Aaaaaalways DEFIB before airway/ventilation - follow the Chain of Survival - call for help, buy time with CPR until defib/trolley arrives, restart the heart with defib, further care.
So many incorrect things here: 1. Compression:ventilation ratio should be 30:2 with BVM and continuous (100-120/min) with an advanced airway 2. Epi/adrenalin is given asap if initial rhythm check is PEA or asystole, for shockable rhythms (VFib/VTach), do 2 minutes of CPR then give epi/adrenalin 3. They should have added ABG on the blood draw to rule out acidosis, also patient most likely had pulmonary embolism (from post hip surgery) rather than AMI unless supported by 12 lead ECG. 4. Putting feet/legs on bed can actually achieve good chest compressions, or designate compression to a taller person. 5. Amiodarone 300mg should have been given when the rhythm was shockable and second dose of 150mg for refractory Vfib. Giving antiarrhythmic drug as soon as possible for a shockable rhythm increases the chance of converting the rhythm to a perfusing one. May consider lidocaine as alternative. 6. Pulse check is done when there is organized rhythm to rule out PEA, frequent checking of pulse is unnecessary as it decreases chest compression fraction (CCF) that could lead to hypoxia and eventually coma. Chest compression interruptions should be no less than 5 or over 10 seconds. I am an AHA instructor and the comments above are based from AHA 2020 guidelines, these are from evidence and research based practices, not sure if they they were using UK guidelines (if there is such).
interesting, we are being taught to give adrenalin 1mg and amiodaron 300mg with an shockable rythm after the 3rd shock for the first time, after that adrenalin all 3-5min. and 150mg amiodarone only after 5th shock
5:43 What difference does it make if her feet was on the bed? If anything it aids in making sure chest compressions are of an acceptable depth. The way she was standing she was bending her elbows ever slightly.
@ loop 4:37, Adrenaline 1mg IV was prescribed. It would have been prescribed after seeing the rhythm on the defib if it was shockable or non shockabale rhythm.
Because the person holding BVM must use both hands to keep the mask firmly sealed over the mouth so air doesn’t escape, which can’t be done with one hand. Therefore, the person doing compressions is pausing anyway so they squeeze the bag instead.
@@Saracen1786too much time of doing compressions. Which is way more important than ventilation. Also if I start being pedantic, they could slow down on their compressions too.
@@Zumaray If using manual ventilation e.g bag mask then you have to pause compressions anyway. The ALS protocol mentions 30 compressions and then 2 ventilations.
@@Saracen1786 That is not what I was taught. We are taught that chest compressions are absolute priority to maintain the coronary and cerebral blood flow to maximise patient’s chance of survival. Even when giving ventilation, there is no need to stop. Especially in the early stages of the patient initially going in to arrest. One person holding and doing the bagging is better than one person doing the compressions and squeezing the BVM!
300 mg of Amiodarone should have been given too after administering 1 mg of Adrenaline when the cardiac arrest shifted from non shockable to shockable rhythm.
This is not true. The Resuscitation Council, UK ALS guidelines state 300mg after the 3rd shock - 2 minute intervals (if stacked shocks x 3 are given, this counts as one shock) , then 150mg in refractory shockable rhythm (after 5th shock )
@@drilonkamishi9025 Incorrect I am afraid. The patient was given 1 mg Adrenaline during management of PEA. Once patient went into VF the second dose must be given 3-5 minutes after the initial dose. The practice of giving the first dose of Adrenaline after the the third shock is specific to a patient who collapses straight into VF/PVT and remains in this for 3 shocks, hence Refractory VF. The drug timings during this scenario are therefore quite correct and meet UK Resuscitation ALS guidelines.
That CRM bs from Aviation’s found it’s way in to medicine. Too much focus on interpersonal co operation at the cost of patient care. Talk talk talk blah blah blah huddle huddle I am the leader listen to meeeee.
This was awesome. The doctor leading did such a great job. Keeping calm and very encouraging of his team.
The monitor arrived on the crash cart and then just vibed there for a minute or two until someone decided to stick the pads on, fantastic
Aaaaaalways DEFIB before airway/ventilation - follow the Chain of Survival - call for help, buy time with CPR until defib/trolley arrives, restart the heart with defib, further care.
Theresa feet off the bed, feet on the floor 😂 fantastic hahaha
Didn't understand that. If she needed this for a better position then that's what she should do
No ABG? Fantastic
So many incorrect things here:
1. Compression:ventilation ratio should be 30:2 with BVM and continuous (100-120/min) with an advanced airway
2. Epi/adrenalin is given asap if initial rhythm check is PEA or asystole, for shockable rhythms (VFib/VTach), do 2 minutes of CPR then give epi/adrenalin
3. They should have added ABG on the blood draw to rule out acidosis, also patient most likely had pulmonary embolism (from post hip surgery) rather than AMI unless supported by 12 lead ECG.
