CGH Code Blue Procedure

1. Cardiac Arrest Resuscitation

2. Terminal Arrhythmia 157 patients with SCD VT degenerated to VF 62% Primary VF 8% Torsade de pointes 13% Bradyarrhythmias 17%

3. Chain of Survival Early Access Early CPR Early Defibrillation Early Advanced Care

5. Team Leader - one voice - interpret inputs (ECG, case-notes, investigations, processes and makes decisions Does not physically participate in Resus Decides when to terminate Resus Doctor 2 - establish IV Drip and administration of IV drugs on orders of Team Leader Nurse 2 - assist Doctor 2 and preparation of drugs, putting up infusions Nurse 3 - performs Chest Compressions 30:2 or 100/min Doctor 1 - BVM followed by Intubation Nurse 1 - assist doctor 1, cricoid pressure during BVM and intubation, check & prepare laryngoscope, ETT, portable ventilator Call Anesthesia if difficult airway Call CVM/Medical ICU Registrar for further management

6. Team Leader - one voice - interpret inputs (ECG, case-notes, investigations, processes and makes decisions Does not physically participate in Resus Decides when to terminate Resus Doctor 2 - establish IV Drip and administration of IV drugs on orders of Team Leader Nurse 2 - assist Doctor 2 and preparation of drugs, putting up infusions Nurse 3 - performs Chest Compressions 30:2 or 100/min Doctor 1 - BVM followed by Intubation Nurse 1 - assist doctor 1, cricoid pressure during BVM and intubation, check & prepare laryngoscope, ETT, portable ventilator Call Anesthesia if difficult airway Call CVM/Medical ICU Registrar for further management

7. Team Leader - one voice - interpret inputs (ECG, case-notes, investigations, processes and makes decisions Does not physically participate in Resus Decides when to terminate Resus Doctor 2 - establish IV Drip and administration of IV drugs on orders of Team Leader Nurse 2 - assist Doctor 2 and preparation of drugs, putting up infusions Nurse 3 - performs Chest Compressions 30:2 or 100/min Doctor 1 - BVM followed by Intubation Nurse 1 - assist doctor 1, cricoid pressure during BVM and intubation, check & prepare laryngoscope, ETT, portable ventilator Call Anesthesia if difficult airway Call CVM/Medical ICU Registrar for further management

9. Resuscitation 1 . Focus on the primary and secondary ABCDs 2 . Decisive, professional, unflappable attitude 3. One voice 4. Ensure that the leader knows all drugs & procedures done 5. Leader gives clear information on next steps to be taken

12. Post-Resuscitation Transfer 1. Relinquish care to a team of equal or greater expertise 2. Provide complete, concise, and well- organised information 3. Ensure that patient airway is secured and patient stabilised prior to transfer

13. Phase 4 Critique 1. Dealing with Grief 2. Debrief 3. Education

15. VF/Pulseless VT

16. VF/Pulseless VT

17. VF/Pulseless VT

18. VF/Pulseless VT

19. VF/Pulseless VT

20. VF/Pulseless VT

21. VF/Pulseless VT

22. VF/Pulseless VT

23. VF/Pulseless VT Drug Shock CPR

24. Thomas Schneider et al, Multicenter, Randomized, Controlled Trial of 150-J Biphasic Shocks Compared With 200- to 360-J Monophasic Shocks in the Resuscitation of Out-of-Hospital Cardiac Arrest Victims Circulation, Oct 2000; 102: 1780 - 1787

35. “ primum nil nocere - First Do No Harm” (Galen 129 AD) Thank you 2. Play video on endotracheal intubation 1. Play video on Bag Valve mask Ventilation