Assessing Arrhythmias

by Patricia Cheney

Patti's current job is as an Assistant Trauma Coordinator at Sharp Memorial Hospital.



Instructional Objective The learner will be able to match acceptable treatments, in sequence, for Ventricular fibrillation (V-fib), Ventricular tachycardia (V-tach) and Asystole, as outlined by the American Heart Association (AHA) Advanced Cardiac Life Support (ACLS).

Learners/context The learners are medical professionals with backgrounds ranging from Respiratory therapists to Registered Nurses and Physicians. The card game would be utilized after having completed the Manual for ACLS. This would reinforce the recognized treatments for the testable arrythmias in ACLS. Its intended purpose is to provide out of class practice for those currently participating in a course, as well as enhance the skills for those candidates recertifying in ACLS.

Rationale ACLS is a very comprehensive course with one day of teaching and one day of testing. It is highly recommended that the participants have a thorough understanding of arrythmias prior to enrolling. Thus, the development of an ACLS card game would have several instructional purposes. First, it provides the learner with the opportunity to practice and remediate newly acquired skills and knowledge. It enhances motivation by generating enthusiasm, excitement and interest in learning treatment modalities. It allows for cultivating decision making skills needed to rationalize specific treatment plans. Lastly, it enables the learner to integrate the principles and relationships of ACLS.

Rules The game may be played by one person, or with four players in teams of two.


* The deck consists of 41 cards. There are 35 playable cards. Six additional cards: 2 titled V-Fib , 2 titled V-Tach and 2 titled Asystole.


* Remove the six cards worded V-Fib, V-Tach and Asystole. These are the cards in which you will initiate and treat the arrythmias.


* It may be necessary to refer to the ACLS manual while playing this game.

For one player: (Follows a solitaire structure)


1. Take three of the cards each worded V-Fib, V-Tach and Asystole and place in a row face up on the table in front of you. (The remaining 3 worded cards may be put away, as they are used for team playing).


2. Shuffle the remaining deck of cards.


3. With the deck to the side begin by dealing out every third card and placing it face up.


4. If that card fits into the sequence of acceptable treatments for any of the three arrythmias in front of you, then you play that card for that arrythmia. It must be in sequence! For example: For V-Fib you could not play the card that says Epinephrine 1:100,000 0.5-1.0mg IV P, if you did not have already on the table under V-Fib the card that states establish I. V. access, since we know that without an IV you cannot give IV drugs. This holds true for all the treatments for all the arrythmias.....They must be sequential!


5. If the third card turned face up is able to be played in sequence for any of the arrythmias, then proceed with the second and first card respectively.


6. After you've gone through the original deck, begin to deal out from the discarded stack. Do not shuffle these cards.


7. The game continues until you've completed all treatments for the arrythmias; or you're unable to complete the arrythmias with the cards you're turning up. (In other lost).


For Team playing Read through the one player rules, as they are applicable to team rules. The exceptions are:


* With teams you use all six worded cards, V-Fib, V-Tach, Asystole (each team has three cards).


* Each team takes a turn dealing out three cards and playing the arrythmia.


* The team that completes the arrythmias first wins the game.

Card Design


Deck Design There are three types of cards used in the game:

1. Arrythmia cards - There are six of these cards, and they are color coded different from the remaining 35 cards for easy recognition when beginning the game.

Face up is written V-fib, V-tach, Asystole, with a graphic of the corresponding arrythmia.

Face down all cards have the same logo, checkered background with a normal heartbeat through the center.

2. Procedure cards- There are a total of 22 these cards. They consist of the following:

a. CPR cards (3)- Face up text reads CPR with hands on the chest.

b. IV access cards (4)- Face up text reads IV showing IV solution.

c. Defribillate cards (8)- Face up text reads Defribillate and the joules used.

d. Cardiovert cards (4)- Face up text reads Cardiovert and the joules used.

e. Intubate cards (2)- Face up text reads airway, graphic of a face.

3. Medication cards- There are a total of 13 cards.

Face up the cards have the medication written, the dosage, and the access. It is important to read each card carefully before playing, as the medication may be the same but the dosage varies. Also remember in your treatments, that oxygen is considered a medication.

Design Process The overall task in designing a game with this content was choosing a structure that would not only lend itself to the individual, but could be utilized in a small study group. The intent for doing this was to encourage mastery of the arrythmias, as well as playing the game effectively. Both the solitaire as well as the group fullfilled these objectives.

Using the Manual provided by ACLS is necessary to assure that proper sequence is followed. Incorporating that sequence into the actual card itself would make it visually unaesthetic. For this card game, it is better that the manual be a resource for those playing.

In evaluating the game itself, four nurses who have taken ACLS in the past were asked to follow the instructions and play the game. (It is fair to state that they had all played solitaire, so therefore were able to follow the rules). The consensus was that the structure and the procedure worked well, but unless played in a team it seemed to lack a "fun" property. They even suggested a double deck that could be played in a "Double Solitaire", with teams actually competing with one another.