optimuscore course printouts file - chq · 2021. 1. 19. · this is the optimus core course...

This is the Optimus CORE Course Printouts File Please print out 1 colour copy of this document on Single Sided Format. You should then have almost all of the documents required for the course with the exception of :

• Participant Packs (print as many copies of this as there are participants, ie. 20 participants = 20 copies)

https://www.childrens.health.qld.gov.au/wp-content/uploads/PDF/research/STORK/PRINT-Participant-Packs-CPR-Form-and-Course-Feedback.pdf

Table of Contents Resource Copies Equipment Checklist 1

Room Sign : Welcome to OPTIMUS CORE 1 Attendance Sheet 1 Room Sign : Case Study 1 SBAR Sheets 4 Airway Station : Room Sign 1 Airway Station : Learning Objectives 1 Airway Station : Overview 1 Airway& Breathing Station : Management Algorithm 1 Airway& Breathing Station : OPA and NPA Diagram 1 Airway& Breathing Station : LMA Diagram 1 Circulation Station : Room Sign 1 Circulation Station : Learning Objectives 1 Circulation Station : Overview 1 Circulation Station : Intraosseous Sizing Chart 1 Circulation Station : Intraosseous Access Sites 1 CPR & Defib Station : Room Sign 1 CPR & Defib : Learning Objectives 1 CPR & Defib : Overview 1 CPR & Defib : Fake Defibrillator 1 Scenario 1 : Room Sign 1 Scenario 1 : Run Sheet 2 Scenario 1 : Prebrief 1 Scenario 1 : Debrief Form 2 Scenario 1 : Emergency Drug Booklet 1 Scenario 2 : Room Sign 1 Scenario 2 : Run Sheet 2 Scenario 2 : Prebrief 1 Scenario 2 : Debrief Form 2 Scenario 2 : Emergency Drug Booklet 1 Assessment Station : Room Sign 1

Assessment Station : Overview 1

Assessment Station : Candidate’s Form 1

Faculty Evaluation Form 1

Participant Evaluation Form 1

Optimus CORE Equipment Checklist Station Equipment Manikins

Based on 4 participants per

station Miscellaneous • 2.5cm brown tape x1 (for airway &

scenarios) • Brown tape x1 (for drainage sets) • Elastoplast x1 (for drainage sets) • Sharpie • Drainage bag set x 2 • Scissors • Sheet of labels for NO IV

Assessments: 1 x infant BLS + 1 from airway 1 x child BLS + 1 from airway

• Paed BVM x 2 (airway & assessments) • Adult BVM x 2 (airway & assessments)

Airway

• Suction catheter 6, 8 • Yankaeur sucker (paed & adult) • Hudson mask x 1 • High-concentration oxygen mask (ie non-

rebreather) large & small x 1 each • 0.5L anaesthetic bag • Pressure manometer • Face mask for BVM (0/1 x2, 3/4 x2) • Manikin lubricant • Tongue depressor x 2 • 10ml syringe x 2 • NG size 8 • Nasal prongs – infant x 1 • High-flow nasal cannula x 1 (20L/min) –

only if relevant to local procedure • Oropharyngeal airway (0, 1, 2, 3) x 1 • Nasopharyngeal airway (3.5, 4.0) x 1 • LMA (1, 1.5) x 1 each

1 x Infant airway head 1 x Infant ALS manikin 1 x Infant BLS infant 1 x Child BLS manikin

Circulation • Drainage circuit & 3-way tap & extension x 1

• 3way tap without extension • 3way tap + extension • 50 mL syringe x 1 • 10mL syringe x 1 • 2mL syringe x 1 • Drawing up needle • Rapid infuser IV Transfusion pump set or

local IV infusion administration set • 1L Normal Saline • IO needles- pink x1, blue x1 • IO driver (as per local area – EZIO)

1 x BLS infant -

• IO dressing • 1cm brown tape • Scissors • Alco wipe • IO crunchies • Adrenaline 1: 1000 x 1 • Adrenaline 1: 10 000 x 1 • 10ml normal saline amp x 1 • Box gloves

CPR/Defib • Rhythm generator • Defib pads – paed x1, adult x1 in

packets • Paed BVM + FM 0/1 x 1 • Adult BVM + FM 3-4 x 1

1 x infant BLS 1 x child (megacode kid or BLS)

Scenario 1 BVM paed & facemask O/1 from CPR / defib Fully stocked resuscitation trolley set up as per local check list is ideal

• Sats probe • Thermometer • Infant BP cuff • Pupil torch • Whiteboard marker • Defib pads, paed X1 • Infant Nasal prongs • Paed FM with reservoir • Suction catheter size 8 • Yankauer sucker paed • NG size 8 • Nasal prongs - infant • Microcuff ETT 3.0,3.5, 4.0 • Small introducer • Laryngoscope • Laryngoscope blade miller 0 + Mac 1 • Oropharyngeal 0, 1, 2 • Nasopharyngeal 4.0 • LMA 1 • Stethoscope • CO2 detector • 50ml syringe • Transfusion pump set (or local IV admin

set) • IO needle (as per local area – pink if

EZIO) • N/Saline x 1L • N/Saline 10 ml amp x 3 • Adrenaline 1:10 000 x 3 • 10ml syringe x 1 • Blood gas syringe • 2ml syringe

ALS infant from airway

• 22g cannula • Tourniquet • Drawing up needle • 3 way tap • Drainage circuit & 3 way tap & extension • Alco wipe

Scenario 2 Adult BVM & facemask ,3/4 from CPR / defib Fully stocked resuscitation trolley set up as per local check list is ideal

• Child BP cuff • Sats probe • Thermometer • Pupil torch • Whiteboard marker • Defib pads, paed, adult • Paed FM with reservoir • Yankauer Sucker • Suction catheter 8 • NG size 8 • Microcuff ETT 4.0, 4.5,5.0 • Medium introducer • Laryngoscope • Laryngoscope blade Miller 1, Mac 2 • Oropharyngeal 0, 1, 2 • Nasopharyngeal 4, 4.5 • LMA 2 • Stethoscope • C02 detector • 50 ml syringe • Transfusion pump set (or local IV admin

set) • N/Saline x 1L • IO needle (as per local area – pink if

EZIO) • N/Saline amp 10mL x 3 • Adrenaline 1:10 000 X 3 • 10 ml syringe x 3 • Blood gas syringe • 2 ml syringe • 22g, 20 g Cannula • Tourniquet • Drawing up needle • 3 way tap • IV bung • Drainage circuit & 3 way tap & extension • Alco wipes

1 x child (megacode kid or BLS) from CPR/defib

Welcome to OPTIMUS CORE

Optimus CORE Attendance List

SITE: DATE:

No.

