitals will fund renewal — ask your clinical educator
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JCI audit reminder: During a JCI accreditation survey, auditors will spot-check nursing staff certification records — including BLS and ACLS expiry dates. An expired certification found during audit is a Requirement for Improvement (RFI) that can affect your ward's score. Your hospital CNO will not be pleased. Renew on time.