@anaesthetic_spr Not sure about evidence, but I think there is value in having an experienced nurse, eg resus officer, or senior nurse in ICU to run the mechanics of the algorithm while a medic stands back and thinks about reversible causes, interventions / reviews the notes and decides to stop

@jewett6a Liability sponge?

@anaesthetic_spr @jewett6a Whilst I don’t know the evidence the best resuscitations I’ve been involved in. Usually on ITU, a senior nurse has run the algorithm allowing doctors space and time to provide treatment. Leadership is dynamic and ensuring an algorithm is followed is useful.

@isitsleepytime @jewett6a The decision maker is distracted by bloods and access, and the nurse is the leader? WTF is going on?

@anaesthetic_spr @jewett6a I appreciate your profile is that of an anaesthetist. In my experience as a reg I often was stood back reviewing the patient history, assessing the situation and deciding upon appropriate treatments and limits. Which would be tricky when having to action something every 2 min

@anaesthetic_spr @jewett6a Are you implying you’d get stuck doing cannulas during an arrest? Have you had the opportunity to manage arrests in ITU?

@isitsleepytime @jewett6a Why do you think I don’t have juniors around who can do the cannulation? Are you implying that you’re busy reading the notes while the nurse (leader) is reading the rhythm? No wonder this profession is screwed.

@anaesthetic_spr @isitsleepytime @jewett6a I guess the question is, what are the more complex decisions? Leading the algorithm and controlling the room, or deciding whether Resus should continue, what the ceiling of care will be, and what’s the likely post-ROSC trajectory if this occurs?

@anaesthetic_spr @isitsleepytime @jewett6a One might argue that somebody who thinks following an algorithm and identifying a rhythm is a more complex ‘doctor’ skill than reading notes and assessing the situation as a whole before deciding a management strategy, might in fact be a reason that medicine is ‘screwed’.

@DrRJWebb @isitsleepytime @jewett6a Richard, you are an ex-nurse, and your views revolve around enabling scope creep of nurses. You’ve become a doctor, and I know this might sound a bit harsh, but: No nurse should lead the arrest. Feel free to let nurses lead while you’re busy “reading the notes” for the entire

@anaesthetic_spr @isitsleepytime @jewett6a If patient safety is your concern, I’ll ask you this: night shift, PICU, 2 doctors (ST7 and ST3), 16 nurses (including 2 band 7s). Cardiac arrest of unventilated level 2 patient, lost access. Allocate your team roles. Go.

@DrRJWebb @isitsleepytime @jewett6a If you don’t have enough doctors, you put out a cardiac arrest call, and more doctors will join to help. The GMC doesn’t give a heck whether you’re short-staffed or not.

@anaesthetic_spr @isitsleepytime @jewett6a And we will, but it takes minutes for the arrest team to arrive. In that time, ST7 can manage airway. ST3 get access. Band 7 lead. Other nurses CPR, defib, drugs, family. As and when more resources available, can be handover of leadership and joint team working.

@anaesthetic_spr @isitsleepytime @jewett6a Parallel interventions by most appropriate people, well-led and controlled situation, with then controlled handover of leadership at appropriate time. Means everyone can focus on their tasks and later share awareness and mental model.

@anaesthetic_spr @isitsleepytime @jewett6a Sounds like a well functioning team to me, with a patient receiving good care. Suspect GMC would probably be okay with it. Tell me again about whether children are safe on my ITU, in your opinion?