Name of Participant

Ward/clinic

Signature Discipline:

Nurse/Allied Health/Medical

eLearning C

ertificate

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24

Case Study

Optimus CORE CASE STUDY

S Situation

B Background

A Assessment

R Recommendation

Airway & Breathing Skills

Optimus CORE Airway/Breathing Skills – 30 minutes per group

Optimus CORE

AIRWAY/BREATHING

SKILLS STATION Learning Objectives:

• Airway opening manoeuvres

Positioning

Suction

Oropharyngeal insertion

Nasopharyngeal insertion

Laryngeal mask insertion (in scope)

• Oxygenation / ventilation – hudson vs non rebreather vs Nasal

prongs vs high flow nasal prongs

• Effective bag mask valve ventilation

• Modified Ayres t-piece (in scope)


Aim The purpose of the airway skills station is for participants to learn how to perform basic and advanced airway skills in the management of the deteriorating child. Identifying the appropriate escalation to advanced airway management in the deteriorating child or cardiac arrest. Facilitate group using a team approach of supportive practice – identify participants with advanced skill to support staff requiring more practice. Facilitator demonstrates the skill first and then supports participants practice. Objectives: By the end of the session, all participants have practiced: Core/Advanced participants:

• Basic airway opening manoeuvers - positioning, suction, oropharyngeal / nasopharyngeal insertion • Effective bag-valve-mask ventilation

Advanced participants: • Effective ventilation using Ayres t-piece / anaesthetic bag • Laryngeal mask insertion

Facilitator: Medical / Nursing Participants: 4 is ideal, max 8 per group Equipment required: Ensure all equipment is in working order Airway position & ventilation : 1 – 2 manikins / part task trainer per participant is ideal. A mix of manikins is useful.

• Paediatric airway head • Infant ALS mannequin • Infant BLS mannequin • Child BLS mannequin

• Oropharyngeal airways size 00, 0, 1, 2, 3 x 1 each • Nasopharyngeal airways size 3.5, 4.5 x 1 each • Paediatric 500mL self-inflating bag x 2 (1 per infant mannequin) • Adult 1200mL self-inflating bag x 2 (1 per child mannequin) • Masks size 0/1, 2 x 2 (1 per infant mannequin) • Masks size 3/4 x 2 (1per child mannequin) • Suction catheters size 6, 8 x 1 each • Yankaeur sucker small and large x 1 each • Tongue depressors x 2 • Nasal prongs x 1 • Nasogastric tube size 8 x 1 • High-flow nasal cannula x 1 (20L/min) – only if relevant to local procedures • Hudson mask x 1 • High-concentration oxygen mask (ie non-rebreather) large & small x 1 each • T-piece / anaesthetic bag 500mL x 1 • LMA size 1, 1.5 x 1 each • Syringes 10mL x 2 • Mannequin lubricant spray x 1 • Paediatric Resuscitation table x 1 • Airway laminates


Airway session guide Suggested scenario to guide flow of session. Max is admitted with bronchiolitis.

• How do you assess paediatric work of breathing? Mild, mod, severe. • Discuss airway compromise in relation to different age groups

o Demonstrate suctioning infant nares • Discuss modes of oxygen delivery

o Nasal prongs (high-flow nasal cannula as relevant to local procedures) o Hudson mask o Face mask with reservoir bag

You are alerted by parent that Max has stopped breathing.

• Demonstrate and practice: 1. Airway positioning to open airway – head tilt-chin lift; jaw thrust 2. Suction 3. Bag and mask ventilation – single and dual operator (2 handed mask technique)

- Self-inflating bag – NB danger of CO2 retention in the self ventilating patient - Anaesthetic bag - advanced participants

4. Oropharyngeal insertion 5. Nasopharyngeal insertion 6. LMA insertion – advanced participants


NPA and OPA

Circulation Skills

Optimus CORE Circulation Skills – 30 minutes per group

Optimus CORE

CIRCULATION

SKILLS STATION Learning Objectives:

• Clinical indicators of circulatory compromise in the paediatric patient.

• Administration of fluid bolus

• Preparation and administration of adrenaline - cardiac arrest /anaphylaxis

• I/O insertion (manual and I/O driver).

Clinical indicators

Insertion sites

Safety and care

• Use of cognitive resources


Aim The purpose of the circulation skills station is for participants to learn how to perform circulatory resuscitation skills in the management of the deteriorating child. Objectives: By the end of the session, all participants have practiced:

Core participants: • Administration of fluid bolus – identifying the volume of

fluid required based upon indicators of circulatory compromise

• Preparation and administration of adrenaline – 1:1000 & 1:10,000 minijet (cardiac arrest dose, anaphylaxis dose)

• Supporting Intraosseous insertion (manual & I/O driver) – identifying clinical indicators, insertion sites, and care

• Using cognitive resources – ie Paediatric Resuscitation Table

Advanced participants: • Core elements + • Intraosseous needle insertion –

manual and I/O driver

Facilitator: Medical / Nursing Participants: 4 is ideal, max 8 per group, mix of core and advanced

Equipment required: Ensure all equipment is in working order

Table 1: Core / Advanced BLS Mannequin (with intravenous access + drainage) 1L 0.9% sodium chloride Rapid infuser set x 1 60mL syringe x 1 3-way tap with extension x 1 3-way tap without extension x 1 Adrenaline 1 :10000 x 1 (minijet/ampoule) Adrenaline 1:1000 x 1 10mL syringe x 1 2mL syringe x 1 Drawing up needle x 1 0.9% sodium chloride ampoules x 1 Drug Book appropriate for your service x 1

Table 2: Core / Advanced I/O leg x 2 OR crunchie bar IO x 2 Manual Intraosseous needle x 1 IO driver x 1 IO driver needles small & medium needles x 1 Box gloves x 1 EZI I/O laminate of positions Spare drainage bag x 1

Identify core and advanced participants. Facilitate group using a team approach of supportive practice – advanced practitioners to support core skill practitioners.

Facilitator demonstrates the skill first and then supports participants practice.


Circulation session guide Suggested scenario to guide flow of session. Jeremy is admitted with vomiting and diarrhoea.

1. How would you assess this child’s circulatory status? (Tachycardic, BP normal, CRT 3 seconds, dry mucous membranes, +/- fontanelle sunken)

2. How would you administer a fluid bolus? (50mL syringe + 3-way tap push / pull technique) 3. How much fluid do you give to an 8 kg infant / 30 kg child? (resus table)

HR increases, CRT 5 secs, hypotensive for age, decreased LOC IV access is unable to be obtained – how else can you obtain vascular access?

4. Identify the sites for I/O insertion 5. Demonstrate and practice I/O insertion

The child’s pulse is no longer able to be obtained and CPR has been commenced. What is the first line drug in managing cardiac arrest? (IV adrenaline)

6. What is the dose of adrenaline for an 8 month old / 30 Kg child? - Demonstrate decanting of smaller dose of adrenalin using 3-way tap

7. Demonstrate assembly of a minijet (if in use at facility)

For the child signs of anaphylaxis, how would you administer adrenaline? 8. What is the dose of IM adrenaline for an 8 month old / 30 Kg child? 9. How do you prepare this?

