Deteriorating Patients

• Early senior decision making around DNACPR, is vital for both staff, patients, and families.
• Document decsion making and communications clearly
• There will be regular updates in “handover” about ICU admission criteria – as these may change over time

CPR (Aerosol Generation Procedure)

1. Recognise cardiac arrest.
   • Look for the absence of signs of life and normal breathing.
   • Feel for a carotid pulse if trained to do so.
   • Do not listen or feel for breathing
   • If there are any doubts – start chest compressions until help arrives.
   • When calling for help/2222, state the risk of COVID 19. 
2. Minimum Level 2 PPE; gown, eye protection, gloves and surgical mask/Hood
   • Rhythm assessment
   • Up to 3 shocks(VF/VT)
   • NO CPR
3. Minimum Level 3 PPE; gown, eye protection, gloves and FFP3 mask/Hood before starting chest compressions
   • No chest compressions or airway procedures such as those detailed below should be undertaken without full AGP PPE.
4. Start compression-only CPR
   • Avoid mouth-to-mouth ventilation and the use of a pocket mask.
   • Place oxygen face mask on the patient’s face during chest compressions (may limit aerosol spread).
   • Restrict the number of staff in the room (if a single room). Allocate a gatekeeper to do this.
5. LMA/ETT insertion –  must be carried out by experienced individuals.
6. Identify and treat any reversible causes 
7. Post-CPR
   • Dispose of, or clean, all equipment used during CPR
   • Remove PPE safely to avoid self-contamination
   • Hand hygiene has an important role in decreasing transmission.
   • Post resuscitation debrief is important and should be planned.

FULL Resus Council – GUIDE HERE