Septic Shock and Cardiac Arrest

Published 03/08/2022

Septic Shock and Cardiac Arrest




Single peripheral cannula 


1L crystalloid at 100mls/hr 


Own. Nasal cannulae 4L oxygen 


In bedspace but switched off 


Blood results revealing elevated WCC/CRP/PCT 

Urinalysis revealing positive nitrites and leucocytes 

Airway trolley 

Arrest trolley 

Clinical Setting

I:       You are the ICU registrar, called by the ICU Nurse to assess a new admission. The HDU registrar reviewed the patient a few hours prior, and the patient has arrived without warning. 

S:      He/she would like a plan for the 59F who has just been transferred from the ED 

B:      Patient been in ED for past 4 hours and transferred with an ED nurse. Suspected diagnosis of LRTI.  

A:     Assess and formulate ICU plan 

R:     Assist the HDU resident  

Clinical Course Summary

  • Initially A clear, B RR 30/min, clear chest, O2 sats 88% on 4L via nasal cannulae, C HR 48bpm SR, NIBP cycling at the start of the scenario – eventually comes up as 76/54 D responds to painful stimuli by groaning, eyes closed 
  • Patient collapses into PEA 
  • Continue in PEA until fluid boluses given, and reversible causes considered 
  • Agonal breathing at rate of 8/min on ROSC, sats remain low – candidate needs to secure airway and commence mechanical ventilation 
  • Reassessment of the patient and institutes post resuscitation care 
  • At this point ICU consultant phones unit to enquire about the new admission. ICU registrar to give summary and formulate a plan with consultant on phone 

Information for Faculty

  • Initial Settings: RR 30/min 
  • O2 sats 88% on 4L via nasal cannulae 
  • Chest fields clear 
  • HR 48bpm SR 
  • NIBP cycling at the start of the scenario – eventually comes up as 76/54 
  • No capnography 


Allow candidate time to assess patient and instigate immediate resuscitative measures/investigations 


  • PEA arrest 


  • Post arrest: No spontaneous respirations 
  • O2 sats 86% on high flow oxygen 
  • HR 126bpm SR 
  • NIBP 166/97 – next BP drops to 90/56 


  • On intubation: RR at whatever ventilator is set at 
    • O2 sats improve to 94% slowly over 1 minute 
    • BP 105/63 if patient has given appropriate pressor/inotrope 
    • HR 118bpm SR 
    • ETCO2 5.6kPa (only if candidate requests capnography) 

Faculty Roles

ED Student Nurse: 

  • You are on your ED placement 
  • You are quite proud and pleased that ED let you transfer the patient alone 
  • Patient is 59 years of age and has a chest infection. She has had some antibiotics – you don’t know which 
  • The ED Consultant said she has given her some “met-arm-olol” for her blood pressure. She also mentioned that she was concerned she might arrest 
  • The patient has one cannula and some fluid running through it 
  • You know nothing else 
  • If the candidate gets upset or disgruntled you get upset and leave the room 
  • Otherwise leave when the patient has a cardiac arrest unless specifically told to stay by the candidate 


HDU Resident: 

  • You are admitting a patient from the ED which is routine and have been assured the patient is stable 
  • When asked by the candidate how the patient is you say they’re fine 
  • You are unaware that the patient is arresting and are quite surprised and shocked 
  • You are incredibly keen to be involved including intubating the patient, which you will be able to do if properly guided 
  • You feel upset that you didn’t realize this was happening and will seek feedback from the candidate as to what went wrong – you will get upset if the feedback is harsh 
  • If the candidate is performing exceptionally well you will start to seek reassurance and distract them while they attempt to resuscitate the patient 
  • Be insistent that doing the “head end” during the intubation would be a brilliant learning opportunity for you 


HDU Nurse: 

  • You are a competent staff nurse who has worked at the unit for a number of years 
  • You were also reassured the patient was stable. You don’t know anything more than the student nurse hands over 
  • You take direction very well and will perform tasks that are asked of you 


HiLLO: 5, 11