Emergency Department KKH Cardiac Arrest Registry
HN
Your answer
Date
MM
/
DD
/
YYYY
Age
Your answer
Sex
DM
HT
CKD/ESRD
COPD
Other
Location of cardiac arrest
Arrival by
Type of cardiac arrest
Bystander CPR
Location of arrest
Total time of CPR before EMS arrival (minutes)
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Response time
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On scene time
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Transportation time
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Initial rhythm at Scene
AED use before EMS arrival
Time of first shock
Time
:
First shock from AED or EMS
Assisted ventilation
Pre hospital adrenaline
Total CPR time before arrival at ED
Your answer
ROSC (before arrival)
Status of arrival at hospital
Initial rhythm at ED
Arrival by
Time of arrival at ED
Time
:
Time of start CPR
Time
:
Time of first dose adrenaline
Time
:
Total doses of adrenaline (prehosp+inhosp)
Your answer
Total doses of defibrillation (doses)
Your answer
Total CPR time (minutes)
Your answer
BUN
Your answer
Creatinine
Your answer
Serum K
Your answer
PH
Your answer
Serum HCO3
Your answer
DTX
Your answer
Trop-t
Your answer
CK-MB
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Hb
Your answer
Lactate
Your answer
7.5%NaHCO3(ml)
Your answer
10% Ca gluconate (ml)
Your answer
Leader of CPR
Cause of arrest
Status after CPR
Survival to Admit (มี ROSC จนกระทั่งได้ Admit)
Survival to hospital discharge
30 day survival
Neurological outcome at discharge
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