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A case of hyperkalaemia resulting in ventricular fibrillation followed by symptomatic bradycardia was simulated.

The simulation highlighted some great learning points worth sharing:

1. In cardiac arrest, it is worth having both medical and nursing team leaders, with physicians focusing on diagnosis and treatment of the underlying cause and nurses running the cardiac arrest algorithm.
2. The use of role & name stickers helps clarify everyones part in the team and improve communication.
3. Requests for additional medications  / CVC set up etc. should be directed to the nurse team leader clearly and slowly, ensuring the scribe has also heard.
4. It is worth slowing down and communicating with full words rather than acronyms, and ensuring the mental model of current status (Update) and next steps (Priorities) is shared (Team Leaders should speak ‘UP‘!).
5. Everyone in the team has a right and a responsibility to know what’s happening and to speak up if something seems wrong.

The team did a great job, recognising and managing the VF and the symptomatic bradycardia, diagnosing the acute kidney injury with hyperkalaemia early and initiating appropriate therapy. Another manikin’s life saved!

Here are some references related to the concepts discussed in the debrief:

1. The variable ECG changes seen in hyperkalaemia (scroll down for the ECGs): http://lifeinthefastlane.com/ecg-library/basics/hyperkalaemia/

2. Therapies for hyperkalaemia (scroll down to ‘Management of hyperkalaemia): http://lifeinthefastlane.com/hyperkalemia/
– make sure you watch the ER video included in that post!

3. In a Scandinavian resuscitation study, higher performing teams showed more effective information exchange and communication, and sharing mental models predicted effective medical management.
Westli HK, Johnsen BH, Eid J, Rasten I, Brattebø G. Teamwork skills, shared mental models, and performance in simulated trauma teams: an independent group design. Scand J Trauma Resusc Emerg Med. 2010;18:47.