The Resus Lottery

Author: Louise Woolrich-Burt / Editor: Nicola Jakeman / Reviewer: Eugene Henry, Nadarajah Prasanna / Codes: Published: 17/09/2021


This question is aimed at ST3 and above. It is best taken after completing the Human Factors knowledge based session. This question focuses on situational awareness. This can be considered in terms of gathering information, anticipating and updating the team.


You are one of 2 middle grade doctors on a busy shift.

Minors is under control but there is a 2.5 hour wait to be seen. Majors is very busy with 14 patients waiting more than 6 hours for an inpatient bed. Resus has 1 empty paediatric bay and one empty adult bay out of a total of 6 bays.

There are 2 nurses and 1 healthcare support worker working in resus.

The Emergency Department (ED) consultant is available by bleep, but is attending an SUI meeting.

In the ED as a whole, there are 2 ED SHOs in minors, 3 in majors, and 1 in paeds. 1 SHO and one middle grade have called in sick. All of these doctors are available to help in resus if necessary, but that would have a resultant impact on the waiting time in these other areas.

You are assigned to resus for the afternoon and take handover:

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The alert phone rings TWICE:

Patient 1: A 76-year-old female with STEMI. ETA 15 minutes.

Patient 2: A 87-year-old cardiac arrest. ETA 5 minutes.

The cardiac arrest patient arrives with a ROSC in the ambulance. She is assigned to Bay 3. The team, comprising an ED nurse, ED SHO and a medical student commence the ALS algorithm.

The STEMI patient is allocated to the paediatric bay, with the hope that the cardiology team will take her to the lab for PCI within a couple of minutes.

As the cardiac arrest patients goes into PEA, the cardiologist tells you that the? STEMI patient does not fulfil the criteria for PCI and leaves resus.

All the resus bays are now full.

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