Principles of Resuscitation

Question 1

what is resuscitation?

Answer 1

process of correcting physiological disorders in an acutely unwell patient

Question 2

describe the pathophysiology of cardiac arrest?

Answer 2

adequate airway, breathing and circulation needed for oxygen delivery to organs > inadequate oxygen delivery > organ failure > cardio-respiratory arrest

Question 3

what are some clinical indicators of deterioration before cardiac arrest?

Answer 3

tachypnoea
tachycardia
hypotension
reduced conscious level
use trends in clinical observations (NEWS)

Question 4

how do you rapidly assess acute illness?

Answer 4

ABCDE

Question 5

important things to consider if patient becomes acutely unwell?

Answer 5

best place/position
equipment needed
help from others
who are you going to call? (ghostbusters)

Question 6

how do you asses airway?

Answer 6

is it open or closed?
obstruction?
blood?
action required?
adjuncts?
do you need anaesthetic support?

Question 7

how can you support an airway?

Answer 7

nasopharangeal
oropharyngeal
chin lift
iGels
Laryngeal mask airway

Question 8

how do you assess breathing?

Answer 8

breathing present or absent
adequate ventilation?
establish oxygen source and means of delivering oxygen
oxygen sats
visual signs - cyanosis, pursed lips etc

Question 9

general rule for oxygen delivery?

Answer 9

all patients get high flow oxygen

- if emergency just give it even if you don’t know whether they have COPD

Question 10

what is hypoxic drive?

Answer 10

central chemoreceptors which usually stimulate breathing when they sense high CO2 levels are down regulated due to chronically high CO2 in COPD patients
they therefore rely on peripheral chemoreceptors which stimulate breathing when they sense low oxygen - therefore by giving high flow oxygen these peripheral chemoreceptors dont sense any low oxygen so dont stimulate breathing

Question 11

how is oxygen delivery managed in COPD patients?

Answer 11

unless someone is a known CO2 retainer then give all breathless patients oxygen
then measure ABGs
- if CO2 fine then monitor
- if CO2 rising then aim O2 sats at 88-92%

Question 12

what can the high CO2 in the acutely unwell patient be confused with?

Answer 12

pulmonary oedema

differentiate by looking at HCO3

Question 13

sepsis 6?

Answer 13

blood cultures
urine output
fluids
antibiotics
lactate
oxygen
BUFALO

Question 14

how do you assess circulation?

Answer 14

present or absent ?
- pulse, BP, CRT, ECG
adequate perfusion
- colour, conscious level

Question 15

what can cause circulatory failure?

Answer 15

internal bleeding/GI haemorrhage
clots - PE, MI, tamponade etc
hypovolaemia (from blood loss)

Question 16

immediate management of a pelvic fracture before hospital?

Answer 16

reduce volume of the pelvis by using a belt around the pelvis

Question 17

where can blood loss occur from?

Answer 17

chest
pelvis
long bones
etc

Question 18

what is done immediately for a severe femoral fracture

Answer 18

Thomas splint

think about where you will get IV access etc

Question 19

how do you assess IV access?

Answer 19

if present, is it working?
if not, what cannula do you use (larger blood loss = larger cannula)
where to put it
what samples to take
do you want to give fluids? (usually start everyone with fluids then blood if needed)

Question 20

fluids considerations?

Answer 20

what fluid?
how much?
how quickly?

Question 21

what is tranexamic acid used for?

Answer 21

massive blood loss

Question 22

what do you shock?

Answer 22

V fib = shock

V tachycardia = only shock if unconscious

Question 23

how do you assess disability?

Answer 23

glucose
neuro
- AVPU, GCS, pupils, weakness etc

Question 24

why must you expose the patient?

Answer 24

to see

• colour
• rashes
• blood loss
• drains (possibly could have slipped out)

Question 25

DEFG?

Answer 25

don't ever forget glucose
if low can cause reduced conscious level
appear acutely unwell
give dextrose orally or IV
IM glucagon
rapid reversal

Question 26

important information to gather about a patient?

Answer 26

who they are
whats the working diagnosis
events preceding acute episode
get notes
get NEWS chart
should you recuscitate

Question 27

whats next after ABCDE?

Answer 27

re-evaluate
continuous monitoring
further investigations
specialist involvement
inform/involve relatives