Code Blue Flashcards
Code Blue
in an emergency
Race team
purpose is to prevent an emergency from happening
Code blue roles (7)
1) Lead
-usually a physician
2) Recorder
3) Airway
-in a larger centre, may be an RT
4) Medications
5) Compressions
6) Crash cart
7) Runner
Defibrillator mode (3)
1) Cardioversion
-big
2) Defib
-big
3) Pacing
-small
What mode is default mode of the defibrillator?
defib
Button to switch to cardioversion
SYNC
Defibrillation
method of terminating VF and pulseless VT
passage of DC electrical shock to depolarize the cells of the myocardium to allow the SA node to resume the role of pacemaker
Monophasic defibrillators
deliver energy in 1 direction
Biphasic defibrillators
deliver energy in 2 directions
What should happen after the initial shock of defibrillation is delivered?
restart CPR
Synchronized Cardioversion
choice of therapy for hemodynamically unstable ventricular or supraventricular tachydysrhythmias
synchronized circuit delivers a counter shock on the R wave of the QRS complex of the ECG
synchronizer switch must be turned ON
Is a patient is unstable, what would be prioritized?
a) meds
b) cardioversion
b) cardioversion
What do you give before cardioversion?
pain meds and sedation
Major similarities between defibrillation and cardioversion (2)
1) use lots of energy
2) stop the heart
Biggest difference between defibrillation and cardioversion
cardioversion - shock is delayed so that it isn’t hitting during the relative refractory period (over the T wave)
What time frame should cardioversion be done within?
first 48 hours
after this, increased risk of blood clots, which you would be helping to transport around the body
Pacing
used to pace the heart when the normal conduction pathway is damaged or diseased
pacing circuit consists of a power source, 1 or more conducting (pacing) leads, and the myocardium
can be used to prevent bradycardia or tachycardia rhythms
Start pacemaker at ___ milliamps
10
Pacemaker spike
pace until you get QRS complex
want complex after every pacer spike
meaning there was enough energy to cause depolarization
if not, not giving enough energy
Pacer/implant types (4)
1) Temporary Transcutaneous Pacemaker
2) Temporary Transvenous Pacemaker
3) Permanent Pacemaker
4) Implantable Cardioverter Defibrillator (ICD)
Temporary Transcutaneous Pacemaker
with pads on tissue
non-invasive
skin should be clean and dry, may need to shave hair
Temporary Transvenous Pacemaker
implanting temporary wires during surgery
e.g. problem with SA node and/or AV node - plant wires where needed
Permanent Pacemaker
permanent device
Implantable Cardioverter Defibrillator (ICD)
for someone that’s had a heart attack before
can read rhythm and defibrillate
Assessing stability of patient
CAB
vitals
neuro - LOC
Neuro LOC
Orientation
Motor function
Pupillary response
T or F: A patient can be alert and lethargic.
FALSE
T or F: A patient can be oriented and drowsy
TRUE
Lethargic (somnolent)
drowsy, appropriate but thinking is slow, inattentive, decrease in spontaneous movement
Obtunded
difficult to arouse, confused when aroused, speech mumbled, incoherent, monosyllabic, requires constant stimulation
Stupor or semi-coma
only responds to physical stimulation, responds to pain, appropriate motor response, groans, reflexes intact
Coma
completely unconscious, no response to pain
Light coma
some reflex activity, no purposeful movement
Deep coma
no motor response
LOC assessment tool
Glasgow Coma Scale
GCS score of 15
fully alert and oriented
GCS of 8 or less
endotracheal intubation to protect the airway (coma)
Potential causes of unresponsiveness (4)
1) Neuro
2) Cardio
3) Resp
4) Endocrine
Neuro causes of unresponsiveness (3)
1) stroke
2) seizure
3) trauma
Cardio causes of unresponsiveness (3)
1) MI
2) Dysrhythmias
3) Cardiac arrest
Resp causes of unresponsiveness (2)
1) pulmonary embolism
2) respiratory arrest (e.g. choking, opioid overdose)
Endocrine cause of unresponsiveness (1)
1) hypoglycemia
You walk into a patient’s room, and they are unresponsive. What do you do?
shake to see if they’re awake
call for help
no pulse —> compressions
Definite Pulse & Normal Breathing
Vital Signs
Assess Responsiveness
Glasgow Coma Scale
Bloodwork/Imaging Tests
e.g. stroke/TIA, slow brain bleed, medication
Definite Pulse & No Breathing
‘C’ Check for pulse; pulse is palpable, but no breathing or breathing is not normal
‘A’ (Airway): Open airway
’B’ (Breathing): Bag Valve Mask
*1 breath every 5-6 seconds
*pulse check every 2 minutes
e.g. obstruction, inadequate respiratory effort, medications (opioids)
No PULSE
’C’: Circulation
No pulse – IMMEDIATE CHEST COMPRESSIONS
-push hard & fast (100-120 compressions per minute)
-depth of at least 2 inches (5cm)
-allow chest recoil
-minimize interruptions in compressions
‘A’ Airway:
Open airway
’B’ Breathing: Bag Valve Mask (BVM) -> 30:2
What does excellent CPR mean?
good compression AND recoil
What do you do when the Code Team arrives?
give information
if giving compressions, let somebody else takeover and give report to the code team
