{"id":739,"date":"2014-03-01T22:27:38","date_gmt":"2014-03-01T22:27:38","guid":{"rendered":"https:\/\/edecmo.org\/?p=739"},"modified":"2021-11-02T18:56:33","modified_gmt":"2021-11-02T22:56:33","slug":"tactical-approach-cardiac-arrest","status":"publish","type":"post","link":"https:\/\/edecmo.org\/tactical-approach-cardiac-arrest\/","title":{"rendered":"Episode 4 &#8211; The Tactical Approach to the Cardiac Arrest"},"content":{"rendered":"<!--powerpress_player--><div class=\"powerpress_player\" id=\"powerpress_player_2348\"><!--[if lt IE 9]><script>document.createElement('audio');<\/script><![endif]-->\n<audio class=\"wp-audio-shortcode\" id=\"audio-739-1\" preload=\"none\" style=\"width: 100%;\" controls=\"controls\"><source type=\"audio\/mpeg\" src=\"http:\/\/media.blubrry.com\/edecmo\/traffic.libsyn.com\/edecmo\/EDECMO-Podcast-20140301-004-Tactical-Approach-Arrest.mp3?_=1\" \/><a href=\"http:\/\/media.blubrry.com\/edecmo\/traffic.libsyn.com\/edecmo\/EDECMO-Podcast-20140301-004-Tactical-Approach-Arrest.mp3\">http:\/\/media.blubrry.com\/edecmo\/traffic.libsyn.com\/edecmo\/EDECMO-Podcast-20140301-004-Tactical-Approach-Arrest.mp3<\/a><\/audio><\/div><p class=\"powerpress_links powerpress_links_mp3\" style=\"margin-bottom: 1px !important;\">Podcast: <a href=\"http:\/\/media.blubrry.com\/edecmo\/traffic.libsyn.com\/edecmo\/EDECMO-Podcast-20140301-004-Tactical-Approach-Arrest.mp3\" class=\"powerpress_link_pinw\" target=\"_blank\" title=\"Play in new window\" onclick=\"return powerpress_pinw('https:\/\/edecmo.org\/?powerpress_pinw=739-podcast');\" rel=\"nofollow\">Play in new window<\/a> | <a href=\"http:\/\/media.blubrry.com\/edecmo\/traffic.libsyn.com\/edecmo\/EDECMO-Podcast-20140301-004-Tactical-Approach-Arrest.mp3\" class=\"powerpress_link_d\" title=\"Download\" rel=\"nofollow\" download=\"EDECMO-Podcast-20140301-004-Tactical-Approach-Arrest.mp3\">Download<\/a> (Duration: 18:49 &#8212; 17.3MB)<\/p><p class=\"powerpress_links powerpress_subscribe_links\">Subscribe: <a href=\"https:\/\/edecmo.org\/feed\/podcast\/\" class=\"powerpress_link_subscribe powerpress_link_subscribe_rss\" target=\"_blank\" title=\"Subscribe via RSS\" rel=\"nofollow\">RSS<\/a><\/p><p>In this episode we talk about how we prepare for, and run, our codes. \u00a0When we began incorporating ECPR into our resuscitation strategy we found ourselves saving patients who would have otherwise died. \u00a0The traditional nihilistic approach to the arresting patient was overturned with ECPR by providing hope that wasn&#8217;t previously there. Naturally, \u00a0we took a closer look at each element of the code, from the time the patient hit the door to the time we started the pump. \u00a0And we realized we were doing a lot of stuff wrong. \u00a0Here is how I do it:<\/p>\n<p><strong>1. \u00a0Medic gurney entry:<\/strong> \u00a0 \u00a0If you&#8217;re doing ECPR, then vascular access of the femoral vessels is a top priority. Most of us are right handed and prefer to access the femoral vasculature on the patient&#8217;s right. \u00a0But that&#8217;s EXACTLY where the medic gurney offloads the patient- big mistake.\u00a0Time is wasted waiting for the medics to move the patient to your hospital gurney, remove monitor leads, pack up the monitor, avoid pulling out IV&#8217;s and then leave the room. \u00a0Only then could the &#8220;line doctor&#8221; push the ultrasound machine into the room, disrobe the patient, gown up, place a sterile US probe cover, prep the field and get to work. \u00a0That&#8217;s precious minutes wasted. \u00a0Stop doing that! \u00a0Bring the medic gurney in on the other side! \u00a0Your &#8220;line doctor&#8221; is already completely ready to go.