4th day..peaceful day in hospital

so..today reach hospital on 7.30.. jz 3 patient only..
peaceful day in hospital..
2/3 patient is psychiatry patient..hahha..
i saw a neurologist came down to check n finally the patient transfer to psychiatric ward instead or neuro.
so..after that i went to resus after i heard 3 bell...
then 1 patient being transfer from medical department to our department.(A&E)
1 malay old lady.PEA.pulseless electrical activity.

so,today i've watch a 50 minutes rescue emergency situation.

as a first year medical student i actually cant do anything..
even the doctor ask me to do CPR.. but i rejected..cause the patient is pulseless..
is about life and death no joke..

so..they just ask me to bcum time runner.evry 2 minutes nid to speak out loudly..

then start defibrillation.

so,first the put they open airway first,then put bag valve mask with O2.

then they put adrenalin on the same time.follow by atropin  and CPR.

then they c ultrasound ,at the same time,charging the defibrillation.

so they say,clear evry1 150kj..then start shocking.

then pulse havent cum back.. then they continue CPR again.this time i bcum time runer again.after 2 minutes they charge again .finally they pulse is back..

after 5 minutes..pulseless again...CPR again.. charge again..

after total 4 time defibrilation ..finally they give up..code blue...

then i saw their family come inside pray for the patient..n with watery eyes again..

serious i can feel my heartbeat when they rescuing the patient..

nervous!!but serious quite sad huh..haizzz...

back to topic..

Here's some basic life support.

PREPARATION FOR INTUBATION
Prepare staff

• airway
• medication & intravenous line

Prepare equipment

• A- airway adjuncts- oropharyngeal airway
• B- bag valve mask with O2
• C- cardiac monitoring
• D- difficult airway equipments
• RY- ryles tube
• L- langoscopy blade and holder
• E- endotracheal tube
• S- suction device,stylet,securing tape,syringe,spO2 monitoring

Prepare patient

• cascular / intra-osseons access
• positioning
• adequate pre-oxygenation

Pre-medication

A- Atropine 0.02mg/kg min 0.1mg/kg

L- Lidocaine 1-1.5mg/kg

D- Defasciculatating agents (1/10 of act dose) see act dose in paralysis agents

O- Opiod -Fentanyl 1-2mg/kg

Induction agents

K- ketamine 1-2mg/kg

E- Etomidate 0.3mg/kg

M- Midazolam 0.1-0.2mg'kg

P- Propofol 2.4mg/kg

Paralysis agents

Depolarizing neuromascular blockage- Suxamethi 1-2mg/kg

Non-depolarizing neuromascular blockage - Rocuronium 0.6mg/kg , Vecorunium 0.1-0.15mg/kg

No more ABC now CARE..

C- compress chest

• Deliver 30 compressions
• heels both hand at centre of chest
• rate 100+ per minutes
• depth at least 2

A- airway

• open airway
• wilt head
• lift chin

R- Rescue breathing

• Pinch nose & seoul mouth
• deliver 2 breath
• about 1 second each breath annd watch chest vise
• continue 30:2 compression to breath cycle

E-external defibrillation 

- use AED