RESUS

Passing Resus

• Pass mark slightly higher than other clinical skills (easier to kill someone!!)

• Percentage passed last year =• Its the station where most students fail

• Key to passing – staying calm!!!!

• Patient MAY NOT BE DEAD when you walk in

ASSESSMENT OF ACUTELY UNWELL PATIENT

ABCDE

A = Airway

• Obstructed?

• Head tilt • Chin lift• Jaw thrust

• Suction• Oropharyngeal airway• (Nasopharyngeal airway)

B= Breathing

• Chest movement• Respiratory rate• Sats• Auscultate in 4 main

areas• Oxygen – prongs?

Mask? Mask + reservoir bag?

• O2 – 15L/min

C = Circulation

• Pulse • Blood pressure

• Capillary refill• Warm peripheries –

hands and feet

• IV access – 250-500ml fluid ASAP!

(D = Disability)

• AVPU – alert, voice, pain, unresponsiveness

• BM – hyper/hypoglycaemic

• Pupils

(E = everything else)

• Expose patient fully and top to toe exam

SHIT THEY’VE ARRESTED...

Confirming arrest

• Measure pulse and watch for resps for 10s

• NB - Airway must be patent or they won’t be able to breathe

HEEEEEELP!!!

• Call 2222• “Cardiac arrest, ward 3”

Hearts definitely stopped...

• CPR 30:2 until defib arrives• 2 breaths should be given with bag valve mask

To defib or not to defib• (video of defib is on eemec)

• Take your time and look at the rhythm on the screen

• Shockable – VF/ VT

• Non- shockable – PEA/Asystole

Algorithm

• In the back of your 3rd year resus study guides!

Drugs

• Need to know doses and timing of 3 drugs

• Non shockable – Adrenaline 1mg immediately and then every 2nd cycle of CPR (Atropine 3mg if PEA <50bpm only once)

• Shockable – Adrenaline 1mg (not immediate) every second cycle, Amiodarone 300mgs after fourth cycle

Reversible causes

• Hypoxia – give oxygen• Hypovolaemia – give fluids/blood• Hypo/hyperkalaemia/metabolic- correct

imbalance• Hypothermia – warm patient• Tension pneumothorax – decompress• Tamponade – drainage of fluid (refer to surgeon)• Toxins – antidotes/dialysis• Thrombosis – anticoagulants

Hoorah they’re back...what the hell do I do now?

• Repeat ABCDE from the beginning• If not breathing on own or unstable BP = ICU• If breathing on own with stable BP = HDU

• The patient may well die or the scenario will be stopped so don’t worry if this happens!