Overview of a Resuscitation

In resuscitation, multiple interventions, both diagnostic and therapeutic, occur simultaneously. These interventions are artificially separated out for the purposes of analysis and education, beginning with the primary survey resuscitation, the so-called ABC, a rapid evaluation and management of cardiopulmonary and cerebral function. The primary survey focuses the clinician on the critical early interventions. After the primary survey, a "resuscitation" phase is begun, which focuses on the acquisition of

Overview of a resuscitation

Preparation Primary survey Airway Breathing Circulation Disability Exposure
Resuscitation Phase Continuation of interventions and monitoring begun in primary survey History
Bedside diagnostic investigations	Blood tests Electrocardiography Diagnostic imaging
Advanced monitoring	Central venous pressure monitoring Pulmonary catheter monitoring Intraarterial catheter monitoring Cardiotocodynamometry (in pregnancy) Non-invasive monitoring (biothoracic impedence) Nasogastric and urinary catheter placement
Secondary Survey Head-to-toe examination (inspection, percussion, palpation and auscultation)
Definitive care phase Diagnostic specific therapy Consultations
Preparations for patient disposition	Transfer Operating room Specialized intensive care unit
Family conference
Resource utilization	Respiratory therapist Social services Religious support services Organ procurement agencies Law enforcement and forensic services Sexual assault and domestic violence

additional data and the continuation of emergent interventions initiated in the primary survey. The secondary survey which follows is a head to toe examination that may reveal abnormalities not yet noted and that may alter further therapy. Finally, the resuscitation enters the definitive care phase, which may continue for the course of several days, as the patient moves from the ED to the operating room, intensive care unit and/or other inpatient treatment areas. Table 1.3 gives the organizational framework of a resuscitation.

Preparation

The few minutes immediately prior to a major resuscitation may be precious. Any advanced notification that a critically ill patient is en route to hospital may be used to assemble the resuscitation team and to ready necessary equipment. This time is not to be taken for granted; if not utilized correctly, it may directly contribute to poor outcomes and inefficient resuscitation. Table 1.4 outlines critical steps that should occur before a patient(s) even arrives.

Table 1.4. Preparation for a resuscitation

Prehospital data analysis
Number of patients
Age and gender of patients (possibility of obstretrical, pediatric and/or neonatal resuscitation)
Description of illness/injury
C-spine precautions in place
Level of consciousness
Airway status
Vital signs
Estimated time of arrival
Need for decontamination (hazardous materials), sterile field (burns)
Need for law enforcement, security personnel (possible compromise of patient, staff safety)

Team assembly

Physicians	Team leader Airway management Procedural support Consultant staff -surgical -interventional cardiology -gastroenterology -neonatal/pediatric -obstetrical
Nursing	Charting and timing Monitor placement Venous access and emergency lab specimens Catheter placement (Foley, NG tubes) and other procedures Resuscitation medications and fluids ready and available Circulating Family and visitor management
Respiratory therapist	Assistance with airway management Ventilator and non-invasive ventilation techniques
Radiation technologist	Perform and develop STAT portable X-rays CT scan running and available
Laboratory personnel	Blood bank readiness STAT laboratory testing
Clerical staff	Provide emergent identification and prepare hospital ID
Equipment
Airway management	Functioning suction with catheter attached Flowing oxygen Airway adjuncts including -an array of sizes of oral airways -bag-valve-mask setup -ET tubes with stylets placed and balloons tested -laryngoscopes with bulbs tested -rescue airway adjuncts ready -medications for rapid sequence intubation ready
Other procedural	Dress and gloves for universal precaution maintenance Blood warming and rapid transfusion equipment Ready procedure trays for -central venous access -thoracostomy and thoracotomy -surgical airway management (cricothyroidotomy) Warmed fluids/blankets, non-invasive warming equipment Adequate tubing for blood/blood product administration Emergency ultrasound at bedside