Study Notes: Team Dynamics & Mega Code Resuscitation

Study Notes: Team Dynamics & Mega Code Resuscitation

1. Importance of Team Dynamics

• Team interaction directly impacts individual effectiveness and patient survival.

• Working together as a team improves outcomes.

• Effective resuscitation requires both clinical knowledge and communication skills.

2. Case Scenario Overview

• Patient: 65-year-old woman, epigastric + back pain, hypotension, bradycardia.

• Deterioration: Progressed to unresponsiveness → pulseless VF.

• Team roles assigned:

  • Chest compressions

  • Defibrillator

  • Recorder

  • Airway management

  • IV/IO access & medications

3. Cardiac Arrest Management (VF/VT protocol)

• Initial actions: O₂, monitoring, IV/IO access.

• Defibrillation sequence:

  • Shock 1 → 200 J

  • Shock 2 → 300 J

  • Shock 3 → 360 J

• Medications:

  • Epinephrine 1 mg every 3–5 min

  • Amiodarone 300 mg after 3rd shock

  • Vasopressin 40 units as alternative/addition

• Ongoing care: CPR between shocks, airway management, monitor chest rise.

• Consider reversible causes (H’s & T’s): hypovolemia, hypoxia, thrombosis, etc.

4. Post–Cardiac Arrest Care

• Check ROSC: sinus tachycardia with weak rapid pulse.

• Actions:

  • Full set of vitals, labs, ECG

  • Advanced airway + capnography

  • Induce therapeutic hypothermia (32–34°C, 12–24 hrs)

  • Treat underlying cause (e.g., STEMI → activate cath lab)

• Hypothermia: only proven intervention to improve neurologic outcomes.

5. Structured Team Debriefing

• Feedback vs. Debriefing:

  • Feedback corrects actions.

  • Debriefing corrects thought processes, improves future performance.

• Benefits: deeper understanding, system improvement, better team performance.

6. Key Elements of Effective Team Dynamics

1. Closed-loop communication – orders confirmed and acknowledged.

2. Clear messages – concise, calm, confident communication.

3. Defined roles & responsibilities – assigned early, matched to skill level.

4. Knowing limitations – ask for help early.

5. Knowledge sharing – input from all team members encouraged.

6. Constructive intervention – correct mistakes tactfully.

7. Summarizing & re-evaluation – repeat info out loud, reassess patient status.

8. Mutual respect & professionalism – maintain controlled, respectful communication.

7. Key Takeaways

• Assign roles before the code to avoid confusion.

• Use tools (metronome, compression checks) to maintain high-quality CPR.

• Early IO access is effective when IV fails.

• Balance airway management: delay advanced airway if compressions are effective.

• Success depends on both technical skill and teamwork.