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Resuscitation Teaching Day Resuscitation Teaching Day

Documentation • • • Experience looking through notes at C 15 - Nil written Documentation • • • Experience looking through notes at C 15 - Nil written - No diagnosis/differential/plan - Chest pain with no ECG - Names, Dates, Triage Not written = Not done

Why Write Anything? • • PRIDE in work despite environment Crunching Numbers Quality Care Why Write Anything? • • PRIDE in work despite environment Crunching Numbers Quality Care Acceptable Management Follow up of patient Front page of newspapers! Litigation

What is our job? • • Employed to treat patients. No-one can be turned What is our job? • • Employed to treat patients. No-one can be turned away by us. Walk-ins: Hx/Assess/Triage/Document Ambulance: Assess/Triage/Document Then may divert patient Report problems after the fact Adverse incident reports to HOD

Reassessment • • After seeing patient, need to go back: Reassess 30 min-2 hrs Reassessment • • After seeing patient, need to go back: Reassess 30 min-2 hrs - Observations - Triage - Treatment: Ab/Analgesia and effect - Ix: U dipstix/CXR/Serial ECGs - Referral or D/C or Handover

Chain of Information • • • History is essential for our diagnosis Ambulance often Chain of Information • • • History is essential for our diagnosis Ambulance often only source Who can read Drs writing? Take on arrival and give on transfer De: Demographics M: Mechanism I: Injuries S: Signs (Obs) T: Treatment

Post Cardiac Arrest Syndrome • Post. Cardiac Arrest Syndrome: Epidemiology, Pathophysiology, Treatment, and Prognostication Post Cardiac Arrest Syndrome • Post. Cardiac Arrest Syndrome: Epidemiology, Pathophysiology, Treatment, and Prognostication A Consensus Statement From the International Liaison Committee on Resuscitation • Circulation 2008; 118; 2452 -2483

Post Cardiac Arrest Syndrome • Poor prognosis: • Mortality 50 -80% • Optimization of Post Cardiac Arrest Syndrome • Poor prognosis: • Mortality 50 -80% • Optimization of Care • ROSC after Cardiac Arrest

What is it? • 1. Brain injury • 2. Myocardial Dysfunction • 3. Systemic What is it? • 1. Brain injury • 2. Myocardial Dysfunction • 3. Systemic ischemia/reperfusion • 4. Underlying pathological cause

Prognostication • • Difficult Need 72 hours at least Use of resources False hope Prognostication • • Difficult Need 72 hours at least Use of resources False hope for family

Therapeutic Strategies • • - Monitoring: ICU - EGDT: Optimize O 2 delivery (? Therapeutic Strategies • • - Monitoring: ICU - EGDT: Optimize O 2 delivery (? Targets) - Oxygenation: Sats 94 -96% - Normocarbia - Lung Protective Ventilation - Manage Dysrythmias (elecs normal etc) - Hypotension: IVF then Inotropes (Echo) - Mechanical support: IABP

Further Management • • Mx of ACS: Reperfusion Therapeutic Hypothermia Sedation and NMB (EEG) Further Management • • Mx of ACS: Reperfusion Therapeutic Hypothermia Sedation and NMB (EEG) Seizure Prevention and Control Glucose control Monitor renal function: Dialysis ICD insertion

Prognostication • • Associated factors - age/sepsis Lack of adherance to CPR guidelines Quality Prognostication • • Associated factors - age/sepsis Lack of adherance to CPR guidelines Quality of CPR Failure to deliver shock Bedside Neurological Tests CT Head Biochemical Markers (NSE)