CPR & Defibrillation Skills

Optimus CORE CPR & Defib Skills – 30 minutes per group

Optimus CORE

CPR and DEFIBRILLATION SKILLS STATION

Learning Objectives:

• DRSABCD algorithm including:

Effective compressions

Application of defibrillation pads

Safety in defibrillation

Recognition of shockable and non-shockable cardiac arrest rhythms

Paediatric cardiac arrest algorithm


Aim

The purpose of the CPR and defibrillation skills station is for participants to learn how to perform cardiopulmonary resuscitation, recognise cardiac arrest rhythms, follow the paediatric arrest algorithm, and perform safe defibrillation. The participants will also be provided with the opportunity to perform in the role of Team Leader.

Objectives: By the end of the session, all participants have practiced:

Core participants: • DRSABCD algorithm including: • Effective cardiac compressions (ratio, rate, depth,

positon, minimise interruption) • Safe application of defibrillation pads • Safety in defibrillation • Identify differences in paediatric and adult cardiac basic

life support

Advanced participants: • Core elements • Recognition of shockable and non-

shockable cardiac arrest rhythms • Paediatric arrest algorithm (in

leadership role) • Safe defibrillation

Assessment of participants Paediatric Life Support performance can also be achieved during this session for both Core and Advanced participants. This is not essential, however If assessments are achieved during this station more time can be allocated to the Simulation component of the course. Facilitator: Medical / Nursing Participants: 4 is ideal, max 8 per group, mix of core and advanced

Equipment required: Ensure all equipment is in working order Mannequin is placed on a table. Participants stand around table and step to the left so that all can practice in various roles – ie airway, CPR, defibrillator.

• Infant BLS mannequin (QCPR if available) • SimJunior/Megacode Kid – or Child BLS mannequin • Paediatric 500mL self-inflating bag • Adult 1200mL self-inflating bag • Mask size 2 • Mask size 3/4 • Infant & adult defibrillator pads x 1 set each • Adrenaline 1:10 000 + 2 & 5mL syringe • 0.9% NaCl + infusion line pre-primed with 3-way tap & 60mL syringe attached • DRSABCD poster x 1 • Local Emergency Response Poster • Rhythm simulator x 1 OR photos of rhythms supplied in resource pack (PEA, asystole, VT & VF) • Defibrillator x 1 OR photos of local Defibrillator – life pack 20 supplied in resource pack • Paediatric Cardiac Arrest guideline poster x 1

Identify core and advanced participants. Facilitate group using a team approach of supportive practice – advanced practitioners to support core skill practitioners.

Facilitator demonstrates the skill first and then supports participants practice.


Layout :

CPR guide You find a child lying in bed, they look very pale and are breathing irregularly. How would you approach this child?

Using around the table approach ask each participant to provide information whilst instructor demonstrates.

D – danger – provide examples of danger to self, patient, others R – assess response using verbal and tactile stimuli - AVPU S – shout / send for help – initiate local emergency response (at 1 min to seek help if none has arrived) A – open airway - briefly discuss airway positions for different ages and interventions (covered in more depth in airway station) B – assess breathing (maintaining airway patency) – not breathing normally or not breathing – 2 x rescue breaths C – check for pulse – location for different ages, assess for no longer than 10 secs.

- Discuss the limitations with pulse checks - if in doubt and no signs of life commence compressions. - Indications to start compressions – you can’t feel a pulse; pulse rate < 60 bpm with associated poor

perfusion; no “signs of circulation/signs of life’; if in doubt commence compressions - Start Compressions – landmarks lower half of sternum, centre of chest, depth – 1/3 depth chest;

method according to age – infants - two hands encircling / two fingers; older children - one hand / two hands; rate 100 - 120bpm; ratio 2 breaths:15 compressions; allow full recoil of chest; minimise hands off chest time

o Utilise metronome rate of 110 bpm or QCPR manikin - CPR continues - How often should we change over? Change rescuer every two minutes to reduce

fatigue and maintain efficacy of compressions - Participants to practice rotation of ventilation/compressions - Use QCPR manikin if available

D – defibrillation - Facilitator demonstrates pad placement: AP vs AL position; discuss the principles of safe defibrillation: metal, oxygen, water.


Paediatric arrest algorithm, rhythm recognition & safe defibrillation guide Facilitator revise arrest rhythms and paediatric arrest algorithm. Demonstrate use of defibrillator and defibrillation process, including rhythm recognition & safe defibrillation.

- Assign participants roles, contextualising to an authentic team at your hospital : • Code Leader • Drugs • Airway • +/- Documentation • CPR compressors • Defibrillation

• If limited participants, faculty can supplement airway, compressions, or drugs role.

To facilitate practice with both shockable & non-shockable pathway, change rhythms between VT, VF, PEA & Asystole as the team rotates. Observe and fill in knowledge gaps with differences in rhythms as they are introduced on each rotation.

- Rotate participants with each 2 min cycle of the arrest algorithm (step to the left): o Progress down the paediatric arrest algorithm with each rotation o All are provided the opportunity to practice in each role according to scope of practice

Advanced participants to take on defibrillation role and demonstrate rhythm recognition and safe defibrillation process; function in the role of Code Leader following the Paediatric Arrest Algorithm to direct what is required for each stage (i.e. obtain access; prep adrenaline / amiodarone; anticipate airway adjuncts / fluid bolus / considers 4H’s & 4 T’s).

Core participants rotate through compression, ventilation & drug roles (focus on minimising interruption to compressions)

- Continue until all participants have rotated through ventilation & compressions and all advanced participants have performed defibrillation and Code Leader role.

Pay attention to reducing hands-off time during rhythm check and discharge / disarm shock.

• Commence CPR • Apply defibrillator pads • Turn on defibrillator • Select joules / energy • Charge defibrillator – asking all to stand clear & remove oxygen whilst charging except

compressions • Once charged – ask compressions to stand clear • Assess rhythm as shockable or non-shockable (check pulse with any potentially perfusing rhythm) • Look around bed to ensure all clear • Recheck shockable rhythm • Discharge asynchronous shock 4 joules / Kg (whilst looking at bed not machine) • Immediately recommence CPR - NB Note: DC shock disrupts electrical conductivity of the heart

which does not always restore immediately. Recommencing CPR immediately maintains blood flow to the brain and heart following the DC shock.

• During the next 2 minutes of CPR ask Defibrillation / Code Leader role what is required in preparation for next round (i.e. obtain access; prep adrenaline / amiodarone; prep for intubation; consider cause)


Scenario options – adapt as applicable to your authentic environment

Close session with a recap of objectives and any key points identified during session. Take note of participants who achieve the criteria for Paediatric Life Support Assessment (cardiopulmonary resuscitation, defibrillation, and code leader). If all participants have achieved assessment, more time can be allotted to the simulation component of the course.