4. Putting feet/legs on bed can actually achieve good chest compressions, or designate compression to a taller person.
5. Amiodarone 300mg should have been given when the rhythm was shockable and second dose of 150mg for refractory Vfib. Giving antiarrhythmic drug as soon as possible for a shockable rhythm increases the chance of converting the rhythm to a perfusing one. May consider lidocaine as alternative.
6. Pulse check is done when there is organized rhythm to rule out PEA, frequent checking of pulse is unnecessary as it decreases chest compression fraction (CCF) that could lead to hypoxia and eventually coma. Chest compression interruptions should be no less than 5 or over 10 seconds.
I am an AHA instructor and the comments above are based from AHA 2020 guidelines, these are from evidence and research based practices, not sure if they they were using UK guidelines (if there is such).
you are 100 percent right. rcuk states the same
interesting, we are being taught to give adrenalin 1mg and amiodaron 300mg with an shockable rythm after the 3rd shock for the first time, after that adrenalin all 3-5min. and 150mg amiodarone only after 5th shock
Regarding 1: so only continuous compressions on intubated patients?
@@liahk1000I think advanced airways in this context might include guedel and LMA
5:43 What difference does it make if her feet was on the bed? If anything it aids in making sure chest compressions are of an acceptable depth. The way she was standing she was bending her elbows ever slightly.
Jesus, her CPR position is a recipe for a shoulder injury! Someone lower the bed!
Fantastic
What’s with the delay in starting compressions??
@ loop 4:37, Adrenaline 1mg IV was prescribed. It would have been prescribed after seeing the rhythm on the defib if it was shockable or non shockabale rhythm.
They noted that it was pea on the defib machine..that's why they kept on continuing cpr
Why was the feet on the bed wrong?
Video is not clear for a new student what is going on is not clear only I got about CPR but how many cycles and why no clue
Om shanti
I was wondering if they put sth underneath the patien's back.. A bed seems to soft to perform cpr on it
Recommendations for that changed, unless there's an inflatable mattress
at the start, why is the person doing compressions also bagging? Why isnt the person holding the BVM squeezing?
Because the person holding BVM must use both hands to keep the mask firmly sealed over the mouth so air doesn’t escape, which can’t be done with one hand.
Therefore, the person doing compressions is pausing anyway so they squeeze the bag instead.
@@Saracen1786too much time of doing compressions. Which is way more important than ventilation.
Also if I start being pedantic, they could slow down on their compressions too.
@@Zumaray If using manual ventilation e.g bag mask then you have to pause compressions anyway. The ALS protocol mentions 30 compressions and then 2 ventilations.
@@Saracen1786 That is not what I was taught. We are taught that chest compressions are absolute priority to maintain the coronary and cerebral blood flow to maximise patient’s chance of survival. Even when giving ventilation, there is no need to stop. Especially in the early stages of the patient initially going in to arrest. One person holding and doing the bagging is better than one person doing the compressions and squeezing the BVM!
Giving morphine to an unconscious patient who can't breathe on his own?
😮
Why not check for trops at some point ?
Sure but even with fast analysis it would be around 30 minutes. And I'm assuming it's always high during cpr?
@@liahk1000 Yeah you’re right
Fantastic 😂
Absolutely…fantastic
Dwyer it
300 mg of Amiodarone should have been given too after administering 1 mg of Adrenaline when the cardiac arrest shifted from non shockable to shockable rhythm.
Only indicated following the 3rd (300mg) and 5th (150mg) shocks in-line with the ALS algorithm
This is not true. The Resuscitation Council, UK ALS guidelines state 300mg after the 3rd shock - 2 minute intervals (if stacked shocks x 3 are given, this counts as one shock) , then 150mg in refractory shockable rhythm (after 5th shock )
@@drilonkamishi9025 Incorrect I am afraid. The patient was given 1 mg Adrenaline during management of PEA. Once patient went into VF the second dose must be given 3-5 minutes after the initial dose. The practice of giving the first dose of Adrenaline after the the third shock is specific to a patient who collapses straight into VF/PVT and remains in this for 3 shocks, hence Refractory VF. The drug timings during this scenario are therefore quite correct and meet UK Resuscitation ALS guidelines.
We give amiodarone standard after the third shock. It’s only then indicated
can someone explain why adrenaline was given after the shock? should they have not waited until 3 shocks ?@@andylegrove7979
That CRM bs from Aviation’s found it’s way in to medicine. Too much focus on interpersonal co operation at the cost of patient care. Talk talk talk blah blah blah huddle huddle I am the leader listen to meeeee.
I dont like the team leader bad atuited