Uhhhhh, where is the venous access? Where’s the epinephrine? Where’s the amiodarone? Am I the only person who came to the comments for this? lol Otherwise, cool video! Thanks
Since he was a patient in a hospital, it is safe to assume he already had an IV access. I think epinephrine is given after 3 cycles and then every 2 cycles (3-5 mins gap), in this situation the patient was able to get ROSC within the first 3 cycles so the drugs weren't needed. Please correct me if I am wrong.
@@sopalakish To answer our buddy Justin's question here, it depends. Firstly, this video is wrong because it doesn't show the patients rhythm, which is the main answer here, If you have a shock rhythm, Adrenaline is given after the second defibrillation attempt, followed by amiodarone after the third defibrillation, then Adrenaline again and so on But if you don't have a shock rhythm, then it's after the first cycle of compressions, main point is this video lacks drugs However, a big no no here is the lack of ambu, they intubated, which is fine, but waiting that long... That's definitely a no good
British doctor: "I wonder if you could put up a cardiac arrest call please, and bring the trolley over, thank you." This would be me: "CARDIAC ARREST ALARM RIGHT NOW AND BRING THE BLOODY TROLLEY!!1"
On rosc - ABCDE again. Investigations can be delegated and happen in the at the same time ( ABG, ecg, cxr request) Make sure H&ts are actually excluded rather than just talked about but prioritise your main dx.
When the arrest/code team arrives, the anesthesiologist or respiratory tech will do the ventilating. Usually a nurse will do compressions and switch off when they get tired. You don't have to switch off every two minutes. Good compressions with minimal interruption is preferred.
Am I the only one who found him abbreviating ventricular fibrillation to "V-Fib" and not "VF" really irritating? Also, why not have the defib charged and ready to shock the moment pulse check is completed? Unless your defib is knackered it's not going to deliver a shock until the button is pressed. Having it charged and ready to shock reduces the duration and frequency of interruptions, which is something we aim for during CPR, and if you find the shock is no longer required you can always "dump" the shock. Also, what about drugs? If they're in VF you should be thinking about Amiodarone or Lidocaine, not just compressions and shocks. And I wouldn't rule out tamponade so quickly - tamponade secondary to acute MI occurs more frequently than one might think - I had to look it up but, according to one paper, as many as 23% of deaths in acute MI patients are from cardiac tamponade. So, don't just dismiss the possibility, actually check! 😊
what's the good physical exam finding to rule out tamponade that the attending asked? I'd imagine JVP and muffled heart sounds are not going to be the most ideal to access in a code blue situation. i also probably won't be able to get portable ultrasound to bedisde that quickly. thanks!
Nice video, really enjoyed it. However, the Hs(Hypoxia, Hypovolemia, Hydrogen, Hyper/Hypokalemia and Hypothermia & Ts(Tension pneumo, pericardial Tamponade, Toxins, Thrombosis(pul/coronary) and Trauma) are for asystole and pulseless electrical activity, which are unshockable rhythms.
The way he is always asking on what to do... it's like this video is made from a student's perspective which feels relatable
When normal rhythm appeared on the monitor. He is supposed to check for pulse because it could be a case of Pulseless electrical activity.
'H's:
- Hypovolemia
- Hypoxia
- Hypothermia
- Hypo/hyperkalaemia
- Hypoglycaemia
'T's:
- Toxins
- Tamponade (cardiac)
- Tension pneumothorax
- Thrombosis (myocardial infarction)
- Thromboembolism (pulmonary embolism)
It's cute when he says he cant remember the other h's. Love the confidence even when he needs help. But I know its just a simulation.
I skipped the vid and saw what I thought was a ridiculously tall man. Then realised he was on a step.
أحسنت الشرح والتوضيح وبارك الله فيك أستاذ عماد
Uhhhhh, where is the venous access? Where’s the epinephrine? Where’s the amiodarone?
Am I the only person who came to the comments for this? lol
Otherwise, cool video! Thanks
Since he was a patient in a hospital, it is safe to assume he already had an IV access. I think epinephrine is given after 3 cycles and then every 2 cycles (3-5 mins gap), in this situation the patient was able to get ROSC within the first 3 cycles so the drugs weren't needed. Please correct me if I am wrong.
@@sopalakish To answer our buddy Justin's question here, it depends.
Firstly, this video is wrong because it doesn't show the patients rhythm, which is the main answer here,
If you have a shock rhythm, Adrenaline is given after the second defibrillation attempt, followed by amiodarone after the third defibrillation, then Adrenaline again and so on
But if you don't have a shock rhythm, then it's after the first cycle of compressions, main point is this video lacks drugs
However, a big no no here is the lack of ambu, they intubated, which is fine, but waiting that long... That's definitely a no good
@@JJJameson. are we on different page ? Adrenaline is given after 3 defibs..we are talking about ALS UK,right?