Rhythm Age & background Causes 4 H’s & 4 T’s

VT 20 Kg 4 yr old Hx renal failure in cardiac arrest, compressions have been commenced

Hyperkalaemia

VF 25 Kg 5 yr old Hx cardiomyopathy in cardiac arrest, compressions have been commenced

Hypoxic (low cardiac output state)

VF 15 Kg 2 yr old Hx drowning in cardiac arrest, compressions have been commenced

Hypoxia, hypothermia

PEA 8 Kg 9month old with gastro & shock in cardiac arrest, compressions have been commenced

hypovolaemia

VT 3 Kg 7 day old 4 hours post cardiac surgery in cardiac arrest, compressions have been commenced

Cardiac Tamponade

VF 45 Kg 14 yr old who has overdosed on tricyclic antidepressants in cardiac arrest, compressions have been commenced

Toxins

VT 50 Kg 10 yr old Hx of Long QT syndrome admitted with respiratory illness, in cardiac arrest, compressions have been commenced


Asystole 10 Kg 1 yr old Hx Posterior Fossa Tumor in cardiac arrest, compressions have been commenced

Hypovolaemia

Asystole 45 Kg 12 yr old in ORS Hx trauma, ruptured spleen, haemorrhage, in cardiac arrest, compressions have been commenced

Hypovolaemia

VT 10 Kg 14-month-old in ORS Hx Local Anaesthetic reaction, in cardiac arrest, compressions have been commenced

Toxins

PEA 5 Kg 5-month-old in PACU Hx bowel resection for intussusception, in cardiac arrest, compressions have been commenced

Hypovolaemia

PEA 18 Kg 4 yr old Hx post insertion of Hickmann’s line, in cardiac arrest, compressions have been commenced

Pneumothorax

Scenario 1

Optimus CORE Scenario 1 Infant – Apnoea

Objectives: 1. Recognise and manage respiratory distress, impending respiratory failure and apnoea in an infant

• Clinical interventions: Suction, airway positioning, nasopharyngeal airway insertion Oxygen and ventilation: high-concentration oxygen; bag-valve-mask; intubation preparation

2. Crisis resource management principles: Call for help early, effective leadership, teamwork, role delineation, communication and handover. Scenario synopsis: 2 month old, admitted via DEM with bronchiolitis. Infant has history of Trisomy 21, is on nasal prong oxygen @ 1l/min. Sim commences with Mother calling for help, is concerned that baby’s breathing is faster. The infant has mod – severe resp effort. Respiratory compromise progresses with apnoea prior to MET / Code arrival. Condition improves following intervention of airway clearance with suction and supportive ventilation. Scenario concludes following handover to MET / Code and team coordination. Equipment Required: • Simbaby + nasal prongs • Emergency Bedside equipment - oxygen & suction • Mock ward medical emergency trolley / scenario equipment on table Sim Facilitator –instructions: 15 min scenario – 15 min debrief • Inform that there will be 3 rotations in this session - 2 scenarios and 1 PLS assessment. • Provide specific information about the case as it progresses. • Debriefing post scenario

o Debrief sheet – provides a suggested structure o Discuss core learning objectives during debrief – role allocation, leadership, handover, recognition and management of clinical deterioration

Prebrief: Refer to OPTIMUS CORE Scenario PreBrief sheet. Handover provided to initial participants (remaining participants are outside the room): Bronte 2/12 admitted @ 0900hrs, with suspected RSV bronchiolitis. 3 day history of respiratory symptoms, Trisomy 21

A: Occasional suctioning of nares. B: Resps 64, tracheal tug & intercostal recession (mild). Occasional moist cough. SaO2 >95% 1L/min NP O2. C. P 150, CRT 2sec D: Lethargic but responding to mother. E: T 38˚C, Poor feeding – EBM, Weight – 5Kg. .


You answer the call bell and are confronted by Bronte distressed mother, who states that Bronte has vomited her feed and is now breathing faster. Please assess Bronte.

Time States Patient Status Expected Actions Teaching Points Recognition of deterioration in condition – resp compromise

A. Nasal secretions +++ B. RR 66, grunting, head bob,

subcostal recession; SaO2 91% C. HR 160; BP 87/45; CRT 3, cool

peripheries, very pale D. Weak cry to stimulus E. T – 38.0

Assess ABCD • Early recognition of deterioration • Call for help • Role allocation • Anticipation of resources

required for management

Call for local assistance Suction High flow O2 - face mask + reservoir

Activate local help – Local emergency number

Allocate Roles – team leader Intermittent 15 second apnoea

A. Nil noises B. RR intermittent 15 second apnoea;

SaO2 86% (improve appropriate to interventions)

C. HR 170; BP 85/45; CRT 3 Very pale, cool.

D. Nil response E. BGL – 6.8mmol/L

Activate escalation criteria – ie MET/ Code Blue

• escalation activation criteria • Respiratory management • Role responsibilities

Airway positioning + Ventilatory support – BVM / T-piece

Circ: prep IV access & fluids

Documenter: wt; resus table; resus record Runner – assit as required

Help arrival Condition improves with airway clearing and supportive ventilation. End scenario

A. Gurgled airway sounds – improves

with position/ suction / naso-pharyngeal airway – does not tolerate oropharyngeal

B. RR 40; SaO2 improves according to oxygen delivery / airway m’ment;

C. HR 160; BP 80/50; CRT 3; cool. D. Responds as appropriate to

management

Handover – SBAR • SBAR handover • Leadership • Team coordination/

Communication • Airway management • Disposition

Integration of team - roles / communication

Nasopharyngeal airway insertion

Prep for intubation

Consider disposition – PICU / RSQ


Objectives: 3. Recognise and manage respiratory distress, impending respiratory failure and apnoea in an infant

• Clinical interventions: Suction, airway positioning, nasopharyngeal airway insertion Oxygen and ventilation: high-concentration oxygen; bag-valve-mask; intubation preparation

4. Crisis resource management principles: Call for help early, effective leadership, teamwork, role delineation, communication and handover. Scenario synopsis: 2 month old, admitted via emergency with bronchiolitis. Infant has history of Trisomy 21, is on nasal prong oxygen @ 1l/min. Sim commences with Mother calling for help, is concerned that baby’s breathing is faster. The infant has mod – severe resp effort. Respiratory compromise progresses with apnoea prior to MET / Code arrival. Condition improves following intervention of airway clearance with suction and supportive ventilation. Scenario concludes following handover to MET / Code and team coordination. Equipment Required: • Simbaby + nasal prongs • Emergency Bedside equipment - oxygen & suction • Mock ward medical emergency trolley / scenario equipment on table Sim Facilitator –instructions: 15 min scenario – 15 min debrief • Inform that there will be 3 rotations in this session - 2 scenarios and 1 PLS assessment. • Provide specific information about the case as it progresses. • Debriefing post scenario


Prebrief: Refer to OPTIMUS CORE Scenario PreBrief sheet. Handover provided to initial participants (remaining participants are outside the room): Bronte 2/12 admitted @ 0900hrs, with suspected RSV bronchiolitis. 3 day history of respiratory symptoms, Trisomy 21

A: Occasional suctioning of nares. B: Resps 64, tracheal tug & intercostal recession (mild). Occasional moist cough. SaO2 >95% 1L/min NP O2. C. P 150, CRT 2sec D: Lethargic but responding to mother. E: T 38˚C, Poor feeding – EBM, Weight – 5Kg. .


