Resuscitation Checklist
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- James Hood
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1 Resuscitation Checklist Actions if multiple responders are on scene Is resuscitation appropriate? Conditions incompatible with life Advanced decision in place Based on the information available, the senior clinician (Paramedic, Nurse or Doctor) on scene agrees that resuscitation would not be in the best interest of the patient, as progressive disease or terminal illness would mean that death is imminent and unavoidable Try to achieve 360 access to patient Establish team leader Assign tasks to named individuals Confirm sufficient resources have been mobilised request enhanced care Are relatives being supported? Establish circumstances leading to arrest Ensure full monitoring availability ASAP During CPR Checklist Scribe Sheet Post Resuscitation Paediatrics Special Circumstances ALS Algorithm For Reference Only Do not return to Clinical Audit - Destroy after use Clinical Quality Improvement clinicalqualityimprovement@swast.nhs.uk
2 During CPR Checklist Ensure high quality chest compressions Rate per min 1/3 chest depth with full recoil Plan actions before interrupting CPR Ensure sufficient supplies are available Use waveform ETCO 2 at earliest opportunity To guide ventilations (10 per min) and good quality chest compressions Aim for above 2.7 KPa Gain vascular access (IV, EJV or IO) Connect fluid for flush and volume resuscitation If periferral IV access is not possible consider external jugular vein or IO Monitor ETCO 2 at all times and prepare for ROSC Hypoxia Airway - oxygenation Hyperkalaemia BM (Metabolic imbalance) Hypothermia Temperature Hypovolaemia Catasphrophic haemmorrhage Tension Pneumothorax Equal chest rise - Consider decompression Tamponade Traumatic cause Toxins Consider Naloxone Thrombosis PPCI
3 Responder Cardiac Arrest Checklist 1 DANGER to you, others and then the patient. Withdraw from scene if unsafe to continue and call the response desk 2 RESPONSE No response, shout for help 3 4 AIRWAY Ensure it s open and clear of the tongue and any vomit BREATHING Assess for up to 10 sec. If not breathing normally and call not given as cardiac arrest. Update Hub via Tetra or hands free mobile ATTACH AED Follow its instructions 30 chest compressions at per min, at one third of the chest depth (5-6cm in adults) Followed by 2 ventilations using the BVM On the AED s second analysis, connect the BVM to Oxygen On the AED s third analysis consider OP airway & suction as required if having airway difficulties Gain immediate history as continuing BLS Continue until the patient is breathing normally or if asked to stop by the attending clinicians Complete AED Event form
4 Handover to Crew Do not write patient identifiable data Age Time of incident Mechanism of injury Injuries sustained Signs and Symptoms Treatment/Needs
5 Resuscitation Scribe Sheet Time of collapse AED switched on Time Rhythm Shock Drugs Post ROSC If potentially appropriate to cease resuscitation outside of guidance - consider and document senior clinical advice
6 Post Resuscitation Remain on scene for at least 10 minutes, unless in-hospital intervention is required Airway Stepwise approach Anticipate spontaneous respirations Conduct and Document 12 Lead ECG Breathing Titrate SpO 2 to 94-98% Optimise ETCO 2 Monitor waveform Circulation Maintain BP >90mmHg or presence of a radial pulse Give 250ml sodium chloride 0.9% if hypotensive Consider low dose adrenaline if indicated 12 Lead ECG BM Temperature SpO 2 ETCO 2 BP Disability Targeted temperature management Measure blood glucose Saline (if required) Transport checklist Post ROSC adrenaline Secure Airway - confirmed following movement connect to waveform ETCO2 Observations taken and recorded Reassess 5 mins after 250mls saline If hypotensive, aged 18+ and with HR <100 despite fluids Oxygen sufficient for transfer Withdraw 1ml of adrenaline 1:10,000 into a 10ml syringe Extrication prepare equipment and plan Dilute with 9ml saline and label syringe Family consider getting patient details and informing them of any plan Administer a 1ml bolus of adrenaline 10mcg Suction available and plugged into power Repeat post ROSC adrenaline as required Destination confirmed with all on scene ATMIST - including sending ECG if applicable Consider atropine for symptomatic and absolute bradycardia
7 Paediatric Paediatric Airway Establish clear airway Manage with a stepwise approach Monitor SpO 2 and ETCO 2 Newborn Stimulate by rubbing patient Establish clear airway Manage with a stepwise approach Monitor SpO 2 and ETCO 2 Breathing 5 initial inflation breaths Circulation Sufficient to depress sternum by at least 1 / 3 depth of the chest: 4cm for an infant 5cm for a child Rate per minute Ratio 15:2 If heart rate is not detectable or slow (<60bpm) start chest compressions Ratio 3:1 No adrenaline or amiodarone Disability Targeted temperature management Ensure newborn babies are kept warm Measure blood glucose Patients age Years Months Last known weight Weight 1-12months 1-5yrs 6-12yrs Sodium chloride 0.9% Adrenaline Amiodarone Glucose (0.5 x age in months) + 4 (2 x age in yrs) + 8 (3 x age in yrs) + 7 Medical 20ml / kg Burns 10ml / kg Trauma 5ml / kg 10mcg / kg 5mg / kg 2ml / kg All patients <18 years old must be conveyed to ED by the ambulance service irrespective of whether a resuscitation attempt is made with appropriate safeguarding completed
8 Special Circumstances Trauma Confirm enhanced care team have been mobilised where available Treat reversible causes early and aggressively If not available, scoop and run to nearest suitable receiving unit Hypovolemia Control catastrophic bleeding Splint suspected fractures of long bones and pelvis Oxygenation Ensure patent airway Maximize oxygen administration Tension Pneumothorax Bilateral needle decompression Also consider in diving incidents and asthma Pregnancy Early intubation Early left lateral displacement of uterus Transfer to ED consider pre-alert for peri-mortem C-Section if >24 weeks gestation Drowning and/or where hypothermia is the cause Early intubation Do not use abdominal thrusts to remove water from lungs or stomach Below 35 C double intervals between drugs should be used e.g. adrenaline every 6 10mins Do not stop resuscitation in the prehospital setting without senior clinical support
9 ALS Algorithm Advanced Life Support Unresponsive and not breathing normally CPR 30:2 Attach defibrillator/monitor Minimise interruptions Call for P1 backup Assess rhythm Shockable (VF/Pulseless Assess rhythm VT) Return of spontaneous circulations Non-Shockable (PEA/Asystole) 1 Shock Minimise interruptions Immediately resume CPR for 2 min Minimise interruptions DURING CPR Ensure high quality chest compressions Minimise interruptions to compressions Give oxygen Use waveform capnography Continuous compressions when advanced airway in place Vascular access (intravenous or intraosseous) Give adrenaline every 3-5 mins Give amiodarone after 3 shocks IMMEDIATE POST - CARDIAC ARREST TREATMENT Use ABCDE approach Aim SpO 2 of 94-98% Aim for normal ETCO 2 range (4-5.7 KPa) 12-lead ECG Treat precipitating causes Targeted temperature management Immediately resume CPR for 2 min Minimise interruptions CONSIDER where available and trained Ultrasound imaging Coronary angiography and Mechanical chest percutaneous coronary compressions to facilitate intervention transfer/treatment Extracorporeal CPR
10 Notes Age Observations: : AVPU Observations: : AVPU Time Medical/Trauma Interventions Signs Time of arrival GCS - EVM RR HR SpO 2 ETCO 2 BM BP Temp GCS - EVM RR HR SpO 2 ETCO 2 BM BP Temp
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