Handout for my presentation (https://www.slideshare.net/JamesThomas434/cpr-in-the-hospital-environment) on CPR in the Hospital Environment. This goes through the A to E assessment of a patient, shockable and non-shockable rhythms and the reversible causes of cardiac arrest.

1. CPR in Hospital
Environment
CP1 Induction
Handout
Jamie Thomas
Teaching Fellow in Emergency Medicine
@mcdreeamie

2. For 1st and 2nd years you’ve learnt about
history taking from patients who are
stable
This handout is about patients who are
critically unwell
It’s about getting as much information as
possible as quickly as possible

3. If you have an unconscious or unwell
patient in front of you find out one piece
of information first:
Do they have a pulse?

4. If they have a pulse we can get help and
perform an A-E assessment:
Airway
Breathing
Circulation
Disability
Exposure

5. Airway
Here we are concerned about how patent
the airway is and if it is at risk of
obstruction
Noise (stridor/snoring/gargling)
Foreign body (toy/vomit/food/false teeth)
Injury (burns/bleeding)
Can they talk?

6. Breathing
Respiratory rate
Oxygen saturations if possible
Any chest wall injuries
Chest movements

7. Circulation
Pulse rate, rhythm and character
Blood pressure
Cyanosis
Temperature
Abdomen
Visible bleeding
Trauma

8. Disability
Here we are worried about the brain
GLUCOSE - key differential
Glasgow Coma Scale
Any focal neurology
Seizure
Pupils

9. Exposure
Top to toe
Front and back
Limb injuries
Open fractures
Trauma
Rash

10. After A-E
Recovery position
Stay with patient
Keep reassessing

11. If no pulse
Your patient is in cardiac arrest
Call for help
CPR immediately
Once started minimise interruptions to
chest compressions
Get help and switch CPR with a helper if
possible

12. In a lot of public places there may be an
Automated External Defibrillator (AED)
During CPR get someone to find it and
attach leads
Follow instructions

13. Not every cardiac arrest needs
defibrillation
Pulseless Electrical Activity (PEA)
Asystole
Do NOT get shocked

14. pulseless electrical activity

15. asystole

16. If Pulseless Ventricular Tachycardia (it is
possible to have a pulse with VT - these
patients get drugs not shocked)
Or
Ventricular Fibrillation
We shock!

17. ventricular tachycardia

18. ventricular fibrillation

19. During resuscitation it’s important to think
about potential reversible causes
Check these off and manage as
appropriate
4Hs and 4Ts

20. During resuscitation it’s important to think
about potential reversible causes
Check these off and manage as
appropriate
4Hs and 4Ts

21. 4Hs:
Hypoxia
Hypothermia
Hypovolaemia
Hyperkalaemia

22. Key Points:
Any CPR is better than no CPR
Prolonged CPR happens
It is possible to have good clinical
outcomes even after very long arrests -
it’s about quality CPR