You answer the call bell and are confronted by Bronte distressed mother, who states that Bronte has vomited her feed and is now breathing faster. Please assess Bronte.

Time States Patient Status Expected Actions Teaching Points Recognition of deterioration in condition – resp compromise

F. Nasal secretions +++ G. RR 66, grunting, head bob,

subcostal recession; SaO2 91% H. HR 160; BP 87/45; CRT 3, cool

peripheries, very pale I. Weak cry to stimulus J. T – 38.0

Assess ABCD • Early recognition of deterioration • Call for help • Role allocation • Anticipation of resources

required for management

Call for local assistance Suction High flow O2 - face mask + reservoir

Activate local help – Local emergency number

Allocate Roles – team leader Intermittent 15 second apnoea

F. Nil noises G. RR intermittent 15 second apnoea;

SaO2 86% (improve appropriate to interventions)

H. HR 170; BP 85/45; CRT 3 Very pale, cool.

I. Nil response J. BGL – 6.8mmol/L

Activate escalation criteria – ie MET/ Code Blue

• escalation activation criteria • Respiratory management • Role responsibilities

Airway positioning + Ventilatory support – BVM / T-piece

Circ: prep IV access & fluids

Documenter: wt; resus table; resus record Runner – assit as required

Help arrival Condition improves with airway clearing and supportive ventilation. End scenario

E. Gurgled airway sounds – improves

with position/ suction / naso-pharyngeal airway – does not tolerate oropharyngeal

F. RR 40; SaO2 improves according to oxygen delivery / airway m’ment;

G. HR 160; BP 80/50; CRT 3; cool. H. Responds as appropriate to

management

Handover – SBAR • SBAR handover • Leadership • Team coordination/

Communication • Airway management • Disposition

Integration of team - roles / communication

Nasopharyngeal airway insertion

Prep for intubation

CHQ OPTIMUS CORE Scenario Pre-Brief

• Welcome participants • This scenario is an opportunity for you to bring together those skills you already have and those you

have learnt today and put them into practice in a supported learning environment (ie objective). • This is not a test and I don’t expect you to do anything outside your normal scope of practice. • When the scenario is over we will debrief the event together. This is an opportunity for you to discuss

the things that you feel went well, and to identify and acknowledge the things that you would do differently next time and how this can be incorporated into your current practice. Is everyone Ok with that?

• I believe that everyone attending is committed to improving their own practice, let’s bring together our knowledge and experience to provide the best possible care for our patients.

Orientate to Mannequin This manikin is not real and some of the information needs to be provided by the Sim Director to help you obtain a visual picture of the patient – please ask for any information you require. It’s easier for the Sim Director to know what you need if you perform the actions as you would normally. During the simulation perform your assessment and interventions, such as listening to the chest with a stethoscope, pressing for 5 seconds for cap refil time, feeling for a pulse and preparing & pushing drugs and fluids through the IV line. Let’s have a look at this manikin….explain what the Sim Director will provide as you introduce each section (ie colour & warmth) Mannequin capabilities – start at the top & place on monitoring & oxygen as you introduce it:

• Head & Airway – pupils, what adjuncts can be inserted • Breathing – respirations, recession, how is oxygen applied – ie face mask, bag & mask • Circulation – Pulse, Cap refill, BP, warmth & colour, IV access (no IV sticker), fluid & drug

administration, defibrillation – NB safety if live defib & sharps disposal • Disability – pupils, movement, response

Orientate to Equipment

• Monitoring – apply to the mannequin • Resuscitation equipment – ask participants to arrange as they would like • Paper work – CEWT, algorithms • How to get help – “buzzer”, phone calls

Allow time for the participants to navigate the equipment and the manikin. Orientate to Process

• 1-2 participants commence scenario at the bed side • The remaining participants are removed from the room and are fed into the scenario as staff on the

floor responding to initial call for assistance and then as Rapid Response / MET respondents (as appropriate to your facility)

• If no critical care or medical staff participating the “Sim Director” will take on role of medical person via phone / telehealth to obtain handover and provide some support.

Director / Santa (if same as person who is providing Pre-brief) I will provide you with handover information for this child then I’d like you to assess the child, intervene where necessary and evaluate interventions, I will give you additional information about the progress of the child condition. If you need further clinical support please call for help.

Optimus CORE Debriefing Guide

Debrief Guide Scenario 1: Respiratory Distress - infant Learning objectives: -Recognise and manage apnoea -Systematic assessment of patient - CRM principles Mark No.

Debrief points / CRM Principle Notes

Reaction Phase

“How are you feeling?…..”

Description Scenario summary (facilitator or participant) + learning objectives Analysis Clinical & CRM

Explore outcomes of reaction phase Focus discussion on expected actions / clinical management / CRM stuff Questioning techniques:

• I noticed that ... I was concerned about ... I am wondering why … • What went well? … Why?.....What did not go well? … Why?......

Summary Thank for participating Summary of key points from Analysis What will you take away from this?.....

CRM Principles: 1. Know your environment 2. Anticipate & plan 3. Call for help early 4. Take a leadership role 5. Communicate effectively 6. Allocate attention wisely. Use all available information. 7. Distribute the workload & use all available resources.

Scenario 2

Optimus CORE Scenario 2 Child – Cardiac Arrest

Objectives: 5. Emergency management of the child with circulatory compromise and cardiac arrest in the context of hypovolaemic shock

• Airway / Breathing – Oxygen and ventilation (high concentration mask (non-rebreather; self-inflating bag & mask) • Circulation – fluid bolus, insertion of intraosseous, CPR, paediatric cardiac arrest algorithm

6. Crisis resource management principles: Call for help early, effective leadership, teamwork, role delineation, communication and handover in a crisis situation

Scenario synopsis: 5 year old admitted to ward with gastroenteritis. Scenario commences with staff responding to oximeter alarm. Child shows signs of circulatory compromise and shock, with rapid decompensation and loss of output. Scenario concludes following management of cardiac arrest (non-shockable pathway). Equipment Required: • Megacode Kid / SimJunior • Emergency Bedside equipment - oxygen & suction • Mock ward medical emergency trolley / scenario equipment on table Sim Facilitator –instructions: 15 min scenario – 15 min debrief • Inform that there will be 3 rotations in this session - 2 scenarios and 1 PLS assessment. • Provide specific information about the case as it progresses. • Debriefing post scenario


Prebrief: Refer to Optimus CORE Scenario PreBrief sheet. Handover provided to initial participants (remaining participants are outside the room): Samuel, 5 years old admitted to the ward from DEM with gastroenteritis. He initially presented to ED with a three day history of fevers, vomiting and profuse diarrhoea with minimal oral intake. He had difficult but successful IV access in ED. Assessed as moderate dehydration requiring IV fluid rehydration. Wt 20kg. Most recent observations:

A. patent B. RR 28, sats 96 C. pale, HR 138, CRT 2-3 sec, BP 90/55, 1x PIVC in situ D. irritable

Oximeter alarms – please assess Samuel.


