EMERGENCY Do not hesitate to declare an emergency.
Allocate tasks, get
trolleys
C O V E R A B C D A SWIFT CHECK
Back
Circulation: If the pulse or ETCO2 fails, feel for a major pulse and start external cardiac massage (1).
Colour: If there is any question of cardiac, circulatory or respiratory compromise, give 100% O2 regardless of the saturation.
Oxygen: Supply 100% oxygen at a very high flow rate if necessary.
Oxygen Analyser: Confirm the inspired gas in the breathing circuit is 100% oxygen.
Ventilation: Ventilate by hand - use a self-inflating bag. Obtain appropriate chest movement, airway pressures and ETCO2 (see breathing below).
Vaporisers: Turn off all vaporisers unless the problem is clearly unrelated or is hypertension or awareness.
Endotracheal tube or laryngeal mask airway: Remove and replace if there is any doubt whatsoever about its position or patency.
Eliminate: The machine, circuit, filter and connections unless the problem is clearly unrelated.
Review monitors: Frequently scan. Allocate someone to review trends and keep notes and ensure sensor integrity.
Review equipment: Check, and remove all non-essential equipment in contact with patient (retractors, diathermy, etc.).
Airway: Go to laryngospasm, airway obstruction, or aspiration algorithms as indicated. Consider intubation..
Breathing: Go to bronchospasm, pulmonary oedema ARDS, ventilation, desaturation algorithms as indicated. Consider ventilation.
Circulation: Go to tachycardia, bradycardia, hypotension, hypertension, myocardial ischaemia, or cardiac arrest.
Drugs: Has there been an error? Ensure all drugs are labelled and keep a record of doses and times.
AAAA: Go to awareness, air (and other) embolism, air in pleura (pneumothorax)
and anaphylaxis algorithms as indicated.
SWIFT CHECK: Go through as indicated when there is time. THIS SECTION IS TO GO INSIDE THE COVER ONCE REWRITTEN
Notes:
(1) CO-ORDINATION Ensure people are allocated to tasks A, B, C1 (external cardiac massage), C2 (IV access and feeling the pulse), D and E (see NOTES in Alert/Ready Mode Þ page xxx). As soon as possible, ensure that COVER, the cardiac arrest algorithms and any other relevant algorithms are cycled through..
ENSURE CONTINUOUS BASIC LIFE SUPPORT External cardiac massage (ECM) at 80-100 per minute Confirm a major (preferably femoral) pulse can be felt Ventilate with 100% oxygen every fifth ECM Confirm that ventilation is adequate (inspect, auscultate) Minimise interruptions during therapeutic manoeuvres
EMERGENCY MANAGEMENT If there is VF or pulseless VT Defibrillate with 200 Joules (twice) then 360 Joules as needed If this fails and VF or pulseless VT continues, OR there is asystole, OR electro-mechanical dissociation, Give adrenaline by IV bolus - 1mg for an adult (ie. about 0.15mg/kg) Consider atropine - 0.6mg for an adult (ie. about 0.01mg/kg) Start an adrenaline infusion 1mg in 20ml at 1-2ml/min (ie. about 0.0007 - 0.0015mg/kg/min) (see page 41) Continue ECM for 60 seconds Give additional adrenaline bolus injections as necessary If there is VF or pulseless VT, Defibrillate with 360 Joules (3 X). If this fails, give lignocaine (1mg/kg) Continue ECM for 60 seconds. If VF or pulseless VT continues Defibrillate with 360 Joules (3 X). If this fails, consider giving bretylium (5mg/kg) OR giving magnesium (0.1mmol/kg).
Basic life support should be continued until return of spontaneous circulation.