<\/p>\n<p>2. <strong>Protocolize EVERYTHING:<\/strong>\u00a0 ACLS provides \u00a0a protocolized framework for running a code. \u00a0But what about all that stuff that happens from the ambulance bay until care is transferred to you? \u00a0And can we improve on the current ACLS algorithm? \u00a0Most of us appreciate that protocoling doesn&#8217;t restrict us; in fact, quite the opposite. \u00a0A protocol allows cognitive offloading of important, yet routine, steps in a process which frees us to focus on tasks specific to that patient.<\/p>\n<p>If you are considering establishing an ED ECMO or ECPR program at your facility, I highly recommend that you take a close look at everything that is done from the time the patient hits your door to the time the ECLS pump is started. We aren&#8217;t saying this is the only way to do it, but this is how we do it:<\/p>\n<h4>Anticipating the Arrival of an Arresting Patient:<\/h4>\n<ul>\n<li><em>Staging the room:<\/em> not unlike a theatrical play, each person and each piece of equipment has a specific role and a specific position in resuscitation suite. \u00a0Do it the same way every single time.<a href=\"https:\/\/edecmo.org\/wp-content\/uploads\/2014\/02\/Slide1.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"aligncenter size-full wp-image-833\" src=\"https:\/\/edecmo.org\/wp-content\/uploads\/2014\/02\/Slide1.jpg\" alt=\"Slide1\" width=\"720\" height=\"540\" \/><\/a><\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<figure id=\"attachment_838\" aria-describedby=\"caption-attachment-838\" style=\"width: 448px\" class=\"wp-caption aligncenter\"><a href=\"https:\/\/edecmo.org\/wp-content\/uploads\/2014\/02\/resusc-room-2014.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-838 \" src=\"https:\/\/edecmo.org\/wp-content\/uploads\/2014\/02\/resusc-room-2014-448x600.jpg\" alt=\"resusc room 2014\" width=\"448\" height=\"600\" srcset=\"https:\/\/edecmo.org\/wp-content\/uploads\/2014\/02\/resusc-room-2014-448x600.jpg 448w, https:\/\/edecmo.org\/wp-content\/uploads\/2014\/02\/resusc-room-2014-765x1024.jpg 765w, https:\/\/edecmo.org\/wp-content\/uploads\/2014\/02\/resusc-room-2014.jpg 1196w\" sizes=\"(max-width: 448px) 100vw, 448px\" \/><\/a><figcaption id=\"caption-attachment-838\" class=\"wp-caption-text\">Accepting the CPR patient on the &#8220;RIGHT Side!&#8221;<\/figcaption><\/figure>\n<p style=\"padding-left: 60px; text-align: center;\">Some roles that are unique to our resuscitation team:<\/p>\n<ul>\n<li>&#8220;Line Doctor&#8221;: MD responsible for femoral vascular access<\/li>\n<li>&#8220;Code Doctor&#8221;: MD responsible for running the code and decision-making<\/li>\n<li>&#8220;Code Team Leader&#8221;: RN responsible for timing of important events (ie drug delivery, shocking, pulse checks, etc). This RN also does computer-based charting.<\/li>\n<li>&#8220;Med\/Electric Nurse&#8221;: RN responsible for pushing drugs and delivering shocks<\/li>\n<li>&#8220;Resuscitation Cart&#8221;: lives just outside the room and has two shelves and house the following:<\/li>\n<\/ul>\n<p style=\"text-align: center;\"><a href=\"https:\/\/edecmo.org\/wp-content\/uploads\/2014\/02\/Screen-Shot-2014-02-12-at-2.25.50-PM.png\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-742 aligncenter\" src=\"https:\/\/edecmo.org\/wp-content\/uploads\/2014\/02\/Screen-Shot-2014-02-12-at-2.25.50-PM-714x600.png\" alt=\"Resuscitation Cart\" width=\"343\" height=\"288\" srcset=\"https:\/\/edecmo.org\/wp-content\/uploads\/2014\/02\/Screen-Shot-2014-02-12-at-2.25.50-PM-714x600.png 714w, https:\/\/edecmo.org\/wp-content\/uploads\/2014\/02\/Screen-Shot-2014-02-12-at-2.25.50-PM.png 910w\" sizes=\"(max-width: 343px) 100vw, 343px\" \/><\/a><\/p>\n<ul>\n<li><em>Quiet the room:<\/em>\u00a0as the medics enter the room, quickly remind everyone to limit unnecessary noise.