Adrenaline and Amiidarone after 3 shocks only. This man had ROSC after 2 shocks.,
@@productsreview31 Oh damn, I didn't consider UK guidelines, my bad, maybe they are indeed different. I was speaking ACLS guidelines
British doctor: "I wonder if you could put up a cardiac arrest call please, and bring the trolley over, thank you." This would be me: "CARDIAC ARREST ALARM RIGHT NOW AND BRING THE BLOODY TROLLEY!!1"
HAHAHAHAH thank you for this
Thank you so much for posting this.
No problem - hope it was useful!
@@OxfordMedicalVideos
Yes I get so nervous when actually doing these, hate them. So thank you, this is helpful.
On rosc - ABCDE again.
Investigations can be delegated and happen in the at the same time ( ABG, ecg, cxr request)
Make sure H&ts are actually excluded rather than just talked about but prioritise your main dx.
Love the adrenaline ride during a code!
Could you please list the H's and T's in the comments? it was difficult to hear the lady in the background. thank you
Hi Chloe. Several variations but we use:
'H's:
- Hypovolemia
- Hypoxia
- Hypothermia
- Hypo/hyperkalaemia
- Hypoglycaemia
'T's:
- Toxins
- Tamponade (cardiac)
- Tension pneumothorax
- Thrombosis (myocardial infarction)
- Thromboembolism (pulmonary embolism)
hypovolemia ,hypo/hyperkalemia, hypothermia and hypoxia..
toxins
tension pneumothorax
tamponade,cardiac
thrombosis
Waoo good job
Its look like in real situation
Awesome awesome awesome
But why is no one giving epinephrine or amiodarone ?
That was something I wondered, too.
Very well demonstrated
Very useful, thank you
Shouldn't the two doing CPR and bag mask ventilation switch positions after 2 mins?
When the arrest/code team arrives, the anesthesiologist or respiratory tech will do the ventilating. Usually a nurse will do compressions and switch off when they get tired. You don't have to switch off every two minutes. Good compressions with minimal interruption is preferred.
Am I the only one who found him abbreviating ventricular fibrillation to "V-Fib" and not "VF" really irritating? Also, why not have the defib charged and ready to shock the moment pulse check is completed? Unless your defib is knackered it's not going to deliver a shock until the button is pressed. Having it charged and ready to shock reduces the duration and frequency of interruptions, which is something we aim for during CPR, and if you find the shock is no longer required you can always "dump" the shock.
Also, what about drugs? If they're in VF you should be thinking about Amiodarone or Lidocaine, not just compressions and shocks. And I wouldn't rule out tamponade so quickly - tamponade secondary to acute MI occurs more frequently than one might think - I had to look it up but, according to one paper, as many as 23% of deaths in acute MI patients are from cardiac tamponade. So, don't just dismiss the possibility, actually check! 😊
amazing video
Is this part of the role play the the Medical Officer is asking all these questions or is he an inexperienced practitioner
If only there was a title and description of the video to answer your ignorance.
Why they didn't switch on chest compressions
So polite!!!
استرها علينا يا رب بكره في الامتحان الراجل في اوكسفورد ومش عارف 4H
المفروض انا في طنطا اعمل ايه
أنا ممتحن بعد يومين ف طنطا طمني 😂😂
I wanna be a doctor instead of homeless unemployed.
good luck
awesome !!
what's the good physical exam finding to rule out tamponade that the attending asked? I'd imagine JVP and muffled heart sounds are not going to be the most ideal to access in a code blue situation. i also probably won't be able to get portable ultrasound to bedisde that quickly. thanks!
physical exam very often doesn't help and you will need to use a FAST ultrasound and apply it to the pericardium window
You're supposed to undo the pt clothing (shirt)
Do you need to check BP before giving fluids when resuscitating or do you just give it straight away?
The patient is dead therefore no circulation or blood pressure
Giving fluids in a patient with VF/VT is a matter for debate. Make sure you don't overload the patient given that the main dx is an ACS.
If your checking for hypo/hyperglycaemia wouldn’t you check the value in the LFTS Us &Es rather than taking a blood gas.
ABG will have PO2, glu and K+ which are part of H&ts
Nice video, really enjoyed it. However, the Hs(Hypoxia, Hypovolemia, Hydrogen, Hyper/Hypokalemia and Hypothermia & Ts(Tension pneumo, pericardial Tamponade, Toxins, Thrombosis(pul/coronary) and Trauma) are for asystole and pulseless electrical activity, which are unshockable rhythms.
4 Hs and Ts are for all arrests, and designed to rapidly rule in or out potentially reversible causes.
We always need them asystole or vF because we need to find out the causes and reverse them if possible.
تب هو ليه لابس كلاافز لما هو قاعد يحك ايده في جسمه
No breaths given initially
sash A, not a requirement these days. There is a residual volume of air available in the lungs experts deem sufficient
It starts with the CPR these days
Initial breaths given only in certain scenarios. One of them is paediatric patients. We begin with rescue breaths First.