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PPMC Rotation > Code Blue > Flashcards

Code Blue Flashcards

1
Q

When to Call a CODE BLUE?

A

Respiratory Arrest

Cardiac Arrest

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2
Q

Assess Adult Patient: CAB

A

Compressions- Feel for a carotid pulse
Airway-Open the ariway, use a chin lift+/ or head tilt
Breathing- Look, listen and Feel

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3
Q

CPR

A

No chest compressions n LVAD patients

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4
Q

Drug Delivery

A

For peripheral iv route, follow 20ml flush

If IV access not readily available, consider IO access

Endrotracheal Drug Delivery
( Lidocaine, EPI, naloxone, vasopression, & Atropine)
—-less predictable pharmacologic effect
—-use 2 to 2.5 times rec IV dose in 5-10 H20 or NS

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5
Q

Drug therapy in VF/Pulseless VT Vasopressors

A

(epinephrine/vaspressin)

can be given after at least 1 shock and 2 minute CPR period

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6
Q

Drug therapy in VF/Pulseless VT

Amiodarone

A

Improves rate of ROSC (Return of spontaneous Circulation) and hospital admission

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7
Q

Drug therapy in VF/Pulseless VT

Magnesium

A

Only for torsades de pointes with a long QT interval

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8
Q

Drug therapy in Pulseless electrical activity(PEA)/ Asystole

A
  • Vasopressor
  • can be given as soon as feasible
  • goal: increase myocardial/cerebral blood flow during CPR
  • Atropine
  • Treating Potentailly reversible causes (H’s and T’s)
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9
Q

Acute Termination of PSVT

A

Vagotonic physcial manuever
—valsalva, breath-holding, ice water submersion, unilateral carotid sinus massage

Narrow QRS
—adenosine, verapamil, diltiazem, metoprolol,

Wide QRS >120msec
–procainamide, ibutilide, amiodarone (if structural heart disease)

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10
Q

CCB, BBB and Digoxin should not be use in

A

Patients with undiagnsed Wide Complex Tachycardias

due to severe hemodynamic deterioration if VT or antidromic AVRT present

Atrioventricular reentrant tachycardia (AVRT) is a type of supraventricular tachycardia (SVT). It accounts for about 30% of all SVTs.

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11
Q

Drugs: Key Elements

A

Goal: facilitate restoration/maintenance of spontaneous rhythm

CPR should be continued to facilitate drug distribution to the heart to optimize response

administration of a 10-20ml bolus of normal saline after each drug to assist drug distribution

If IV access not available, then intraosseous admin should be considered for all drugs

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12
Q

Epinephrine dose

A

1 mg IV/IO q 3-5 mins

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13
Q

Epinephrine classification

A

Vasopressor receptors: alpha adrenergic

beta 1 and 2 adrenergic

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14
Q

Epinephrine Indication

A
  • Pulseless VT/VF
  • Symptomatic bradycardia
  • PEA
  • Asystole
  • Anaphylaxis
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15
Q

Epinephrine Actions

A
  • Increase cerebral and coronary perfusion pressures
  • increase HR
  • Increse myocardial contractility
  • Improve Return of spontaneous Circulation (ROSC)
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16
Q

Vasopressin dose

A

40 units IV (replace 1st or 2nd dose of epinepherine)

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17
Q

Vasopressin classification

A

Vassopressin 1 &2

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18
Q

Vasopressin indication

A 
• Pulseless VT/VF 
• PEA
• Asystole 
• 1 dose may replace 1st does of epi 
***insuf evidence in ped cardiac arrest
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19
Q

Vasopressin indication

A
  • increase coronary perfusion

* increase vasoconstriction

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20
Q

Amiodarone dose

A

VF/pulseless VT: 300 mg IVP, MR with 150mg in 3-5 mins

Stable VT; 150 mg IV over 10 minutes

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21
Q

Amiodarone Class

A

Antiarrhythimic Class III

potassium-channel blockade. Delay repolarization (phase 3) and thereby increase action potential duration and effective refractory period.

22
Q

Amiodarone Indications

A
  • Pulseless VT/VF
  • Hemodynamic stable monomorphic VT
  • Polymorphic VT with normal QT
  • Afib/Aflutter
23
Q

Amiodarone Actions

A

Prolongs AP duration and refractory period

Slows AV conduction/ Increase PR and Qtc

Increase short term survival to hospita admission

24
Q

Lidocaine dose

A

1-1.5 mg/kg
MR 0.5-0.75 mg/kg to max of 3mg/kg
Start gtt 1-4 mg/min

25
Q

Lidocaine Classification

A

Antiarrhythmic Class IB

IB - weak Small reduction in phase 0 slope; reduce APD; decrease ERP.

