At a recent live code, I again noted how common it is for less experienced teams to attempt to "do everything at once" and priorities can easily become confused in the hurried rush to save a life. I have put together a few reflections from this event.
The most important part of any resuscitation attempt is to do the basic things well!
One of the first things I noted was the hesitancy to initiate CPR. This is a decision point that all CPR students struggle with. If I suggest to you that you may feel a pulse, in which case there is no need to start an aggressive act, you may decide that you feel one. This is the reason that the AHA guidelines are so clear. If you do not DEFINITELY feel a pulse within 10 seconds, it is time to get on the chest.
Another thing that I saw was the incessant "need" of the provider to hyperventilate the patient. Multiple individuals took turns using a bag mask on the patient prior to intubation, and providers were bagging the patient approximately once per second, even during CPR (when it should be 30 compression to 2 breaths). After intubation, providers were attempting to bag the patient approximately every three seconds (should be one every 6 seconds at this point). (for more on the dangers of hyperventilation, see: http://www.carpentercprsolutions.com/-blog/key-components-of-high-quality-cpr-continued-part-2)
My advice is that you take care not to make your need to "do something" into a process that hurts the victim. AHA guidelines are evidence based, and the evidence clearly states that hyperventilated patients have poor outcomes.
Provider "need" to do something, and act, can easily turn into detrimental outcomes for the patient. This patient had no need for hyperventilation, yet all healthcare providers seem to do it.
In this code, there was a rush to intubate, and a rush to get the monitor set up, and to get an IV line in place, but a decided delay in placing the pads, hooking the bag mask to oxygen, and defibrillation.
REMEMBER, in order to save a life, the emphasis must be on doing the basic things correctly-- early, HIGH quality CPR and early defibrillation are the keys here. Everything else is just theory. In codes done correctly, there will be little other activity going on. Providers feel the need to ACT, and ACT NOW, but please don't forget that much of a code is spent doing nothing more than the basics, and those measures are the real life savers, not the advanced stuff done in a hurried fashion.
This particular patient was ultimately resuscitated with HIGH quality CPR, and defibrillation, with CPR being done during defibrillator charging, and resumption immediately after the shock.
The most important part of any resuscitation attempt is to do the basic things well!
One of the first things I noted was the hesitancy to initiate CPR. This is a decision point that all CPR students struggle with. If I suggest to you that you may feel a pulse, in which case there is no need to start an aggressive act, you may decide that you feel one. This is the reason that the AHA guidelines are so clear. If you do not DEFINITELY feel a pulse within 10 seconds, it is time to get on the chest.
Another thing that I saw was the incessant "need" of the provider to hyperventilate the patient. Multiple individuals took turns using a bag mask on the patient prior to intubation, and providers were bagging the patient approximately once per second, even during CPR (when it should be 30 compression to 2 breaths). After intubation, providers were attempting to bag the patient approximately every three seconds (should be one every 6 seconds at this point). (for more on the dangers of hyperventilation, see: http://www.carpentercprsolutions.com/-blog/key-components-of-high-quality-cpr-continued-part-2)
My advice is that you take care not to make your need to "do something" into a process that hurts the victim. AHA guidelines are evidence based, and the evidence clearly states that hyperventilated patients have poor outcomes.
Provider "need" to do something, and act, can easily turn into detrimental outcomes for the patient. This patient had no need for hyperventilation, yet all healthcare providers seem to do it.
In this code, there was a rush to intubate, and a rush to get the monitor set up, and to get an IV line in place, but a decided delay in placing the pads, hooking the bag mask to oxygen, and defibrillation.
REMEMBER, in order to save a life, the emphasis must be on doing the basic things correctly-- early, HIGH quality CPR and early defibrillation are the keys here. Everything else is just theory. In codes done correctly, there will be little other activity going on. Providers feel the need to ACT, and ACT NOW, but please don't forget that much of a code is spent doing nothing more than the basics, and those measures are the real life savers, not the advanced stuff done in a hurried fashion.
This particular patient was ultimately resuscitated with HIGH quality CPR, and defibrillation, with CPR being done during defibrillator charging, and resumption immediately after the shock.