Time States Patient Status Expected Actions Teaching Points

Recognition of deterioration in condition

A. Patent B. RR 35, shallow; SaO2 86% C. HR 150; BP 90/40; CRT 5s;

mottled, cool. IV tissued (oedematous hand)

D. Responds to painful stimuli by groaning

E. T39.3

Assess ABCD • Early recognition of deterioration + call for help

• MET activation criteria • Ward Role allocation

Airway positioning High flow O2 - face mask + reservoir

Call for local assistance

Activate MET – Local emergency number

Allocate Ward Roles – team leader

Circulatory compromise

A. Patent B. RR 42, SaO2 76% C. HR 170; BP 80/40; CRT 7s;

dusky D. Unresponsive E. Large bowel motion noted

Ventilatory support – PEEP - adv • Supportive ventilation • Anticipatory planning Prep IV/ IO access & fluid boluses

Cardiac arrest (PEA)

A: Apnoeic, nil obstruction B: RR 0; SaO2 not trace detected C: (HR70) Pulseless; BP undetectable; CRT 7s D: unresponsive. BGL 8.8mmol/l.

Effective CPR

• Indications for CPR • CPR

Prep adrenaline

Prep intubation

MET arrival End scenario following 2 non-shockable cycles

A: Nil obstruction B: RR 0; SaO2 not trace detected C: PEA rate 70; BP undetectable; CRT 7s ROSC – following adrenaline 10mcg/kg D: BGL 8.8mmol/l

Handover to MET – SBAR

• SBAR handover • Leadership • Role delineation, Team

coordination • Communication • Shockable / non-shockable

pathway

Apply defib pads, Rhythm recognition, Safe charging for defibrillation 4j/kg (dumped) Adrenaline 10mcg/kg, Fluid bolus(es)

Consideration of 4 H’s & 4 T’s


Objectives: 7. Emergency management of the child with circulatory compromise and cardiac arrest in the context of hypovolaemic shock

• Airway / Breathing – Oxygen and ventilation (high concentration mask (non-rebreather; self-inflating bag & mask) • Circulation – fluid bolus, insertion of intraosseous, CPR, paediatric cardiac arrest algorithm

8. Crisis resource management principles: Call for help early, effective leadership, teamwork, role delineation, communication and handover in a crisis situation

Scenario synopsis: 5 year old admitted to ward with gastroenteritis. Scenario commences with staff responding to oximeter alarm. Child shows signs of circulatory compromise and shock, with rapid decompensation and loss of output. Scenario concludes following management of cardiac arrest (non-shockable pathway). Equipment Required: • Megacode Kid / SimJunior • Emergency Bedside equipment - oxygen & suction • Mock ward medical emergency trolley / scenario equipment on table Sim Facilitator –instructions: 15 min scenario – 15 min debrief • Inform that there will be 3 rotations in this session - 2 scenarios and 1 PLS assessment. • Provide specific information about the case as it progresses. • Debriefing post scenario


Prebrief: Refer to OPTIMUS CORE Scenario PreBrief sheet. Handover provided to initial participants (remaining participants are outside the room): Samuel, 5 years old admitted to the ward from DEM with gastroenteritis. He initially presented to ED with a three day history of fevers, vomiting and profuse diarrhoea with minimal oral intake. He had difficult but successful IV access in ED. Assessed as moderate dehydration requiring IV fluid rehydration. Wt 20kg. Most recent observations:

E. patent F. RR 28, sats 96 G. pale, HR 138, CRT 2-3 sec, BP 90/55, 1x PIVC in situ H. irritable

Oximeter alarms – please assess Samuel.


Time States Patient Status Expected Actions Teaching Points

Recognition of deterioration in condition

F. Patent G. RR 35, shallow; SaO2 86% H. HR 150; BP 90/40; CRT 5s;

mottled, cool. IV tissued (oedematous hand)

I. Responds to painful stimuli by groaning

J. T39.3

Assess ABCD • Early recognition of deterioration + call for help

• MET activation criteria • Ward Role allocation

Airway positioning High flow O2 - face mask + reservoir

Call for local assistance

Activate MET – Local emergency number

Allocate Ward Roles – team leader

Circulatory compromise

F. Patent G. RR 42, SaO2 76% H. HR 170; BP 80/40; CRT 7s;

dusky I. Unresponsive J. Large bowel motion noted

Ventilatory support – PEEP - adv • Supportive ventilation • Anticipatory planning Prep IV/ IO access & fluid boluses

Cardiac arrest (PEA)

A: Apnoeic, nil obstruction B: RR 0; SaO2 not trace detected C: (HR70) Pulseless; BP undetectable; CRT 7s D: unresponsive. BGL 8.8mmol/l.

Effective CPR

• Indications for CPR • CPR

Prep adrenaline

Prep intubation

MET arrival End scenario following 2 non-shockable cycles

A: Nil obstruction B: RR 0; SaO2 not trace detected C: PEA rate 70; BP undetectable; CRT 7s ROSC – following adrenaline 10mcg/kg D: BGL 8.8mmol/l

Handover to MET – SBAR

• SBAR handover • Leadership • Role delineation, Team

coordination • Communication • Shockable / non-shockable

pathway

Apply defib pads, Rhythm recognition, Safe charging for defibrillation 4j/kg (dumped) Adrenaline 10mcg/kg, Fluid bolus(es)

Consideration of 4 H’s & 4 T’s

CHQ OPTIMUS CORE Scenario Pre-Brief

• Welcome participants • This scenario is an opportunity for you to bring together those skills you already have and those you

have learnt today and put them into practice in a supported learning environment (ie objective). • This is not a test and I don’t expect you to do anything outside your normal scope of practice. • When the scenario is over we will debrief the event together. This is an opportunity for you to discuss

the things that you feel went well, and to identify and acknowledge the things that you would do differently next time and how this can be incorporated into your current practice. Is everyone Ok with that?

• I believe that everyone attending is committed to improving their own practice, let’s bring together our knowledge and experience to provide the best possible care for our patients.

Orientate to Mannequin This manikin is not real and some of the information needs to be provided by the Sim Director to help you obtain a visual picture of the patient – please ask for any information you require. It’s easier for the Sim Director to know what you need if you perform the actions as you would normally. During the simulation perform your assessment and interventions, such as listening to the chest with a stethoscope, pressing for 5 seconds for cap refil time, feeling for a pulse and preparing & pushing drugs and fluids through the IV line. Let’s have a look at this manikin….explain what the Sim Director will provide as you introduce each section (ie colour & warmth) Mannequin capabilities – start at the top & place on monitoring & oxygen as you introduce it:

• Head & Airway – pupils, what adjuncts can be inserted • Breathing – respirations, recession, how is oxygen applied – ie face mask, bag & mask • Circulation – Pulse, Cap refill, BP, warmth & colour, IV access (no IV sticker), fluid & drug

administration, defibrillation – NB safety if live defib & sharps disposal • Disability – pupils, movement, response

Orientate to Equipment

• Monitoring – apply to the mannequin • Resuscitation equipment – ask participants to arrange as they would like • Paper work – CEWT, algorithms • How to get help – “buzzer”, phone calls

Allow time for the participants to navigate the equipment and the manikin. Orientate to Process

• 1-2 participants commence scenario at the bed side • The remaining participants are removed from the room and are fed into the scenario as staff on the

floor responding to initial call for assistance and then as Rapid Response / MET respondents (as appropriate to your facility)

• If no critical care or medical staff participating the “Sim Director” will take on role of medical person via phone / telehealth to obtain handover and provide some support.

