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 – ml 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 3 rd year resus study guides!

Drugs Need to know doses and timing of 3 drugs Non shockable – Adrenaline 1mg immediately and then every 2 nd 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!