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Crash Call Audit Form
Department of Anaesthesia & Intensive Care
Eric Williams Medical Sciences Complex
Please fill out all details as best as possible
*
Indicates required field
Date
*
Location
*
AICU
HDU
AED
Adult Surgical Ward
Adult Medical Ward
OT
Recovery Room
Radiology-MRI
Radiology-CT
Radiology-USS
Cath Lab
ECHO
Clinic
PED
PICU
Paediatric Ward
Other
In-Transit
If other, please state
*
Gender
*
Male
Female
Age
*
Brief History/Summary of Patient
*
Did AICU/PICU attend crash?
*
Yes
No
Reason for not attending
*
Select all teams involved in management
*
AED
Medical
Surgical
Cardiology
General Surgery
Thoracic Medical
Thoracic Surgical
Neurosurgery
Urology
Vascular
PED
Paediatric Medicine
Paediatric Surgery
Opthalmology
ENT
Maxillofascial
Plastic Surgery
Cardiac Surgery
State primary team
*
State other teams
*
Time crash called
*
Patient status
*
Unknown
Poor prognosis (not documented)
Documented poor prognosis
Documented DNR
Documented not for escalation
Seemingly salvageable
Well, unexpected deterioration
False alarm (not a crash)
Nurse-led BLS in progress?
*
Yes
No
Functional monitors present?
*
Yes
No
If monitor present, was on patient on arrival?
*
Yes
No
Appropriate equipment present
*
Yes
No
Appropriate drugs present
*
Yes
No
Specific issues/things missing
*
First team to arrive
*
Time of arrival
*
Time of arrival of AICU
*
Level of AICU Staff present
*
Consultant
Registrar
House Officer
None
Highest Level of Other Specialty Doctors Present
*
Consultant
Registrar
House Officer
None
Interventions performed
*
IV access sited
Basic fluid resuscitation
Monitors attached
Halted resuscitation of a DNR
Bag-mask ventilation
Intubated
Mechanical ventilation
Cardioversion/defibrillation
CPR
Certified patient
Decision not to intervene
Outcome
*
Unsuccessful resuscitation
Return of spontaneous circulation
Interventions performed
Total length of CPR performed
*
Submit
Home
Feedback
Anaesthesia & AICU Projects
Paeds Anaesthesia Prep
Critical Incident Form
Internal Request Form
Switching Shift Form
Switching 8am to 4pm Form
Certifications Details
Crash Call Audit
PICU Projects
PICU Crash Sheet
Bed Booking Form: PICU
Other Projects
CMJ-test
Brewing Creations
Mead-Semisweet
PDFs
Private Documents