With the International Liaison Committee on Resuscitation (ILCOR)’s worksheets now being made available for viewing as part of a worldwide effort involving hundreds of dedicated researchers working together over many years, UCEM has decided to preempt the next iteration of guidelines by creating their own. These guidelines were compiled from Professor Bristol’s toilet-side notebook in under 12 minutes. Nevertheless, UCEM is confident that even the most hardened of resuscitators will find these guidelines informative, realistic and highly practical.
As a wise man once said:
First check your own pulse.
Then start with the ABCs:
And end with D and E:
Between C and D, put on your Code Gold! CD and consider the following therapeutic options:
- Shout — communication is paramount. The best approach is to establish your leadership role on entering the room by shouting at a deafening volume: “If you are not doing anything, get out of the room!” With a bit of luck, you might be able to leave as well…
- Help — always call for help, even if that means curling up into the fetal position on the floor, sucking one’s thumb, and screaming “help, help, help!”…
- Intubate as required — to save on cost, don’t bother with a laryngoscope, a torch and a bent spoon will suffice.
- Tobacco smoke enemas should be considered as a last ditch measure — As Prof Bristol always says, “If you’re going out, you might as well go out in a puff of smoke”.
Assign appropriate tasks to Medical Emergency Team (MET) members:
- Stand back and let the MET CNL (senior nurse) run the show — things will go much more smoothly and you can sit back and relax.
- House officers — Keep them as far away from the patient as possible by assigning them the job of looking through the patient’s medical records for the ‘Do Not Resuscitate’ order that surely must be there somewhere…
- Invite the biggest burliest orderlies you can find on the way to the code to come along with you, to ensure that the CPR is effective.
- Telephone duty — An important role best assigned to the medical registrar, with the added advantage of also keeping him or her as far away from the patient as possible.
Remember these points:
- Stab the patient in the heart with an adrenaline-filled syringe at the first available opportunity — after all, it worked well in Pulp Fiction, and even if it doesn’t work it looks heroic and is bound to impress the medical students.
- How many minutes should you continue to resuscitate for before calling it a day? If in doubt, try this formula: 80 – (age in years). Multiply by 3 if a toxicological cause is suspected.
- Is your suction working? If you haven’t checked you’d better be wearing gumboots as you have a 99.9% chance of ending up wading through a pool of vomit.
- The outcome of the resuscitation has no relationship to the effectiveness of the resuscitation effort – unless more than one person ends up dead at the end of it.
And finally, The Bottom Line (aka ‘the Flat Line’):
The likelihood of a good outcome following cardiac arrest follows a ‘flat, line-shaped‘ curve after the first few minutes. Good outcome is on the y-axis (admittedly you need a magnifying glass to see it) and any variable you can think of goes on the x-axis.
Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.
After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.
He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.
His one great achievement is being the father of three amazing children.
On Twitter, he is @precordialthump.