“Adrenaline Rush”

Edition 4 5th October 2009

Editorial

Last month I looked after a patient who had been successfully resuscitated with an AED on a Taranaki oil rig. At the same time I heard of an equally successful resuscitation on an Air flight. There is good work going on out there everywhere, keep it up!

This month we go in search of an executive officer. The position description has been developed, has been approved by the executive, and will be advertised within the week on the NZRC website, and also seek.co.nz.

Finally, I would like to extend my condolences towards the people of Samoa. I know I speak for all of the council when I say our thoughts are with you.

Rob Frengley

From the CINZ Chair

Last month I wrote about the need for quality and national consistency within the CORE framework. One of the ways that we have been trying to maintain that philosophy is to establish a consistent approach to CORE Instructor training. For those who may not be aware these courses are now being conducted at the Waikato Clinical Skills and Simulation Centre at the Waikato Clinical School. The use of this excellent facility has enabled instructor candidates to experience teaching and learning modelled within a purpose-built centre for undergraduate and postgraduate training. It is only with the generous support of Rob Sinclair, Director of the Centre, and Professor Ross Lawrensen, Head of Waikato Clinical School, that this has been possible. I must also acknowledge the efforts of both Steve Jenkins from Palmerston North and Andy Davies, from Tauranga. Both have made valuable contributions on the faculty of the instructor courses, have ensured standardisation and have helped to develop the course format. This year we have been able to conduct an additional course in Auckland and look forward to a course in in November. Instructor Course dates for 2010: March 6th and 7th, May 15th and 16th, July 24th and 25th, October 16th and 17th.

Kevin Nation Conference 2010

Below is the provisional programme, based around the ILCOR worksheet topics. I hope to have the finalised programme with speakers to you before Christmas.

PROVISIONAL PROGRAMME

Thursday 29th April 2010

0800-1830 Registration Open 0900-1700 Workshops Time tbc Industry Liaison Group Meeting 1700-1830 Welcome Reception

Friday 30th April 2010

0900-0930 Plenary 1 0930-0945 First Aid Burns 0945-1000 Poisonings 1000-1015 Severe Allergic Reactions 1015-1030 Spinal Immobilisation 1030-1100 Morning Tea 1100-1130 BLS AED 1130-1145 CPR Prior to Defibrillation 1145-1200 Compression/ventilation Ratio 1200-1215 Checking the Rhythm 1215-1230 Dispatcher Instructions 1230-1245 Ventilation 1245-1330 Lunch 1330-1500 Free Papers 1500-1530 Afternoon Tea 1530-1600 ALS Supraglottic Airways 1600-1615 Cricoid Pressure 1615-1630 Impedence Threshold Devices 1630-1645 Physiologic Feedback 1645-1700 Open Chest CPR 1700-1715 Waveform Analysis 19.30 Conference Dinner

Saturday 1 May 2010

0900-0930 Plenary 2 0930-0945 Education, CPR Feedback 0945-1000 Implementatio Predicting In- Cardiac Arrest 1000-1015 n & Teams Timing for ALS Training 1015-1030 Team & Leadership Training 1030-1100 Morning Tea 1100-1130 Neonatal IO vs IV 1130-1145 CPAP & IPPV 1145-1200 Room Air vs O2 1200-1215 LMA 1215-1230 Bradycardia & CO2 Monitoring 1230-1245 Ventilatory Times & Pressures 1245-1330 Lunch 1330-1400 Paediatric ET vs IV drugs 1400-1415 Supraglottic Airways 1415-1430 Compression/ventilation Ratio 1430-1445 Energy Doses 1445-1500 Pads vs Paddles 1500-1530 Afternoon Tea 1530-1545 Acute Diagnosis of STEMI 1545-1600 Coronary Prehospital fibrinolysis 1600-1615 Syndromes PCI following ROSC 1615-1630 Prophylactic Antiarrhythmics 1630-1645 B Blockers & Statins 1645-1700 PTCA vs Fibrinolysis

Focus on a DHB.

Greetings from Dunedin

The DHB Resuscitation Committee re-formed towards the end of 2007. Since then the committee has been working on standardisation of our resuscitation policies and equipment.

The policies covered: • Improvement of the co-ordination of our responses to cardiac arrests and medical emergencies • CPR training • Standardising the resus equipment and checking process. The equipment update was a major project that has just been completed. We implemented the roll out the equipment in stages and we were able to make wee tweaks as we went along. This helped with the education process.

Our major changes include: • Standardising the defibrillators; now all hospital manual defibrillators are biphasic. This built on the work commenced by the procurement team and has co-ordinated the product implementation across the hospital. • The introduction of basic emergency kits for outpatient areas and . Because of the physical location of the site, the Dunedin Public Hospital resuscitation team does not respond to Wakari hospital. The kits contain basic airway equipment and AEDs for initial life support until the ambulance arrives. • New portable suction units. • Standardising the Advanced Resuscitation Trolley (crash trolley) to the same model trolley, content and layout.

One innovation we developed was putting an intubation basket on the trolley. This contains equipment for an uncomplicated intubation: ET tubes, fibre-optic laryngoscope, KY gel, syringe, ET tape & stethoscope. The basket is small enough to sit beside the patients head. This has been very well received with feedback from the nursing team’s in particular being very positive. A consistent point that is identified is that the basket set simplifies the intubation process for the nurses attending as they only have to get additional troubleshooting equipment as requested by the clinician.

In 2008 we introduced a standardised resuscitation team. This was welcomed by medical staff as the response to medical emergencies and arrest was chaotic and highly variable at times. The resus team responds to both medical emergencies and cardiac arrests. In the future we would like to introduce a separate medical emergency team. At the moment the current system seems to be working well. As it seems to be a common theme through out the country we are currently working on updating the resuscitation and medical emergency record form. Thank you to Auckland, Mid Central & Wellington for allowing us to use elements of the formats developed in these centres. The aim is to eventually be able to audit arrests and enter our data into the NZRC national CPR registry.

If you would like more information or use of any of our documents we are happy to share.

Some areas maybe interested in our old stainless steel crash trolleys (going cheap!). If you are interested in them contact Lesley Dennison phone on (03) 4740999 ext: 8111.

Cheers Meg Martin

Letters to the Editor

Dear All,

There has been a suggestion that intubation equipment, (laryngoscopes and tubes), should be removed from our (CCDHB) Resus Trolleys.

The proposed alternative is that our ICU registrar would take the equipment to the cardiac arrest/emergency.

There are various reasons for this: technical problems with laryngoscopes and concerns over rushing to inept attempts at intubation are among them.

Has anyone else dispensed with intubation equipment from their Resus Trolleys? Or heard of anyone else who has? Or is aware of any evidence that this is a good thing to do?

I'd be grateful for any thoughts on the matter.

Regards,

Ben Barry Wellington Hospital

Ed Note: The Medical Advisory Committee is currently completing a document “Recommended equipment for resuscitation trolleys”, we expect to complete this for approval at the full next council meeting in November. If approval is given, it will be made available for downloading from the website in December.