EmergencyPedia – Free Open Access Medical Education
C.O.A.C.H.E.D. COACHED – a Mnemonic for Safe Defibrillation – generally used by ALS nurse and in EDContinue compressions (I won’t shock you)Oxygen away (only required to be removed if on free flowing BVM)All else clearCharging Defibrillator (200 joules)Hands off pleaseEvaluate rhythmDefibrillate OR Dump ChargePost- resuscitation care (what to do after a successful resuscitation?)Airway?need for adjuncts/ intubation (anaesthetics pager 8460)BreatingMaintain sats >94%- avoid hypoxiaABGAvoid hypercapnoeaAssess differentials- ?PE/ pneumothoraxCirculationMaintain BPIV fluids (cold v warn)Vasopressors: metaraminol/ adrenaline12 lead ECG and monitoringAssess other circulation problems that may have caused arrest - ?tamponade/ MI/ dissectionDAssess GCS and pupilsAssess differentials ?SAH/ toxinsETemperature ?hypo/hyperthermic?therapeutic temperature management- avoid hyperthermiaFIVFsGMaintain normoglycaemiaManagement of acute STEMIDual antiplateletsAspirin 300mg (can give NG/ PR if unable to swallow)Clopidogrel 600mg/ prasugrel 60mg/ ticagrelor 180mgAnalgesiaMorphine/ fentanylNitrates: use with caution in inferior STEMIAvoid hypoxia and hyperoxia- aim sats 94-98%Heparin- consider bolus +/- infusion on cardiology’s adviceActivate cath lab urgentlyNotify patient/ family of need for cath but leave formal consent for cardiology035941000Time is muscle! ................
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