CCT in Anaesthetics - Core Level Training

Published: 13/08/2019

Management of respiratory and cardiac arrest in adults and children

[To be gained during the first 6 months of training]

For those who have not completed an ALS/APLS/EPLS course successfully, simulation may be used to assist in the teaching and assessment of these competencies

Learning outcomes:

  • To have gained a thorough understanding of the pathophysiology of respiratory and cardiac arrest and the skills required to resuscitate patients
  • Understand the ethics associated with resuscitation
  • Be able to resuscitate a patient in accordance with the latest Resuscitation Council (UK) guidelines. [Any trainee who has successfully completed a RC(UK) ALS course in the previous year, or who is an ALS Instructor/Instructor candidate, may be assumed to have achieved this outcome]
Knowledge

Competence

Description

Assessment

Methods

GMP

RC_BK_01

Lists the causes of a respiratory arrest, including but not limited to:

  • Drugs, toxins
  • Trauma
  • Pulmonary infection
  • Neurological disorders
  • Muscular disorders

C,E,S

1

RC_BK_02

Lists the causes of a cardiac arrest, including but not limited to:

  • Ischaemic heart disease
  • Valvular heart disease
  • Drugs
  • Hereditary cardiac disease
  • Cardiac conduction abnormalities
  • Electrolyte abnormalities
  • Electrocution
  • Trauma
  • Thromboembolism

C,E,S

1

RC_BK_03

Describes the basic principles of the ECG, and recognises arrhythmias including but not exclusively:

  • Ventricular fibrillation
  • Ventricular tachycardia
  • Asystole
  • Rhythms associated with pulseless electrical activity  [PEA]

C,E,S

1

RC_BK_04

Discusses the mode of action of drugs used in the management of respiratory and cardiac arrest in adults and children, including but not limited to:

  • Adrenaline
  • Atropine
  • Amiodarone
  • Magnesium sulphate
  • Naloxone

C,E,S

1

RC_BK_05

Identifies the doses of drugs, routes given [including potential difficulty with gaining intravenous access and how this is managed] and frequency, during resuscitation from a respiratory or cardiac arrest

C,E,S

1

RC_BK_06

Explains the physiology underpinning expired air ventilation and external chest compressions

C,E,S

1

RC_BK_07

Explains the need for supplementary oxygen during resuscitation from a respiratory or cardiac arrest in adults and children

C,E,S

1

RC_BK_08

Lists advantages and disadvantages of different techniques for airway management during the resuscitation of adults and children, including but not limited to:

  • Oro and nasopharyngeal airways
  • Laryngeal Mask type supraglottic airways, including but not limited to: LMA, Proseal, LMA supreme, iGel • Tracheal intubation

A,C,E,S

1

RC_BK_09

Explains the reasons for avoiding hyperventilation during resuscitation

C,E

1

RC_BK_10

Compares the methods by which ventilation can be maintained in a patient suffering a respiratory or cardiac arrest, using:

  • Mouth to mask
  • Self-inflating bag
  • Anaesthetic circuit
  • Mechanical ventilator

A,C,E,S

1

RC_BK_11

Explains the mechanism of defibrillation and the factors influencing the success of defibrillation

C,E,S

1

RC_BK_12

Recalls the energy used to defibrillate a patient

C,E,S

1

RC_BK_13

Discusses the principles of safely and effectively delivering a shock using both manual and automated defibrillator 

C,E,S

1,2

RC_BK_14

Explains the need for continuous chest compressions during resuscitation from cardiac arrest once the trachea is intubated

C,E,S

1

RC_BK_15

Explains the need for minimising interruptions to chest compressions

C,E,S

1

RC_BK_16

Lists the reversible causes of cardiac arrest and their treatment, including but not limited to:

  • Hypoxia
  • Hypotension
  • Electrolyte and metabolic disorders
  • Hypothermia
  • Tension pneumothorax
  • Cardiac tamponade
  • Drugs and toxins
  • Coronary or pulmonary thrombosis

C,E,S

1

RC_BK_17

Recalls/describes the Adult and Paediatric Advanced Life Support algorithms

C,E,S

1

RC_BK_18

Discusses the specific actions required when managing a cardiac arrest due to:

  • Poisoning
  • Electrolyte disorders
  • Hypo/hyperthermia
  • Drowning
  • Anaphylaxis
  • Asthma
  • Trauma
  • Pregnancy [including peri-mortem Caesarean Section] 
  • Electrocution

C,E,S

1

RC_BK_19

Lists the signs indicating return of a spontaneous circulation

A,C,E,S

1

RC_BK_20

Lists the investigations needed after recovery from a respiratory or cardiac arrest and describes the potential difficulties with obtaining arterial blood samples and how this may be overcome in these patients

C,E,S

1

RC_BK_21

Discusses the principles of care required immediately after successful resuscitation from a respiratory or cardiac arrest 

C,E,S

1,3,4

RC_BK_22

Discusses the importance of respecting the wishes of patients regarding end of life decisions

C,E,S

1,3,4

RC_BK_23

Outlines who might benefit from resuscitation attempts and the importance of knowing/accepting when to stop

C,E,S

1,3,4

RC_BK_24

Discusses the importance of respecting the wishes of relatives to be present during a resuscitation attempt

C,E,S

3,4

RC_BK_25

Describes the value of debriefing meetings and the importance of active participation

C,S

3,4

 

Skills

Competence

Description

Assessment

Methods

GMP

RC_BS_01

Uses an ABCDE approach to diagnose and commence the management of respiratory and cardiac arrest in adults and children

D,S

1

RC_BS_02

Recognises cardiac and respiratory arrest

S

1,2

RC_BS_03

Maintains a clear airway using basic techniques with or without simple adjuncts:

  • Head tilt
  • Chin lift
  • Jaw thrust
  • Oro- and nasopharyngeal airways

D,S

1,2

RC_BS_04

Demonstrates correct use of advanced airway techniques including:

  • Supraglottic devices, including but not limited to LMA, Proseal, LMA supreme, iGel
  • Tracheal intubation

D,S

1,2

RC_BS_05

Maintain ventilation using:

  • Expired air via a pocket mask 
  • Self-inflating bag via facemask, or advanced airway  • Mechanical ventilator

D, S

1,2

RC_BS_06

Performs external cardiac compression 

D,S

1,2

RC_BS_07

Monitors cardiac rhythm using defibrillator pads, paddles or ECG lead 

D,S

1,2

RC_BS_08

Uses a manual or automated defibrillator to safely defibrillate a patient 

D, S

1,2

RC_BS_09

Turn a patient into the recovery position

D

1,2

RC_BS_10

Prepare a patient for transfer to a higher level of care

A,M

1,2

RC_BS_11

Maintains accurate records of all resuscitation events

A,M

1,2