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RESUS

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.

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RESUS

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  1. RESUS

  2. 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

  3. Assessment of acutely unwell patientABCDE

  4. A = Airway • Obstructed? • Head tilt • Chin lift • Jaw thrust • Suction • Oropharyngeal airway • (Nasopharyngeal airway)

  5. B= Breathing • Chest movement • Respiratory rate • Sats • Auscultate in 4 main areas • Oxygen – prongs? Mask? Mask + reservoir bag? • O2 – 15L/min

  6. C = Circulation • Pulse • Blood pressure • Capillary refill • Warm peripheries – hands and feet • IV access – 250-500ml fluid ASAP!

  7. (D = Disability) • AVPU – alert, voice, pain, unresponsiveness • BM – hyper/hypoglycaemic • Pupils

  8. (E = everything else) • Expose patient fully and top to toe exam

  9. SHIT THEY’VE ARRESTED...

  10. Confirming arrest • Measure pulse and watch for resps for 10s • NB - Airway must be patent or they won’t be able to breathe

  11. HEEEEEELP!!! • Call 2222 • “Cardiac arrest, ward 3”

  12. Hearts definitely stopped... • CPR 30:2 until defib arrives • 2 breaths should be given with bag valve mask

  13. 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

  14. Algorithm • In the back of your 3rd year resus study guides!

  15. Drugs • Need to know doses and timing of 3 drugs • Non shockable – Adrenaline 1mg immediately and then every 2nd cycle of CPR (Atropine 3mg if PEA <50bpm only once) • Shockable – Adrenaline 1mg (not immediate) every second cycle, Amiodarone 300mgs after fourth cycle

  16. 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

  17. 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!

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