hi sharon okay no worries yeah just to let you know that today we have the lovely and gary
they're going to be your helpers so yeah get some help you can call them yeah sure and they are very
capable and competent but luckily yeah great so john i'm going to give you a scenario and ask you
to please repeat it back to me all right so you've been called in to assess the gentleman who has
got a one-hour history of some chest pain that is radiating through to his left arm
uh he's a 58 year old man and he's got a history of skin with heart disease he looks
quite unwell and pale and sweaty and i'd like you to please come and assess him and then allocate
sure and what's his name sharon his name's george so george 58 year old male he's got a one-hour
history of central chest pain radiation radiating down his left arm with the background of cardiac
disease and he's unwell and needs assessing correcting sure quite different okay so walk
into the room and look for danger and i'll just say hi george how you going oh hi how are you yeah
good thanks how are you feeling um okay we'll have a look at that for you so he's airways okay he's
talking to me i might need to come back but at the moment i'm happy so i'm just gonna have a listen
to your chest so what's his respiratory rate sharon okay and i'll just auscultate his chest
just as clear and palpate his trick here is that midline and is he making much respiratory effort
and i'll just pop a sat probe on his finger which hopefully i've got one here okay just going to pop
this on your finger and check his sets what's so sets for 97 so i think i'll leave oxygen for now
okay so i'm gonna pop some monitoring on as well i might pop the pads on at this stage to get a
heart rate and also check his blood pressure
can i get a blood pressure okay just going to monitor your heart there so i've
got a blood pressure 110 on 60. heart rate's 111 looks okay but tachycardic
has he got a line in sharon he doesn't have any access i might get some help actually because i'd
like to get a 12-lead ecg as well so i might call sophie and garrus just checking his cap refill
sorry two seconds hi sophie so this is george he's got some chest pain he's got a history of cardiac
disease he's not feeling that well at the moment can you please put in a line and take some bloods
and do a fbc use the knees and we'll do a ck in japoning and also check a blood sugar
and i might get gareth is gareth can you get the ecg machine and do 12 lead for me gareth
so circulation i might move on to disability so we'll check the blood sugar
and how you feeling at the moment george
okay so we might need to give him some um gtn for that you said his blood pressure was 110.
okay so we might just give you a tablet or spray under your tongue for your chest pain
is he on aspirin uh he's not okay and he has so we might also gareth um would you mind getting um
some aspirin ordered okay great yep okay so um so i'm on d so he's uh he's an avp who is an a at the
moment and we've checked his blood sugar is there any medication on his chart that's new or okay so
we just have a little look at him maybe i'm gareth if you can just have a look at his calves mommy
check there's no swelling and we'll just check there's no bleeding anywhere or over his signs
okay
okay so we just george can you open your eyes he's not responding is he making any respiratory effort
can't feel a pulse okay sophie can you start cpr please at 30k steady
compression is cheapest can you call a code gareth and then manage the airway
okay actually i might get you to put the pads on actually for me
so pads are on pads are on okay so he's arrested we've called for help we've got cpr going we'll
do a rhythm check i'm going to come down here so continue compressions oxygen charging 200
so i'm going to it's a shockable rhythm can you please shock it gareth 200 jewels delivering a
shark shot and we'll restart cpr please and we'll get some more help hopefully so that
we can swap over regularly so we're going to do two minutes of cpr 30 compressions to two breaths
and if we've got someone on airway we might put in a um a supraglottic device because it will mean
we can do continuous compressions so establish resuscitation don't need to give any drugs so
we need to think about reversible causes i think the most likely thing is from thrombosis so you
might have had an ami could have had a pe though so they're my most likely causes but thinking
about toxins she said he hadn't started on any new drugs we don't think he's taking anything
um gareth when we next do the the breasts can we have a quick listen to make sure that we've got
equal air entry so charles just trying to exclude attention in the thorax i checked the joker before
it's midline so toxins tension temp cardiac tamponade we might need to get an echo to
determine that and we we can call for one of those so that we can check and then we'll just
go through the hs so hypoxia he starts with 97 you said he was a bit uh maybe a bit short of
breath but sure okay so not too worried about that and we're managing the airway is that going okay
yeah so we're managing the airway don't think it's hypoxia and um we could do a blood gas
now so i can check his electrolytes so i want to see what his k's doing
yeah so it could be a hypo hyperkalemia or other electrolyte disorders and check his acidosis as
blood gas status as well so hypovolemia hemorrhage there's no signs of any bleeding or anything like
that and a temperature check i forgot to do that before okay so i think it's most likely it's
coronary thrombosis but we just need to sure so can we do another rhythm check please gareth yep
so continue compressions oxygen's away all for your top and bottom
that's a shockable rhythm gareth can you deliver a shot please
okay and we need to give one milligram of adrenaline please iv and then um continue cpr
it's a milligram of adrenaline given we probably need a bit more help but
so we've given one milligram of adrenaline we're doing good cpr we're managing the airway
i've sort of been through the reversible causes i mean we could give some fluid but i'm not sure
that it's really necessary but we could maybe give 250 ml it's probably not going to hurt okay so
can we do another rhythm check please okay so compressions continue everyone else stand
clear i'm charging to 200 joules so that's a shockable rhythm sophie can you shock that please
so that's our third shock so we also need to give amiodarone 300 milligrams now
we'll give that over three minutes in 30 meals of dextrose and continue cpr
okay so um so we're in bf we think it's a thrombosis we've gone through all the
other reversible causes did we get the gas back
so there's nothing really to change there so we just need to keep doing effective cpr
and we gave adrenaline on the second shock sophie so
we can probably draw up another one milligram ready in case we need it at the next rhythm check
sure so can sophie can you do another rhythm check please and gareth once we've done the
rhythm check can you unless we need to do something different restart cpr straight
away okay so compressions continue everyone else is it's vf can you shop please sophie
yep and we recommend cpr ideally i'd like to swap but we haven't got enough help
okay so we're continuing cpr okay can please do another rhythm check sophie and be ready to um
recommend cpr afterwards gareth if need be okay so professions continue
so can you please disarm it's an unshockable rhythm gareth can you please check a pulse
we have a boss okay so that's good so let's go into a reassessment stage now so
um airway is still got the lma in is he trying to wake up at all sharon
okay so let's get the separate we've got sets of 96. so if you're happy to keep
managing the airway and finish supplementary breaths please give them but we've got a
set of 96. sophie can i get you to have another listen yeah an oscar tape so um
he's making respiratory effort we've got good sats jakir probably hasn't moved since
last time so we move on to circulation and get a blood pressure please and it's got st elevation
there on the monitor so let's get a 12 lead ecg and cool cardiology we probably could have done
that earlier but call them urgently i think he might need to go to the cath lab potentially
he's got blood pressure poles just recheck his cap refill yeah and we'll just keep maintenance
iv fluids we won't fill him too much at the moment so e george any eye opening
so he's a v or p so he's a p or a u sorry
sure okay and we'll recheck the blood sugar and follow up the bloods and then we'll just check we
haven't caused any damage while we've been doing cpo can we please also organize the chest x-ray
and we'll probably start preparing to transfer him so let's get all our emergency equipment set up so
we've got airway management drugs the d-fib oxygen and get the team so that we can transport him to
potentially cath lab potentially icu depends on what cardiologist say thank you
sure
that's a bit nerves oh thank god for that phew that's a relief
thanks
you