Resuscitation Teaching Day

Documentation Experience looking through notes at C15 - Nil written - No diagnosis/differential/plan - Chest pain with no ECG - Names, Dates, Triage Not written = Not done

Why Write Anything? PRIDE in work despite environment Crunching Numbers Quality Care Acceptable Management Follow up of patient Front page of newspapers! Litigation

What is our job? Employed to treat patients. No-one can be turned away by us. Walk-ins: Hx/Assess/Triage/Document Ambulance: Assess/Triage/Document Then may divert patient Report problems after the fact Adverse incident reports to HOD

Reassessment After seeing patient, need to go back: Reassess 30min-2 hrs - Observations - Triage - Treatment: Ab/Analgesia and effect - Ix: U dipstix/CXR/Serial ECGs - Referral or D/C or Handover

Chain of Information History is essential for our diagnosis Ambulance often only source Who can read Drs writing? Take on arrival and give on transfer De: Demographics M: Mechanism I: Injuries S: Signs (Obs) T: Treatment

Post Cardiac Arrest Syndrome PostCardiac Arrest Syndrome: Epidemiology, Pathophysiology, Treatment, and Prognostication A Consensus Statement From the International Liaison Committee on Resuscitation Circulation 2008;118;

Post Cardiac Arrest Syndrome Poor prognosis: Mortality 50-80% Optimization of Care ROSC after Cardiac Arrest

What is it? 1. Brain injury 2. Myocardial Dysfunction 3. Systemic ischemia/reperfusion 4. Underlying pathological cause

Prognostication Difficult Need 72 hours at least Use of resources False hope for family

Therapeutic Strategies - Monitoring: ICU - EGDT: Optimize O2 delivery (?Targets) - Oxygenation: Sats 94-96% - Normocarbia - Lung Protective Ventilation - Manage Dysrythmias (elecs normal etc) - Hypotension: IVF then Inotropes (Echo) - Mechanical support: IABP

Further Management Mx of ACS: Reperfusion Therapeutic Hypothermia Sedation and NMB (EEG) Seizure Prevention and Control Glucose control Monitor renal function: Dialysis ICD insertion

Prognostication Associated factors - age/sepsis Lack of adherance to CPR guidelines Quality of CPR Failure to deliver shock Bedside Neurological Tests CT Head Biochemical Markers (NSE)