<\/li>\n<\/ul>\n<h4>Patient Arrival:<\/h4>\n<ul>\n<li>The paramedic gurney (with ongoing CPR) enters the room on the right side of the room (if you are looking from outside to inside the room), not the left (which is how you are likely accepting your patients now.)<\/li>\n<\/ul>\n<p><a href=\"https:\/\/edecmo.org\/wp-content\/uploads\/2014\/02\/Slide2.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"aligncenter size-full wp-image-834\" src=\"https:\/\/edecmo.org\/wp-content\/uploads\/2014\/02\/Slide2.jpg\" alt=\"Slide2\" width=\"720\" height=\"540\" \/><\/a><\/p>\n<p>&nbsp;<\/p>\n<ul>\n<li>After transfer of the patient from the medic gurney to the ED bed, chest compressions are immediately assumed by &#8220;Chest compressor #1&#8221;. \u00a0compressions then move back and forth between the two &#8220;Chest compressors&#8221; at pulse checks.<\/li>\n<li>Since femoral vascular access is a huge focus, I would also recommend that you assign a free hand (RN or tech) to &#8220;groin access,&#8221; who is standing outside the room with trauma shears in one hand a bottle of betadine in the other. \u00a0Once the patient is moved from the medic gurney to the ED Bed, that individual is tasked with stripping the pants off (by cutting or pulling) and drenching the groins in betadine. \u00a0It becomes an efficient task for the &#8220;line doc&#8221; to drop a drape, place the US probe, and gain femoral vascular access.<\/li>\n<li>Of course, the need for both of these human chest compressors (and valuable real estate in the resuscitation room) is eliminated if you have a mechanical chest compression device such as the LUCAS2:<\/li>\n<\/ul>\n<p style=\"text-align: center;\"><a href=\"https:\/\/edecmo.org\/wp-content\/uploads\/2014\/02\/LUCAS2.jpeg\"><img loading=\"lazy\" decoding=\"async\" class=\"aligncenter size-full wp-image-836\" src=\"https:\/\/edecmo.org\/wp-content\/uploads\/2014\/02\/LUCAS2.jpeg\" alt=\"LUCAS2\" width=\"259\" height=\"194\" \/><\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>In this episode we talk about how protocols, defined roles, and pre-planned choreography of a medical code works. And we also do a few things different than you&#8230;<\/p>\n","protected":false},"author":4,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"EDECMO #4 - The Tactical Approach to the Cardiac Arrest http:\/\/wp.me\/p3JzC4-bV","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","enabled":false}}},"categories":[4],"tags":[56],"jetpack_publicize_connections":[],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/p3JzC4-bV","_links":{"self":[{"href":"https:\/\/edecmo.org\/wp-json\/wp\/v2\/posts\/739"}],"collection":[{"href":"https:\/\/edecmo.org\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/edecmo.org\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/edecmo.org\/wp-json\/wp\/v2\/users\/4"}],"replies":[{"embeddable":true,"href":"https:\/\/edecmo.org\/wp-json\/wp\/v2\/comments?post=739"}],"version-history":[{"count":1,"href":"https:\/\/edecmo.org\/wp-json\/wp\/v2\/posts\/739\/revisions"}],"predecessor-version":[{"id":6823,"href":"https:\/\/edecmo.org\/wp-json\/wp\/v2\/posts\/739\/revisions\/6823"}],"wp:attachment":[{"href":"https:\/\/edecmo.org\/wp-json\/wp\/v2\/media?parent=739"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/edecmo.org\/wp-json\/wp\/v2\/categories?post=739"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/edecmo.org\/wp-json\/wp\/v2\/tags?post=739"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}