Director / Santa (if same as person who is providing Pre-brief) I will provide you with handover information for this child then I’d like you to assess the child, intervene where necessary and evaluate interventions, I will give you additional information about the progress of the child condition. If you need further clinical support please call for help.

Optimus CORE Scenario Resources

Debrief Guide Scenario 2: Sepsis – cardiac arrest - child Learning objectives: -Effective CPR -Management of paediatric cardiac arrest -Safe and appropriate use of defibrillator - CRM principles Mark No.

Debrief points / CRM Principle Notes

Reaction Phase

“How are you feeling?…..”

Description Scenario summary (facilitator or participant) + learning objectives Analysis Clinical & CRM

Explore outcomes of reaction phase Focus discussion on expected actions / clinical management / CRM stuff Questioning techniques:

• I noticed that ... I was concerned about ... I am wondering why … • What went well? … Why?.....What did not go well? … Why?......

Summary Thank for participating Summary of key points from Analysis What will you take away from this?.....

CRM Principles: 8. Know your environment 9. Anticipate & plan 10. Call for help early 11. Take a leadership role 12. Communicate effectively 13. Allocate attention wisely. Use all available information. 14. Distribute the workload & use all available resources.

Scenario 2 : Resources

s

CPR & Defib Assessment

Optimus CORE CPR & Defib Assessment

Aim : • The testing station provides an opportunity for participants to demonstrate learning and meet annual paediatric life

support competency requirements • The session format incorporates a team approach while everyone’s performance is critiqued at assessment level • It will be at the discretion of local faculty to decide the assessment requirements of each participant. Equipment required : • ALS mannequin e.g. ALS baby ™ or Megacode kid ™ or SimJunior ™ • Self-inflating resuscitation bag to suit mannequin • Mask sizes 0/1, 2, 3-4 • Paediatric and adult defib pads – laminates provided in resource pack if none available • Paediatric resuscitation trolley OR if not available – at a minimum

o Airway – oropharyngeal airways, tongue depressor o Circulation - 1L 0.9% NaCl x 1; IV infusion line; 3-way tap, 60mL syringe; IO driver (or manual); 1mL

syringe o Drugs – Adrenaline 1:10 000; Amiodarone 150mg; syringes 10mL, 5mL, 2mL

• Paediatric resuscitation table • CPR and defibrillation assessment sheets • Paediatric CPR assessors reference sheet • Paediatric Cardiopulmonary arrest algorithm • Defibrillator and rhythm simulator OR photo laminates of defibrillator and 4 arrest rhythms (for defib assessment) Layout :

Structure : Running the assessment as a group provides the opportunity for observation of those being assessed on their code leadership and resuscitation management skills. Creation of psychological safety is paramount, place emphasis that discussion around others performance outside the assessment space is not condoned. Please note this assessment is not an attempt to ‘catch out’ or fail participants who are clearly capable of providing Basic Life Support. As with the simulations the manikin is not real and some small amounts of prompting may be required to trigger appropriate actions. Small errors may be addressed by marking as ‘Requires further development’ and used as an opportunity for brief discussion at the end of the session with the group as a whole.


All participants are encouraged to utilise all cognitive tools – ie medication guides; paediatric arrest algorithm. Begin the session by orientating the participants to the environment, equipment available and process – like Pre-briefing a simulated scenario. Below is a guide to running the session as a group and will need modification of roles based on the number of participants. We would suggest 3 – 6 participants per assessment group that is authentic to reality. Example:

• Participant 1 is the first responder and is provided with a clinical scenario relevant to their practice. They are to proceed through the standard DRSABCD algorithm as per their assessment sheet and then take on the Code leadership role, if required withing their practice.

• Participant 2 & 3 arrives to help on request for “send for help’ and takes over CPR • Participant 4 places on defibrillation pads and runs the defibrillator – this participant may

also be in the position of Code leader. • Participant 5 gives fluid bolus and adrenalin

‘Core’ participants are expected to successfully perform DRSABCD – up to application of defibrillation pads & respond appropriately to directions for safety. They can give fluid bolus and adrenaline as directed. ‘Advanced’ participants are expected to successfully proceed through the standard DRSABCD algorithm and then to continue on through attaching a defibrillator and successfully treating the rhythms provided. Leadership component includes allocating roles and direction to the team in managing the scenario. Resources : On the following pages, please find resources including :

• Scenario options – print 1 per group • Detailed performance criteria – print 1 per group • Participant assessment sheets – local assessment sheets may be used – 1 per participant


Scenario Options:

Performance Criteria : Performance Criteria Evidence of Achievement Danger Checks for and addresses danger to self, patient and others

• Articulates the various types of danger to self and other health professionals. Example : electrical hazards, water/spills, cytotoxics, body fluids

• Identifies how to correct / mitigate potential risk: ie using PPE, ergonomic safety

• Discusses the potential danger to the patient

Response Checks response by using verbal and tactile stimuli

• Demonstrates tactile and verbal behaviour to elicit a response from the patient. Example “Are you alright?” and firm central stimulation.

Shout / Send for Help If patient is unresponsive calls for help

• Identifies the appropriate method for gaining the necessary assistance according to their work area and the situation. Ie. Press emergency buzzer and initiate local medical emergency response

• Recognises that if there is no local assistance, proceeds with CPR for one minute prior to seeking help

Airway Clears and Opens the Airway

• Checks the mouth for any foreign material • If no foreign material in the mouth, places patient supine • If vomit/foreign material in the mouth, turns the patient if able and clears

the mouth using suction if available • Maintains open airway using the appropriate technique for age group. • Considers use of airway adjunct once CPR is in progress - oropharyngeal

airway – to facilitate airway opening and effective bag-mask ventilation

Breathing • Looks for chest wall movement

Rhythm Age & background Causes 4 H’s & 4 T’s

VT 20 Kg 4 yr old Hx renal failure in cardiac arrest, compressions have been commenced

Hyperkalaemia

VF 25 Kg 5 yr old Hx cardiomyopathy in cardiac arrest, compressions have been commenced


VF 15 Kg 2 yr old Hx drowning in cardiac arrest, compressions have been commenced

