“Sir, sir, are you alright?”
I tap on his shoulder and look at this chest to see if it’s rising. He isn’t breathing. I palpate his carotid and can’t find a pulse.
“Hey, can you get the crash cart? And you, start compressions.”
I place the paddles for a quick look and see that he’s in ventricular tachycardia. I charge the defibrillator while a nurse continues with the compressions.
I make sure no one is touching the patient and deliver the shock. My helpers continue to give CPR. Thirty compressions, 2 breaths. Thirty compressions, 2 breaths. In the meantime, I attach the leads of the monitor to the patient and open an IV line to deliver drugs and fluids as necessary.
“What set are you on?”
“You guys switch after his 5th set.”
When the 5th set is finished, I take a look at the monitor and find that the patient is in sinus tachycardia. It’s not a shockable rhythm.
And we continue until our TA tells us to stop. This is my first week of 3rd year and we started with a crash course in ACLS.
We sit around in a circle and listen to the feedback. We had missed some crucial things. I forgot to check the pulse when I realized the patient had sinus tachycardia. I took too long to place the endotracheal tube. I gave adrenaline in the middle of the 5 set cycle. But we did the most important parts pretty well: 19 seconds to first compression, 33 seconds to shock. The compressions were good and we were working in sets of 5, following protocol.
Each scenario is about 5-10 minutes. Anyone who’s done CPR knows that it’s exhausting. Effective compressions require fast (at least 100/min) and deep (2” or 5 cm) pushes but allowing full recoil for the heart to fill up again. Compressors are switched every 2 minutes because compressions become less effective after a minute, even if you are well built and in shape. On average, a code lasts about 30-40 minutes. It’s hard to imagine going for that long but I guess the adrenaline will kick in during a real code.
The first few times we ran the drill, we were quite clueless. It’s so easy to miss something in the heat of the moment. Even though we had studied the protocol, we forgot things during the drills. Even though I know what someone did right and wrong when I’m observing someone else doing a drill, when I’m on the spot, suddenly, I missed little (or sometimes important) details. I’m glad we have Resusci Anne to practice and that we are running drills continuously so when there is an actual code, all the protocol steps come naturally. I’m sure I will make mistakes, but with practice I will make less mistakes and perhaps help save someone’s life.
Did you know that there is a backstory behind Resusci Anne?