Resus Your Resus – Clinical Grind

Let’s set the scene with a case. You’re working a regular shift when a patient in cardiac arrest comes in. You get to the room and find the patient’s family and multiple team members are already there. You see that things are not going well because there are communication issues amongst the resus leader, head nurse, other team members, and family members. Chaos is about to ensue. How do you go about handling this situation? In this episode, our host, Andy, is joined by our guests, Matthew Delaney, Chris Colbert, and Tiffany Proffitt, to discuss how to “Resus your Resus.”

Get back to the basics:

• Define roles before the resus comes in.
  • Who is leading? Who is charting?
  • Delegate these roles out loud.
• Help redirect by getting everyone to focus on the basics – ABCs.
  • Is the airway secure? Do we have vascular access? Are we supplying good-quality compressions?

Reset communication:

• Take command of the room and be direct.
  • There are different approaches you can take to control a room that is getting too loud or chaotic.
    • Loud approach to “shock” the room
      • Grab everyone’s attention by escalating your voice.
    • Whisper approach to redirect individuals one by one
      • Pull the individuals that are causing the problems aside and tell them they need to remain calm or redirect their energy.
      • Sometimes speaking more quietly and not being another person blasting orders may be the best approach.
    • Code review
      • Ask the charting nurse to do a code review
        • Medications given? What has been done?
      • It allows them to escalate their voice to grab everyone’s attention and refocus on what is left to do.
  • Limit irrelevant conversation.
    • Maintain the gravity of the situation and avoid jokes and chatter.
    • This keeps the team focused and reassures the family that the best possible effort is being given to their loved one.
  • Set and maintain expectations for the resus.
    • You must maintain a culture that promotes good discussion and good decision-making.
    • Empower your team members to have a voice in the room and reset when things get out of hand.

How do you deal with family members in the room?

• Introduce yourself and assess their relationship to the patient.
• If they are cooperative and calm, try kindly and directly addressing them.
  • “I want you to be here and involved in the care of your family member, but we have to do it in a way that best allows us to take care of the patient.”
  • “It will help the most to have you sit aside right now and we will come check up on you and update you on how things are going.”
• What if the family member is a healthcare worker?
  • Establish their role in the patient’s care.
  • Give them something to do.
    • It may be helpful if they can assist in relaying information to the rest of the family.
    • They can help “run” the family room.
  • They may want to provide insight even if the situation is out of their expertise.
    • Bring the family to reality.
      • They can’t act as the doctor/nurse/etc in this situation, but they can play an active role by relaying information to the rest of the family thus helping to free up focus on the actual resus effort.
    • Focus on what they are able to do.

Take Homes:

1. Different approaches can be used to reset a room that is getting out of hand.
2. Get everyone on a shared goal/vision.
3. Dominate your resus!

Post by Jordan Palmer, OMS-III

 

 

About Our Guests:

Matthew Delaney, MD is currently an Associate Professor and the Associate Program Director at the University of Alabama, Birmingham.

Chris Colbert, DO is a longtime friend and multi-episode guest of the show. He is currently the Assistant EM Residency Director, Assistant Professor of Clinical Emergency Medicine, and Director of Health Disparities at the University of Illinois, Chicago.

Tiffany Proffitt, DO is an attending physician at HonorHealth Scottsdale Osborn Medical Center and host of UrgentCareRAP.

 References:

1. https://www.stemlynspodcast.org/e/five-free-strategies-to-improve-your-resuscitations-simon-carley-at-stemlynslive/
2. https://blog.impraise.com/360-feedback/the-power-of-peer-coaching-5-tips-to-improve-your-teams-performance
3. https://emottawablog.com/2018/09/5-tips-to-improve-your-resuscitation-skills/

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