Hypoxia, hypothermia

PEA 8 Kg 9month old with gastro & shock in cardiac arrest, compressions have been commenced

hypovolaemia

VT 3 Kg 7 day old 4 hours post cardiac surgery in cardiac arrest, compressions have been commenced

Cardiac Tamponade

VF 45 Kg 14 yr old who has overdosed on tricyclic antidepressants in cardiac arrest, compressions have been commenced

Toxins

VT 50 Kg 10 yr old Hx of Long QT syndrome admitted with respiratory illness, in cardiac arrest, compressions have been commenced


Asystole 10 Kg 1 yr old Hx Posterior Fossa Tumor in cardiac arrest, compressions have been commenced

Hypovolaemia

Asystole 45 Kg 12 yr old in ORS Hx trauma, ruptured spleen, haemorrhage, in cardiac arrest, compressions have been commenced

Hypovolaemia

VT 10 Kg 14-month-old in ORS Hx Local Anaesthetic reaction, in cardiac arrest, compressions have been commenced

Toxins

PEA 5 Kg 5-month-old in PACU Hx bowel resection for intussusception, in cardiac arrest, compressions have been commenced

Hypovolaemia

PEA 18 Kg 4 yr old Hx post insertion of Hickmann’s line, in cardiac arrest, compressions have been commenced

Pneumothorax


Assess for normal breathing (look, listen and feel) Demonstrates effective delivery of breaths to the patient

• Listen for expelled air • Feel for escape of air from nose and mouth • If patient not breathing and self-inflating bag is available provide rescue

breaths. • If self-inflating bag is not readily available, assess circulation and

commence chest compressions (ie no delay in commencing CPR) whilst equipment is being obtained

• Deliver 2 breaths using self-inflating bag and appropriate size mask to achieve an effective seal.

• Observe for chest wall movement

CPR Assess for signs of life for up to 10 seconds Commence CPR – Demonstrates compressions at correct depth, rate and ratio to breaths

• Assess response to resuscitation breaths, ie cough and spontaneous movement, normal breathing

• Assess central pulse in appropriate location • Infant <1 yr – brachial/femoral

o Child >1 yr – carotid / femoral • Start chest compressions if:

o There are no “signs of circulation/signs of life” o You can’t feel a pulse o Pulse rate is <60 bpm with associated poor perfusion

• If in doubt, commence compressions • Ensures patient is on a firm surface Ie. Deflate any mattresses, utilise CPR

backboards • Demonstrates appropriate hand position according to age

o Infant <1 yr – 2 fingers or 2 thumbs o Child > 1 yr – 1 or 2 hands

• Demonstrates the use of the correct compression technique

o Lower half of the sternum all ages o 1/3 depth of the chest all ages

• Compression to breath ratio single & dual rescuer 15:2 • Ensure chest wall fully recoils between compressions • Shoulder vertically over the sternum, compressing arm remains straight,

equal time for compression and relaxation • Compresses at a rate of 100 – 120 per minute • Pauses compressions to give 2 breaths • Communicates with second rescuer to avoid any unnecessary interruptions

to compressions • Coordinates rotation of rescuers every 2 mins. • Advanced participants aware of continuous compressions once patient

intubated, ie no need to pause for breaths

Defibrillation – core & advanced

• Demonstrates appropriate placement of defibrillation pads o One over apex of mid axillary line and the other immediately below

the clavicle to the right of the sternum o OR anterior / posterior – between shoulder blades on the back and

to the left of the sternum • Discuss safety aspects of defibrillation

o Ensure implanted devices (i.e. pacemaker), GTN patch, ECG dots and leads are not under the defibrillation electrodes

o Look for danger – water, oxygen other flammable substances • Advanced participants

o The operator is responsible for the safety of the patient and members of the team – “all stand clear” and perform a visual sweep

o Shockable rhythm = Ventricular tachycardia and ventricular fibrillation

o Non-shockable rhythm = PEA / Asystole o Paediatric joules = 4J/kg

o Uses paediatric arrest algorithm to guide practice

Fluids and medications • Adrenaline


o Dose = 10micrograms / kg o Utilise resources available – ie Resuscitation Table

• Amiodarone (Advanced) o Dose = 5mg / kg o Utilise resources available – ie Resuscitation Table

• Fluid Bolus

o 0.9% Sodium Chloride 10 - 20mL/kg o Intraosseous route if no access

Communication,

documentation, and management

• Demonstrate use of Resuscitation Table / Medication Guides • Awareness of documentation requirements • Discusses resources available for carers and staff • Discuss ongoing patient observation post resuscitation (ABCD assessment) • Familiar with replacement of medical emergency equipment Advanced: • Demonstrate use of Paediatric Cardiac Arrest Algorithm – shockable & non-

shockable pathways • Directs team members in providing fluid bolus & adrenaline according to

Algorithm • Consideration of 4H’s & 4 T’s


CPR & Defib Assessment Form

Element Performance Criteria Achieved Needs Further Development

OR Not Applicable to level

Danger Checks for and addresses danger to self, patient and others

Response Checks response by using verbal and firm central stimulus

Shout / Send for help

Calls for help Initiates local emergency response

Airway Opens and clears the Airway using appropriate position for age

Breathing

Assesses for normal breathing Demonstrates effective delivery of breaths (2)

CPR

Assesses for Pulse/ signs of life – no longer than 10 seconds Commence CPR – Demonstrates compressions at correct depth, rate & ratio to breaths – 2 breaths:15 compressions

Continues to call for help

Ensures continuous CPR whilst calling again for help after 1 minute if no immediate help arrives

Pad placement and safety

Demonstrates appropriate placement of defibrillation pads Understands safety aspects of defibrillation

Pre-charge Charge defibrillator to 4J/kg (Rounding up if required) CPR continues whilst charging Oxygen removed Others away

Rhythm Recognition

Recognise rhythm to determine the need for defibrillation or disarming of energy

Shock delivery Delivers shock safely – clearly articulating and ensuring that all are clear Disarms shock if not required prior to CPR recommencing Recommences CPR immediately, minimising hands-off time CPR continues for 2minutes before reassessing rhythm and presence of pulse Defibrillator is pre-charged prior to end of 2-minute cycle

Fluids & medications

Knowledge of fluid resuscitation (fluid type and volume) – 10mL- 20mL/Kg 0.9% Sodium Chloride Knowledge of drug dose – utilises resources as appropriate.


Element Performance Criteria Achieved Needs Further Development

OR Not Applicable to level

- Adrenaline 10mcg/kg for administration following 2nd shock. Or immediate if non-shockable rhythm - Amiodarone 5mg /kg following 3rd shock

Communication Uses communication strategies such as closed

loop, allocation of roles, recapping, SBAR

Paediatric Resuscitation Assessment Achieved: Needs further development: Comments / Recommendations:

Date: Assessee: (Print Full Name) Signature: Designation: Personal Assignment No/s: Work Location: Line Manager: (Print Full Name) Assessor: (Print Full Name) Signature: Designation:

Optimus CORE Course Faculty Evaluation

Optimus CORE Faculty Evaluation 2020

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