Cardiac Arrest Scribe

Cardiac Arrest Scribe Template

Recognition of Cardiac Arrest & Initial Response

• Time of cardiac arrest: 14:12:00
• Time of emergency response activation: 14:12:15
• Initial response actions:
  • Patient collapsed in GP waiting room; found unresponsive.
  • Carotid pulse absent, agonal breathing noted.
  • Practice emergency alarm activated; 999 called for Category 1 ambulance.
  • Resuscitation trolley and AED fetched immediately.
  • High-quality chest compressions commenced on firm floor surface.

CPR & Airway Management

• Time of CPR initiation: 14:12:30
• CPR details: Continuous manual chest compressions at 110/min, depth 5–6 cm, 30:2 ratio initially, transitioning to continuous compressions post-SGA insertion. 5 cycles completed in total.
• Time of airway intervention: 14:14:00
• Airway management details: Oropharyngeal airway (OPA) size 4 inserted initially with bag-valve-mask (BVM) ventilation. Upgraded to size 4 i-gel supraglottic airway at 14:16:30; bilateral chest rise and auscultation confirmed good seal.
• Oxygenation & ventilation details: High-flow O2 at 15 L/min (FiO2 ~0.85) via BVM, asynchronous ventilation at 10 breaths/min, tidal volume ~500 mL.

Defibrillation & Rhythm Assessment

• Time of first rhythm check: 14:14:30
• Rhythm findings: Coarse ventricular fibrillation (VF).
• Time of defibrillation: 14:14:45
• Defibrillation details: Shock 1 delivered at 150 J biphasic. Immediate resumption of CPR.
• Subsequent rhythm checks:
  • Time of rhythm check: 14:16:45
  • Rhythm findings: Persistent VF.
  • Time of defibrillation: 14:17:00
  • Defibrillation details: Shock 2 delivered at 200 J biphasic. Immediate resumption of CPR.
  • Time of rhythm check: 14:19:00
  • Rhythm findings: Refractory VF.
  • Time of defibrillation: 14:19:15
  • Defibrillation details: Shock 3 delivered at 200 J biphasic. Immediate resumption of CPR.
  • Time of rhythm check: 14:21:15
  • Rhythm findings: Organised sinus tachycardia; strong carotid pulse palpable (ROSC).

Medications Administered

• Time of medication administration: 14:19:30
• Medication details: adrenaline (epinephrine) 1 mg IV bolus, followed by 20 mL 0.9% NaCl flush. No immediate rhythm change prior to next cycle check.
• Additional medications:
  • Time of medication administration: 14:19:45
  • Medication details: amiodarone 300 mg IV bolus, followed by 20 mL 0.9% NaCl flush. Followed by successful conversion to sinus rhythm at next check.

Patient’s Response to Interventions

• Time of patient response: 14:21:15
• Patient’s response details: ROSC achieved. Palpable central and radial pulses, HR 108 bpm, BP 115/74 mmHg. Spontaneous respiratory effort returned at 8 breaths/min; assisted ventilation continued.
• Additional responses:
  • Time of patient response: 14:23:00
  • Patient’s response details: SpO2 96% on 15 L/min O2, ETCO2 4.8 kPa (connected on paramedic arrival). GCS 6 (E1 V1 M4), pupils 3 mm equal and sluggishly reactive.

Procedures Performed

• Time of procedure: 14:15:30
• Procedure details: 18G IV cannula inserted into right antecubital fossa; patent and flushed.
• Additional procedures:
  • Time of procedure: 14:22:30
  • Procedure details: 12-lead ECG performed post-ROSC showing anterolateral ST-segment elevation.

Communication & Leadership

• Time of communication: 14:12:30
• Communication details: Senior GP assumed team leader role. Allocated airway to Practice Nurse, compressions to Junior GP, and scribe/timing to Healthcare Assistant.
• Additional communications:
  • Time of communication: 14:18:00
  • Communication details: Paramedic crew arrived on scene; brief handover given during compression cycle while maintaining ALS algorithm.
  • Time of communication: 14:23:30
  • Communication details: SBAR handover to Critical Care Paramedic following ROSC and 12-lead ECG acquisition.

Outcome & Disposition

• Time of ROSC or termination: 14:21:15
• Outcome details: Sustained ROSC achieved following 3 shocks and ALS pharmacological intervention. Post-resuscitation care initiated with airway support, continuous haemodynamic monitoring, and 12-lead ECG identifying STEMI.
• Final disposition: Blue-light ambulance transfer directly to regional Primary PCI centre / Cardiac Cath Lab at 14:28:00, accompanied by paramedic crew. Next of kin notified by practice manager.