There are times when a resuscitation goes bad. Every possible combination and permutation of failures and difficulties will conspire to shape the situation into a large overripe pear. Staff will get frazzled, patience will evaporate, leadership will diverge and tempers will flare.
Every piece of equipment will either fall apart in your hands or simply disappear into the ether at the vital moment it is needed most. Batteries will go flat, patients veins will go flat, ECG tracings will go flat.
At times like these you need a few tricks to get yourself back into the zone:

• Palpate the midline: when it all turns to shit, its pretty easy to have a mental brown-out. Your mind goes off all over the place trying to sort out all the problems simultaneously whilst trying to keep up on top of what is happening and listen to all the carry on. So, the first thing to do is palpate your midline.
  Take a moment to bring your mind back into your brain where it is needed most.
  Pay note to your breathing which is probably all up in your chest and re-center it back down into your diaphragm. Stand up straight and feel your feet on the floor. Takes a couple of moments to do….remembering to do it is the hard part.
• One thing: now the trick is to just do one thing at a time and bring all your attention to it. Forget multitasking which is for unit managers and circus plate spinners. Find the very next task that needs to be attended to and give it your full package.
• Slow speed: Somewhere between rushing around like a headless chook and dropping into ‘frozen in the headlights’ inertia, is a zone of slow speed where tasks are performed with an easy fluidity. Once you have centered yourself and focused your breathing for a moment it is pretty easy to drop into this niche. And with some slow speed applied to the one thing, you will begin to accomplish a lot quickly.
• Make good ripples: if one member of the resuscitation team is flustered or getting steamed up, these emotions will quickly spread though the entire team. Thats the bad news. The good news is you can change this dynamic with your own actions.
• Follow the leader: there is only one team leader. You know who it is. Follow their directions and don’t be distracted by all the other cooks making soup.
• Attend to the trinity: Air goes in and out. Blood goes round and round. Oxygen is good. This was taught to me by Dr Hollis who is much much smarter than I am and leads me to…
• Know shit: no point getting into the zone unless you’ve got something to do in there. Watch the difference between a doctor or nurse who knows their stuff when things go bad, and one who does not. Now let me assure you I am not even in the same ball-park as an uber-nurse, but let me tell you that when things are happening and you understand why they are happening and you know how to manage the happenings and it all fits together, well that’s a powerfully beautiful thing to experience. So open a book and ask lots of questions. Here endeth the lesson.
  Oh, maybe just one more….
• Remember it could always be worse: it could be you on the bed.

Now this all probably sounds like I’m channelling Flipper right now, but just give it a try next time you are helping during a difficult intubation and you drop the laryngoscope and trip up in the ECG cables as you try and catch it, and collect the IV tubing on your way down and drag the whole resuscitation scenario down onto the floor with you.