IN HOSPITAL CARDIAC ARREST – THOUGHTS ON FIRST STEPS

by Darin Abbey

The Case
There you are working in the hospital when you and your team are called to attend an in hospital cardiac arrest [IHCA]. On your way to the patients room you think about the importance of getting in the right headspace to “run this code.” You scan your memory for lessons learned at your last ACLS course, and as you start to refresh the “H’s and the T’s” your recall is sideswiped by the uncomfortable memory of the chaos and confusion of that “other code.”

Upon entering the patients room there is a scrum of activity.

  • Someone is performing chest compressions and asking for a step stool
  • Someone is gathering IV access supplies while expressing the apparent difficulty of the access
  • Someone has stationed themselves at the head of the bed and after placing an oral pharyngeal airway and is synchronizing bag valve mask ventilations with the chest compression provider
  • Someone has turned on the defibrillator monitor and is placing the hands free defibrillator pads

 

Team first steps…
Slightly out of breath from the dash to the room, you inhale as you consider what choice leadership and followship strategies might be used to take this team of experts and quickly forge an expert team. What do you say to get this medical flash mob working in parallel to succeed in meeting the initial patient care priorities? What communication strategies will contribute to: a climate of safety, a shared understanding, and effectively obtaining the goals of resuscitation?

Medical first steps…
As the team works on the priorities of high quality CPR, questions begin to arise on the cause of the arrest and what interventions can be done to assure a positive outcome. Again the “H’s and the T’s” return to your mind. Here in the hospital bed, it is clear that the patient has not suffered the insults of a traumatic or hypothermic arrest, but what of the other causes? What is the frequency of the different causes of IHCA? How effective are clinicians at searching for and finding these various etiologies?

The Bottom Line…
During cardiac arrest, successful patient outcomes often hinge on teams abilities to negotiate the first steps of enacting high quality basic life support, and following this with the ongoing assessment and appropriate interventions of the secondary ACLS survey,  and the searching for and treating of reversible causes.

 

Suggested reading and to learn more:

West, M. and Lyubovnikova, J. (2013) Illusions of Team Working in Health Care. Journal of Health Organization and Management 27: 1, 134-142.

Bergum, D. et al. (2015) Causes of in hospital cardiac arrest – incidences and rate of recognition. Resuscitation 87, 63:68.

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