What is Resuscitation – making clinical decisions based on limited time and information – gambling essentially.
☙ The sicker and more unstable they become, the greater their risk.
Be comfortable with making important decisions with limited information and accepting the risks you may make the wrong decision and that sometimes there is harmful outcomes
- Know that failure to act and decide is also a choice and has its own consequences.
☙ Be aggressive when resuscitating – especially pre-arrest patients
- Delay in treatment and loss of pulse results in damage control and trying to recover with minimal brain damage if possible.
- There are no black-and-white recommendations in pre-arrest patients
- there is a risk of having underlying causes that lead to death based on the treatment given.
- Identifying anything time-sensitive - don’t delay
☙ Anaphylaxis or sepsis – once identified or high suspicion – treat!
☙ Toxicology – treat with activated charcoal if possible
☙ Toxic shock – remove (replace if needed with clean dressing), use caution with abx in this case.
☙ Critical Bradycardia – give atropine.
☙ Critical hypotension – start a vasopressor (whatever you have or are comfortable with to start) to stabilize and switch to a different pressor afterwards if needed
☙ Look at H’s and T’s for initial diagnosis and treat quickly in ACLS
Slower decline patients in delirium
- Small dose of ketamine to help sedate
Phoning a friend – causes delays of min 5 and greater – attribute the harm that comes with delays.
Protocols of resuscitation
IV fluid – 2 L of fluid – much time spent on what fluid to give and how fast to run it in – Don’t delay other treatments on fluid. Other times, there are other more effective treatments than just fluid.
☙ Think ahead to be ahead – while waiting for transport, think about what is coming next – transport. Try to be two steps ahead of where the patient is at. What might the patient need next – set up for airway, set up for vasopressors and pump programmed ready to go, get d-fib pads on if cardiac issues arise (ex. STEMI or arrhythmia patients)
☙ Think about barriers to transport!
- What can you do to expedite the process? Team arrival is not the saviour.
- It’s the destination the patient is going to.
- The goal is to help the transport team as much as possible.
- Delaying basic interventions can be detrimental to patient care and delay transport to definitive care.
Ex. What drugs are the patient going to need and get them going prior to transport? If you can give them meds before transport and reduce the amount needed in transport, that would be better.
- If IV is not reliable, then start another. Consider a central line or IO.
- Heavier sedation during transport is normal due to the amount of stimulation experienced during transport.
Resuscitation is rarely black and white where you know 100% what to do. Get comfortable with having a limited picture and play the odds and probability of the patient's best interests.
☙ Analysis Paralysis is how you lose at the resuscitation game.
☙ Get comfortable with being uncomfortable