26
Q

Lidocaine Indication

A

• Pulseless VT/VF
—- if amio unvail
• Hemodynamic stable monomorphic VT
• RSI (Rapid sequence intubation)

27
Q

Lidocaine Actions

A

Relative weak Sodium channel blocker

28
Q

Magnesium dose

A

Pulseless VF/VT-Torsades

1-2 grams IV in 10 ml of NS r 5-20 mins (if no pulse)

29
Q

Magnesium Classification

A

Electrolyte/ antiarrhythmic

30
Q

Magnesium Indication

A
  • Torsades de pointes
  • Pulseless VT/VF with prolonged QT/ torsades
  • Asthma
  • Hypomagnesemia
31
Q

Magnesium Actions

A

cofactor in variety of cell processes including control of Na and K transport

32
Q

Atropine dose

A

symtomatic bradycardia;

0.5 mg IV max dose 3 mg

33
Q

Atropine Classification

A

Anticholinergic

34
Q

Atropine indication

A

symtomatic bradycardia

toxins/over dose

RSI (Rapid sequence intubation)
** (consider in Peds before succin/ketamine)

35
Q

Atropine Actions

A 
Increase HR 
in PEA(pulseless electrical activity) asystole unlikely to have benefit NOT recommended
36
Q

Na bicarbonate

A

Alkalinizing agent

Indicated: Hyperkalemia, pre-existing metabolic acidosis, TCA OD

Reverses metabolic acidosis, Increases CO2 and pH.

37
Q

Drugs not recommended for routine use in cardiac arrest

A

Na bicarbonate
Calcium chloiride 10%
Flumazenil
Naloxone

38
Q

Calcium Chloride 10%

A

Electrolyte

Indicaiton: hypocalcemia, hyperkalemia, hypermagnesemia, CCB overdose

maintains cardiac contractility, platelet aggregation

39
Q

Dextrose

A

Carbohydrate

Indication:
Hypoglycemia 
-newborn 10%
-infant/child 25%
-Adults 50% 
Hyperkalemia (with insulin)
40
Q

Flumazenil dose

A

0.2 mg, inc to 0.3 and 0.5 mg q 1 min. Max of 3 mg

41
Q

Flumazenil

A

Acute W/D sx including chrnoic user

Benzo OD

Binds to GABAa receptor/ prevents attachement of benzodiazepines to their receptor

42
Q

Adenosine dose

A

6 mg IV x1

MR w/12 mg for 2nd dose

43
Q

Adenosine Indication

A

Antiarrhythmic

Indication:

  • stable narrow complex regular tach
  • unstable narrow complex regular tach
  • stable, regular, monomorphic wide complex tach

as a therapeutic diagnostic tool

44
Q

Adenosine actions

A

*Blocks AV node conduction
depresses sinus node *Automaticity
brief period of *systole/bradycardia

45
Q

Naloxone dose

A

0.04 -0.4 mg IV

MR q 2-3 mins

46
Q

Naloxone

A

Opioid reversal

Indicaition: narcotic OD

Action: potent opioid receptor antagonist
acute W/D: pain, HTN, Tachycardia

47
Q

Rapid Sequence Intubation

Etomidate -short acting hypnotic agent

A

Dose: 0.3 mg/kg IV push~20 mg in a 70 kg person

Onset:10-20 secs

Duration: 4-10 mins

Adverse effects: Adrenal suppression

48
Q

Rapid Sequence Intubation

Ketamine-general anesthetic

A

Dose: 1-2 mg/kg

Onset: 30-40 secs

Duration: 5-10 mins

Adverse effects: hypertension, cardiac dysrhythmias, increased ICP, laryngeal spasm
Avoid the use in cardiac, traumatic brain injury patients

49
Q

RSI-Paralytics

Succinylcholine

A

Succinylcholine

Dose: 1-1.5 mg/kg

Onset: 30-60 secs

Duration : 5-15 mins

AE: Hyperkalemia
(avoid ESRD)
Inc ICP, Respiratory depression

50
Q

RSI-Paralytics

Rocuronium

A

dose: 0.6-1.2 mg/kg
(usually 1mg/kg

Onset: 1-2 mins

duration: 30-90 mins

AE: Respiratory depression

51
Q

RSI-Paralytics
Vecuronium
(in med tray)

A

dose:0.1-0.2 mg/kg

Onset: 2-4 mins

Duration: 30-45 mins

AE: Respiratory depression

PPMC Rotation (12 decks)

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