Junior Doctor Tips - Cardiac Arrests
As a Doctor, you will almost certainly be a member of the hospital cardiac arrest team. When faced with a cardiac arrest situation, staying calm and following a well-learned plan of action is essential. In this blog article, we'll walk you through the crucial steps to respond effectively to cardiac arrest situations.
Cardiac Arrest Calls
1. Prioritise Immediate Life Support (ILS):
Your absolute priority is to ensure adequate ventilation and perfusion (good quality chest compressions & patent airway) - once this is achieved, or as soon as help arrives, then the management should be as per the ALS guidelines
Follow the Advanced Life Support (ALS) algorithm and refer to the Resuscitation Council guidelines for the most up-to-date information.
2. Perform DR ABC:
- D for Danger: Check for danger around the patient and move them to a safe location if needed.
- R for Response: Determine if the patient is responsive by performing a squeeze, shake, and shout. If unresponsive, proceed to the next steps.
- A for Airway: Open the airway and check for any obstructions, ensuring clear airflow.
- B for Breathing: Assess the patient's breathing for a maximum of 10 seconds.
3. Call for Help:
Shout for help and activate the cardiac arrest team using the hospital's standard 'crash call' number (usually 2222).
State the patient's location, mention it's an adult cardiac arrest, and request the adult cardiac arrest team.
4. Ensure Airway Security:
Use adjuncts like oropharyngeal (OP) or nasopharyngeal (NP) airways if necessary.
Administer oxygen.
Only attempt supraglottic airway insertion or tracheal intubation if you are specifically trained - any attempt must be confirmed by clinical examination and capnography.
5. Initiate CPR:
Begin cardiopulmonary resuscitation (CPR) with two people working in rotations (30 chest compressions followed by 2 breaths).
If alone without a bag-valve mask or oxygen, focus on effective chest compressions (100-120 beats per minute, 5-6 cm depth).
6. Use a Defibrillator:
Attach a defibrillator, ideally with a cardiac monitor, within 3 minutes of confirming arrest.
Ensure proper placement of the pads, and minimise the 'hands-off' time (less than 5 seconds) when delivering a shock.
7. Attach Cardiac Monitoring and IV Access:
Monitor the patient's cardiac rhythm and establish intravenous (IV) access.
8. Follow the ALS Algorithm:
Adhere to the ALS algorithm based on the Resuscitation Council (UK) guidelines for further guidance on managing the situation.
Tips:
Familiarise yourself with the hospital's defibrillator and crash trolley.
Always wear gloves and consider using universal precautions.
Note the time of the crash call for tracking.
Communication is key; discuss decisions with the entire medical team, the nursing staff, the patient (if competent), and the family.
Consider any advance directives (living will) given by the patient.
Remember that "not for resus" does not preclude other medical measures.
Regularly review the resuscitation status, and document discussions meticulously.
Seek guidance from your defence union if you're uncertain about the guidelines.
“Do Not Resuscitate” Orders:
Decisions not to resuscitate should be made when success is unlikely or if the patient prefers not to be resuscitated.
Only a registrar (i.e. ST3+) or above can change a patient's resuscitation status.
Good communication with the patient, family, and medical team is vital.
Follow any advance directives provided by the patient.
Resuscitation status should be reviewed regularly.
Document all discussions regarding CPR status in the medical notes.
Seek guidance from your defence union in case of uncertainties.
Conclusion
Responding to cardiac arrests is a critical responsibility for healthcare professionals. By following these steps and guidelines, you can improve your preparedness and effectiveness in managing such emergencies while prioritizing patient well-being and ethical considerations. Always stay updated with the latest guidelines and seek support when needed.
Enjoyed this article? See more from Happy Medics by following us on Instagram!
