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Invest to Save: Invest to Save: Cardiopulmonary Resuscitation
inCardiopulmonary Resuscitation inQueen Mary HospitalQueen Mary
Hospital
Dr W M CHANDr W M CHANConsultantConsultantAdult Intensive Care
UnitAdult Intensive Care UnitQueen Mary HospitalQueen Mary
Hospital
Hospital Authority Convention 2007 (8 May 2007 Presentation
SPP-6.1)
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2
InIn--hospital Resuscitationhospital Resuscitation
It is better to It is better to anticipateanticipate than to
than to resuscitateresuscitate
CardioCardio--pulmonarypulmonary--cerebral resuscitation
cerebral resuscitation (CPCR) rather than Cardiopulmonary (CPCR)
rather than Cardiopulmonary Resuscitation (CPR)Resuscitation
(CPR)
Activate InActivate In--hospital Resuscitation Team via hospital
Resuscitation Team via CPR Hotline (Ext. 3333)CPR Hotline (Ext.
3333)
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3
Line of ActivationLine of Activation
Routine daily checking calls by Telephone Routine daily checking
calls by Telephone Operator in the morning for all CPR
PagersOperator in the morning for all CPR Pagers
CPR Hotline Ext 3333
Telephone Operator should answer Telephone Operator should
answer the call within 3 rings bythe call within 3 rings by
Basic Life Support must be initiatedBasic Life Support must be
initiated
Once paged to a CPR scene, the doctor(s) should make every
effort to arrive at the scene within 2-3 minutes
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4
CPR Hotline (Ext. 3333)CPR Hotline (Ext. 3333)
333 - xxxx - YYY
Hospital message code for CPR
Extension of the Ward
Location of the Ward
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5
Cardiopulmonary Resuscitation TeamsCardiopulmonary Resuscitation
Teams
Organization of CPR in QMHOrganization of CPR in QMH
Parent Team Doctors, Dept of Medicine Dept of SurgeryDept of
Clinical Oncology
Parent Team Doctors, Parent Team Doctors, Dept of Dept of
Medicine Medicine Dept of Dept of SurgerySurgeryDept of Dept of
Clinical OncologyClinical Oncology
Central Resuscitation TeamIntensivistAnaesthestist
Always back up by on-site Specialist
Central Resuscitation TeamCentral Resuscitation
TeamIntensivistIntensivistAnaesthestistAnaesthestist
Always back up by onAlways back up by on--site site
SpecialistSpecialist
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6
Review on CPR Activities in 2005
A total of 273 CPR episodesA total of 273 CPR episodesReviewed
203 resuscitation records that was sent to the CND Reviewed 203
resuscitation records that was sent to the CND
CPR in AICU & OTS were excludedCPR in AICU & OTS were
excludedPaediatricPaediatric CPR ExcludedCPR Excluded
Comparing Central Resuscitation Team (CT) Comparing Central
Resuscitation Team (CT) vsvs Parent Team (PT):Parent Team
(PT):Baseline Demographic DataBaseline Demographic Data
No. of CPR episodesNo. of CPR episodesDepartments, age,
etc.Departments, age, etc.
Surrogate Outcomes of CPRSurrogate Outcomes of
CPRPagePage--toto--Turn up Time Turn up Time Restoration of
Spontaneous Circulation (ROSC)Restoration of Spontaneous
Circulation (ROSC)
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7
Results (1)
CT attended to only 6.6% of all CPRCT attended to only 6.6% of
all CPRTime of CPR activationTime of CPR activation
08300830--2030:2030: 47.3%47.3%20302030--0830: 0830:
52.7%52.7%
Department Code
151 55.3 55.3 55.342 15.4 15.4 70.715 5.5 5.5 76.254 19.8 19.8
96.03 1.1 1.1 97.18 2.9 2.9 100.0
273 100.0 100.0
MedSurgO&TInside AICUOthersInside OTTotal
ValidFrequency Percent Valid Percent
CumulativePercent
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8
Results (2)Results (2)
--1818185185Total No. of CPR EpisodesTotal No. of CPR
Episodes
ppCTCTPTPT
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9
Results (3)Results (3)
NoNo significant difference for PT and CT on:significant
difference for PT and CT on:Immediate outcomeImmediate outcome
Timeliness of activation of CPRTimeliness of activation of
CPR
LimitationsLimitationsRetrospective dataRetrospective data
Hospital Survival not measuredHospital Survival not measured
Small Number of CPR by Central TeamSmall Number of CPR by
Central Team
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10
Strategy for Further Improvement
A Dedicated Central Team to take care of A Dedicated Central
Team to take care of all CPR in the Hospital is unlikely to all CPR
in the Hospital is unlikely to improve CPR outcomeimprove CPR
outcome
The latest CPR Guidelines were simplified The latest CPR
