Silent CPR: A concept at United Hospital Emergency
Dr Abdullah Al Farook
One afternoon, a patient came to United Hospital Emergency with cardiac arrest. The receiving nurse shouted for help and started chest compression. The “Silent CPR” team arrived and started their designated tasks. The team leader’s voice was the only voice heard during CPR. The ACLS protocol was well coordinated since everyone knew what to do next. Within a short period of time the code blue team arrived and the patient was well managed and there was ROSC (return of spontaneous circulation). After the initial stabilization the patient was sent to Coronary Care Unit. The way the above case was managed is called “Silent CPR” and is designed to manage a patient in emergency situation until the full “code blue” team converges.
The concept of “Silent CPR” was first introduced at United Hospital Emergency in July 2015. Three step approach is followed to perform “Silent CPR”
Step 1: Preparation: During every nursing shift a group of nurses will be pre-selected for code blue; a “code blue nursing roster” will be maintained according to the nursing priority of code blue management.
Step 2: Understanding the “Nursing Priority” of Code Blue management: It is important to recognize the priority of management during code blue situation. Here is the task list of nursing priority during code blue.
• 1st Nurse: Chest Compression.
• 2nd Nurse: Airway Assistant.
• 3rd Nurse: Monitor and suction.
• 4th Nurse: DC shock and drug preparation
• 5th Nurse: IV access and drug pushing.
• 6th Nurse: Data Management.
• 7th Nurse: Standby for CPR.
• 8th Nurse: Standby for procedures like ABG if needed.
Step 3: Leadership: A team leader must be predetermined per shift. A leader’s job is to give orders and correct team mistakes. All code blue orders must go through him/her.
So, to perform Silent CPR in UHL, the total manpower needed is ten (two doctors and eight nurses). The nursing Unit Supervisor must maintain a code blue roster for nurses per shift and a Shift In-Charge doctor is needed as a team leader.
Dr Farook Abdullah, Senior Emergency Medical Officer at United Hospital, has put in a tremendous effort and introduced the “Silent CPR” concept in the hospital Emergency Department in July, 2015