cgh code blue procedure

Cardiac Arrest Resuscitation : 

Cardiac Arrest Resuscitation

Terminal Arrhythmia : 

Terminal Arrhythmia 157 patients with SCD VT degenerated to VF 62% Primary VF 8% Torsade de pointes 13% Bradyarrhythmias 17%

Slide 3: 

Chain of Survival Early Access Early CPR Early Defibrillation Early Advanced Care

Slide 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

Slide 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

Slide 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

Slide 8: 

Adult Cardiac Arrest Primary ABCD Phase Check responsiveness Focus on ABCD - basic CPR(30:2) and defibrillation Activate code blue - 1414 Secondary ABCD Phase A Airway : perform endotracheal intubation (video) B Breathing : Ventilate with BVM, portable ventilator C Circulation : check pulse, give chest compressions D Differential Diagnosis & Defibrillate Assess rhythm Code Blue

Resuscitation : 

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

Secondary Survey (some points) : 

Secondary Survey (some points) C. Circulation Ante-cubital vein / external jugular vein Infusion fluid : Normal saline Drugs administered via ETT : adrenaline, atropine Circulation time in cardiac arrest Atropine

Secondary Survey (more points) : 

Secondary Survey (more points) Differential Diagnosis What caused the arrest? Are there any reversible causes - those that had a specific therapy? Are there any complications of resuscitation that have an immediately remediable cause?

Post-ResuscitationTransfer : 

Post-ResuscitationTransfer 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

Phase 4Critique : 

Phase 4Critique 1. Dealing with Grief 2. Debrief 3. Education

Slide 15: 

VF/Pulseless VT

Slide 16: 

VF/Pulseless VT

Slide 17: 

VF/Pulseless VT

Slide 18: 

VF/Pulseless VT

Slide 19: 

VF/Pulseless VT

Slide 20: 

VF/Pulseless VT

Slide 21: 

VF/Pulseless VT

Slide 22: 

VF/Pulseless VT

Slide 23: 

VF/Pulseless VT Drug Shock CPR

Slide 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 VictimsCirculation, Oct 2000; 102: 1780 - 1787

Automated Defibrillation : 

Automated Defibrillation Recommended mode for those not ACLS trained

Step 1 : 

Step 1 Switch to AED mode

Step 2 : 

Step 2 Connect electrodes to patient and to defibrillator

Step 3 : 

Step 3 Analyse rhythm Do not touch patient

Step 4 : 

Step 4 Shock the patient

Step 5 : 

Step 5 Check ECG & patient, Start CPR (30:2) if no pulse

Slide 33: 

Hypovolemia - Volume Infusion Hypoxia - Ventilation Hypothermia - Rewarming, warmed fluids Hyperkalemia - CACL2, Insulin, Glucose, NAHCO3, Dialysis Hydrogen ion (Acidosis) - NAHCO3 Tamponade - Pericardiocentesis Tension Pneumothorax - Needle Decompression Thrombosis (AMI) - Rx Cardiogenic Shock Thromboembolism - Thrombolysis Tablets -Overdose - Lavage, Activated Charcoal, Specific Rx Non VF/VT Cardiac Arrest Reversible Causes - 5Hs & 5Ts

Slide 35: 

“primum nil nocere - First Do No Harm” (Galen 129 AD) Thank you