Guidelines were simplified to make it easier for everybody to
learnto make it easier for everybody to learn
Crucial for PT to initiate CPR at bedsideCrucial for PT to
initiate CPR at bedside
Empowerment Empowerment of PT in enhancing of PT in enhancing
resuscitation care and practicesresuscitation care and
practices
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11
CPR is Made Easy
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12
TrainingTraining
Policy on CPR Training for NursesPolicy on CPR Training for
Nurses
Refresher Seminars for NursesRefresher Seminars for Nurses
Seminar on Seminar on ““Update on CPR Update on CPR
GuidelinesGuidelines””
Highlighting the 2005 American Highlighting the 2005 American
Heart Association Guidelines for Heart Association Guidelines for
Cardiopulmonary Resuscitation and Cardiopulmonary Resuscitation and
Emergency Cardiovascular CareEmergency Cardiovascular Care
Abbreviated doctorsAbbreviated doctors’’ training training
workshopsworkshops
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13
Pocket Sized Cue CardsPocket Sized Cue Cards
For Neonatal & For Neonatal & PaediatricPaediatric
CPRCPR
For Adult CPRFor Adult CPR
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Operation ManualOperation Manual
33rdrd Edition of Edition of ““Operation Operation Manual for
InManual for In--hospital hospital ResuscitationResuscitation””
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CPR Hotline 急救熱線
Caller來電者
TelephoneOperator
電話接線生
是否有提供所需醫生姓名
問明病房所屬專科、位置、內線號碼
是發出 CPR 訊息
代號 333 – 內線 – 位置
否
I. 腫瘤科 Primary Team # On-call MOCOD
II. 內科 Primary Team #, 各病房專責Med. 9300, 9339 On-call MO,
9300, 9339
III. 腦外科 Primary Team #, On-call MONeurosurgery On-call MO
IV. 兒科 Primary Team #, 9682, 9220Paed. 9682, 9220(初生嬰兒一個月以下)
(Neonates & Obstetrics)
V. 兒科. Primary Team #, 9220, 9221Paed 9220, 9221
(一個月或以上至18歲以下)
VI. 小兒外科 Primary Team #, On-call MO,Paed. Surgery On-call MO,
9220, 9221
9220, 9221
VII. 外科 Primary Team #, On-call MOSurgery On-call MO
發出 CPR 訊息代號 333 – 內線 – 位置
個別臨床部門專責急救醫生
辦工時間 非辦工時間
• ENT 耳、鼻、喉科
• Ophthalmology 眼科
• O&G 婦產科
• Oral Maxillofacial & Dental Surgery 口腔頜面外科及牙科
• O&T 矯形及創傷外科
• Psychiatry 精神科
• Radiology (X-ray) 放射科
• SOPCs, Blk S S座專科門診
• Chemotherapy Day Centre (K6N) 日間化療中心
• Dental Clinic 牙科門診 註︰1. # Primary Team 醫生姓名須由病房/單位提供。2.
電話接線生必須與來電者確認需傳呼之專責急救醫生,
以確保CPR訊息正確無誤。
辦工時間 非辦工時間
部門是否有專責急救之
醫生
是
中央急救隊 Central Resuscitation Team (CRT)
否
一個月或以上至18歲以下9220, 9221
電話接線生需填寫以下資料:
日期:________________________________
時間: ________________________________
病房/單位: ____________________________
所屬專科: ____________________________
來電內線號碼: ________________________
專責急救醫生:______________*個別部門 / 中央急救隊 (*成人 / 兒科 / 初生嬰兒)
專責急救醫生傳呼機號碼: ______________
發放訊息時間: ________________________
CAS call status checked:* Yes / No
* 請刪除不適用者
中央急救隊CPR Team支援之臨床部門
初生嬰兒 一個月以下
9682, 9220
18歲或以上9460, 9333
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Before Arrival of Doctor After Arrival of Doctor One Nurse Nurse
A
(Team Leader) Nurse B Doctor
(Team Leader) Nurse A Nurse B
Level of support BLS BLS ALS
Co-ordination
Call for help & activate medical support
Airway/breathing * * *
Circulation * * *
IV access & medication
Prepare / Assist
Defibrillation
Prepare when it is feasible
Prepare / Assist
Documentation
* Rotate the compressor role every 2 minutes or 5 cycles of
CPR
Role Delineation within the Adult CPR TeamRole Delineation
within the Adult CPR Team
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Standardized E-Trolley Content and Layout
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18
Acknowledgement
Members of Resuscitation Subcommittee
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I came to realize that life lived to help others is the only one
that matters and that it is my duty... This is my highest and best
use as a human. Ben Stein, E! Online, 12-20-03
I came to realize that life lived to I came to realize that life
lived to help others is the only one that help others is the only
one that matters and that it is my duty... matters and that it is
my duty... This is my highest and best use as This is my highest
and best use as a human. a human. Ben SteinBen Stein, , E! Online,
12E! Online, 12--2020--0303
In-hospital ResuscitationLine of ActivationCPR Hotline (Ext.
3333)Cardiopulmonary Resuscitation TeamsReview on CPR Activities in
2005Results (1)Results (2)Results (3)Strategy for Further
ImprovementCPR is Made �EasyTrainingPocket Sized Cue CardsOperation
ManualStandardized E-Trolley Content and LayoutAcknowledgement