Cardiac arrest(rev 4 2011)

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CGH Code Blue Procedure

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Cardiac arrest(rev 4 2011)

  1. 1. Cardiac Arrest Resuscitation
  2. 2. Terminal Arrhythmia 157 patients with SCD VT degenerated to VF 62% Primary VF 8% Torsade de pointes 13% Bradyarrhythmias 17%
  3. 3. Chain of Survival Early Access Early CPR Early Defibrillation Early Advanced Care
  4. 5. Team Leader - one voice - interpret inputs (ECG, case-notes, investigations, processes and makes decisions Does not physically participate in Resus Decides when to terminate Resus Doctor 2 - establish IV Drip and administration of IV drugs on orders of Team Leader Nurse 2 - assist Doctor 2 and preparation of drugs, putting up infusions Nurse 3 - performs Chest Compressions 30:2 or 100/min Doctor 1 - BVM followed by Intubation Nurse 1 - assist doctor 1, cricoid pressure during BVM and intubation, check & prepare laryngoscope, ETT, portable ventilator Call Anesthesia if difficult airway Call CVM/Medical ICU Registrar for further management
  5. 6. Team Leader - one voice - interpret inputs (ECG, case-notes, investigations, processes and makes decisions Does not physically participate in Resus Decides when to terminate Resus Doctor 2 - establish IV Drip and administration of IV drugs on orders of Team Leader Nurse 2 - assist Doctor 2 and preparation of drugs, putting up infusions Nurse 3 - performs Chest Compressions 30:2 or 100/min Doctor 1 - BVM followed by Intubation Nurse 1 - assist doctor 1, cricoid pressure during BVM and intubation, check & prepare laryngoscope, ETT, portable ventilator Call Anesthesia if difficult airway Call CVM/Medical ICU Registrar for further management
  6. 7. Team Leader - one voice - interpret inputs (ECG, case-notes, investigations, processes and makes decisions Does not physically participate in Resus Decides when to terminate Resus Doctor 2 - establish IV Drip and administration of IV drugs on orders of Team Leader Nurse 2 - assist Doctor 2 and preparation of drugs, putting up infusions Nurse 3 - performs Chest Compressions 30:2 or 100/min Doctor 1 - BVM followed by Intubation Nurse 1 - assist doctor 1, cricoid pressure during BVM and intubation, check & prepare laryngoscope, ETT, portable ventilator Call Anesthesia if difficult airway Call CVM/Medical ICU Registrar for further management
  7. 8. <ul><ul><ul><li>Adult Cardiac Arrest </li></ul></ul></ul><ul><ul><ul><li>Primary ABCD Phase </li></ul></ul></ul><ul><ul><ul><li>Check responsiveness </li></ul></ul></ul><ul><ul><ul><li>Focus on ABCD - basic CPR(30:2) and defibrillation </li></ul></ul></ul><ul><ul><ul><li>Activate code blue - 1414 </li></ul></ul></ul><ul><ul><li>Secondary ABCD Phase </li></ul></ul><ul><ul><li>A Airway : perform endotracheal intubation (video) </li></ul></ul><ul><ul><li>B Breathing : Ventilate with BVM, portable ventilator </li></ul></ul><ul><ul><li>C Circulation : check pulse, give chest compressions </li></ul></ul><ul><ul><li>D Differential Diagnosis & Defibrillate </li></ul></ul>Assess rhythm Code Blue
  8. 9. Resuscitation 1 . Focus on the primary and secondary ABCDs 2 . Decisive, professional, unflappable attitude 3. One voice 4. Ensure that the leader knows all drugs & procedures done 5. Leader gives clear information on next steps to be taken
  9. 10. Secondary Survey (some points) <ul><li>C. Circulation </li></ul><ul><ul><ul><li>Ante-cubital vein / external jugular vein </li></ul></ul></ul><ul><ul><ul><li>Infusion fluid : Normal saline </li></ul></ul></ul><ul><ul><ul><li>Drugs administered via ETT : adrenaline, atropine </li></ul></ul></ul><ul><ul><ul><li>Circulation time in cardiac arrest </li></ul></ul></ul>Atropine
  10. 11. Secondary Survey (more points) <ul><li>Differential Diagnosis </li></ul><ul><ul><ul><li>What caused the arrest? </li></ul></ul></ul><ul><ul><ul><li>Are there any reversible causes - those that had a specific therapy? </li></ul></ul></ul><ul><ul><ul><li>Are there any complications of resuscitation that have an immediately remediable cause? </li></ul></ul></ul>
  11. 12. Post-Resuscitation Transfer 1. Relinquish care to a team of equal or greater expertise 2. Provide complete, concise, and well- organised information 3. Ensure that patient airway is secured and patient stabilised prior to transfer
  12. 13. Phase 4 Critique 1. Dealing with Grief 2. Debrief 3. Education
  13. 15. VF/Pulseless VT
  14. 16. VF/Pulseless VT
  15. 17. VF/Pulseless VT
  16. 18. VF/Pulseless VT
  17. 19. VF/Pulseless VT
  18. 20. VF/Pulseless VT
  19. 21. VF/Pulseless VT
  20. 22. VF/Pulseless VT
  21. 23. VF/Pulseless VT Drug Shock CPR
  22. 24. Thomas Schneider et al, Multicenter, Randomized, Controlled Trial of 150-J Biphasic Shocks Compared With 200- to 360-J Monophasic Shocks in the Resuscitation of Out-of-Hospital Cardiac Arrest Victims Circulation, Oct 2000; 102: 1780 - 1787
  23. 25. Automated Defibrillation <ul><li>Recommended mode for those not ACLS trained </li></ul>
  24. 26. Step 1 <ul><li>Switch to AED mode </li></ul>
  25. 27. Step 2 <ul><li>Connect electrodes to patient and to defibrillator </li></ul>
  26. 28. Step 3 <ul><li>Analyse rhythm </li></ul><ul><li>Do not touch patient </li></ul>
  27. 29. Step 4 <ul><li>Shock the patient </li></ul>
  28. 30. Step 5 <ul><li>Check ECG & patient, </li></ul><ul><li>Start CPR (30:2) if no pulse </li></ul>
  29. 33. <ul><li>Hypovolemia - Volume Infusion </li></ul><ul><li>Hypoxia - Ventilation </li></ul><ul><li>Hypothermia - Rewarming, warmed fluids </li></ul><ul><li>Hyperkalemia - CACL 2 , Insulin, Glucose, NAHCO3, Dialysis </li></ul><ul><li>Hydrogen ion (Acidosis) - NAHCO3 </li></ul><ul><li>Tamponade - Pericardiocentesis </li></ul><ul><li>Tension Pneumothorax - Needle Decompression </li></ul><ul><li>Thrombosis (AMI) - Rx Cardiogenic Shock </li></ul><ul><li>Thromboembolism - Thrombolysis </li></ul><ul><li>Tablets -Overdose - Lavage, Activated Charcoal, Specific Rx </li></ul>Non VF/VT Cardiac Arrest Reversible Causes - 5Hs & 5Ts
  30. 35. “ primum nil nocere - First Do No Harm” (Galen 129 AD) Thank you 2. Play video on endotracheal intubation 1. Play video on Bag Valve mask Ventilation

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