You are working one evening in the clinic when the receptionist calls you, saying a patient just walked in and looked very unwell.
You go out an find an older gentleman who looks pale, is walking unsteadily, and is clutching his chest.
You quickly bring him to an exam room and begin to assess him. Within 10 seconds, he slumps over, unresponsive.
You cannot reliably find a pulse, though note some gasping breaths.
What do you do?
The patient appears to have just arrested.
Yell for help.
Lower the resident to the floor and begin chest compressions.
Two nurses, a social worker, and the receptionist arrive.
What do you ask them to do?
Maintain control of the situation, unless a more senior staff member arrives, in which case you should formally hand over leadership if you feel appropriate.
As the leader, request specific staff members to:
- take over chest compressions (freeing you to lead)
- retrieve the emergency kit, including AED, bag, and oxygen (if available)
- provide positive pressure ventilation
- call 911, stating a cardiac arrest has just taken place
- record the unfolding events
- prepare a chart summary for EMS arrival and transport
Take a moment to review what emergency equipment you have available in your organization, and where it is stored.
Staff soon arrive with the requested equipment.
How do you describe high quality CPR?
Compressions should be 100-120 BPM, at a depth of approx 2 inches.
Ventilation should occur at a rate of 2 breaths for 30 compressions. Ventilation should include head tilt or chin lift to open the airway while maintaining a good seal.
What do you do with the AED?
Continue high quality chest compressions while a knowledgeable staff member activates the AED. When ready, remove clothing and attach pads, following commands.
The AED delivers a shock.
What do you do next, as you wait for EMS to arrive?
Immediately resume CPR, and continue with two minute cycles.
It is prudent to do a glucometer check, especially if the patient is diabetic.
If you have IV supplies and expertise, you may consider starting a peripheral IV.
The EMS team arrives. How do you hand over?
Describe the presentation immediately prior to the arrest, and what has occurred through the emergency. Provide a brief background of the patient, referring to the chart for fuller details.
EMS transports the patient to the emergency department, where resuscitation continues. You later learn he regained circulation and was admitted to the ICU for further care. A large MI is diagnosed, and he successfully undergoes catheterization.
He returns to your clinic weaker, but very thankful, 2 weeks later.
