Chapter 8 – Resuscitation CPSA Stations

Introduction

These are typically focused on a candidates leadership of a scenario, but also there is often a skill or some sort of conflict to deal with, for example cardiac arrest due to inadvertent administration of an incorrect dose of local anaesthetic. Ensure you try to tease out what additional things the scenario wants you to cover and use the principles in the communication chapter (chapter 4) to manage this.

Resources

It is difficult to try and provide a generic approach that encompasses both the variety of possible stations. Hopefully, the broad themes below are helpful in helping to develop your approach. 

The ALS/APLS/NLS/ATLS and ETC manuals provide a good foundation and will cover a large number of the scenarios likely to come up in resuscitation stations. The RCEM learning website also contains useful modules, particularly on the environmental emergencies.  The Wessex Adult and Paediatric trauma guidelines along with the NHS Clinical Guidelines on Major Incidents and Mass Casualty Events are also recommended reading for trauma stations.

“Hello, my name is Phil. I am one of the medical students.”

“Can I confirm your name and level of seniority?”

“We have received the following pre-alert…”

“We need to spend some time preparing the: Team; Environment and Equipment.”

2222 call via switch board for:

Trauma: Trauma call

Paediatric: Paediatric medical emergency/cardiac arrest

Adult: ITU/maternal crisis (obstetric emergencies/delivery)

  • Introduce yourself
  • Give the ATMIST brief
  • Ask the team to introduce themselves; their level of competance and what role they will be performing.
  • State any anticipated problems and who will intervene if needed:  
    • Code red nurse for trauma
    • Who will perform urgent interventions
    • Who will manage defibrillation if needed
  • If time perform a ‘mission rehearsal’ – describe what will happen in the first few minutes.

Ensure team in PPE

Airway

  • Oxygen
  • Suction 
  • Airway trolley

Breathing

  • Sats probe
  • BVM/Water’s circuit
  • End tidal CO2
  • Thoracostomy

Circulation

  • IV access / IO
  • Fluids
  • Cardiac monitoring/ BP cuff
  • Defibrillator
  • Major haemorrhage trolley
  • Thoracotomy equipment

Disability

  • Pen torch
  • Thermometer
  • Bair Hugger/warming device

Drugs

  • RSI packs
  • Resuscitation drugs
  • Tranexamic acid

Other

  • Ultrasound
  • Resuscitative hysterotomy equipment
  • Resuscitaire 
  • PICU drug calculator + WETFLAG calculations
  • Lateral canthotomy equipment
  • Prealert: radiology / blood bank

Run the scenario as appropriate

Depends on scenario; may be:

  • Handing over to another speciality
  • Dealing with conflict appropriately 
  • Sign posting to further learning if a teaching element
  • Team debrief

Example scenarios

As mentioned above your standard life support manuals provide a core foundation for these topics, and if there is an algorithm that is the management you should be following.  Links have been added to relevant clinical presentations to direct to other sources of learning that previous candidates have found useful.

Adult ALS

Special circumstances:

Paediatric – APLS/NLS

Special circumstances:

Trauma – ATLS/ETC