Code Blue Flashcards
When to Call a CODE BLUE?
Respiratory Arrest
Cardiac Arrest
Assess Adult Patient: CAB
Compressions- Feel for a carotid pulse
Airway-Open the ariway, use a chin lift+/ or head tilt
Breathing- Look, listen and Feel
CPR
No chest compressions n LVAD patients
Drug Delivery
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
Drug therapy in VF/Pulseless VT Vasopressors
(epinephrine/vaspressin)
can be given after at least 1 shock and 2 minute CPR period
Drug therapy in VF/Pulseless VT
Amiodarone
Improves rate of ROSC (Return of spontaneous Circulation) and hospital admission
Drug therapy in VF/Pulseless VT
Magnesium
Only for torsades de pointes with a long QT interval
Drug therapy in Pulseless electrical activity(PEA)/ Asystole
- 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)
Acute Termination of PSVT
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)
CCB, BBB and Digoxin should not be use in
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.
Drugs: Key Elements
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
Epinephrine dose
1 mg IV/IO q 3-5 mins
Epinephrine classification
Vasopressor receptors: alpha adrenergic
beta 1 and 2 adrenergic
Epinephrine Indication
- Pulseless VT/VF
- Symptomatic bradycardia
- PEA
- Asystole
- Anaphylaxis
Epinephrine Actions
- Increase cerebral and coronary perfusion pressures
- increase HR
- Increse myocardial contractility
- Improve Return of spontaneous Circulation (ROSC)
Vasopressin dose
40 units IV (replace 1st or 2nd dose of epinepherine)
Vasopressin classification
Vassopressin 1 &2
Vasopressin indication
• Pulseless VT/VF • PEA • Asystole • 1 dose may replace 1st does of epi ***insuf evidence in ped cardiac arrest
Vasopressin indication
- increase coronary perfusion
* increase vasoconstriction
Amiodarone dose
VF/pulseless VT: 300 mg IVP, MR with 150mg in 3-5 mins
Stable VT; 150 mg IV over 10 minutes
Amiodarone Class
Antiarrhythimic Class III
potassium-channel blockade. Delay repolarization (phase 3) and thereby increase action potential duration and effective refractory period.
Amiodarone Indications
- Pulseless VT/VF
- Hemodynamic stable monomorphic VT
- Polymorphic VT with normal QT
- Afib/Aflutter
Amiodarone Actions
Prolongs AP duration and refractory period
Slows AV conduction/ Increase PR and Qtc
Increase short term survival to hospita admission
Lidocaine dose
1-1.5 mg/kg
MR 0.5-0.75 mg/kg to max of 3mg/kg
Start gtt 1-4 mg/min
Lidocaine Classification
Antiarrhythmic Class IB
IB - weak Small reduction in phase 0 slope; reduce APD; decrease ERP.
Lidocaine Indication
• Pulseless VT/VF
—- if amio unvail
• Hemodynamic stable monomorphic VT
• RSI (Rapid sequence intubation)
Lidocaine Actions
Relative weak Sodium channel blocker
Magnesium dose
Pulseless VF/VT-Torsades
1-2 grams IV in 10 ml of NS r 5-20 mins (if no pulse)
Magnesium Classification
Electrolyte/ antiarrhythmic
Magnesium Indication
- Torsades de pointes
- Pulseless VT/VF with prolonged QT/ torsades
- Asthma
- Hypomagnesemia
Magnesium Actions
cofactor in variety of cell processes including control of Na and K transport
Atropine dose
symtomatic bradycardia;
0.5 mg IV max dose 3 mg
Atropine Classification
Anticholinergic
Atropine indication
symtomatic bradycardia
toxins/over dose
RSI (Rapid sequence intubation)
** (consider in Peds before succin/ketamine)
Atropine Actions
Increase HR in PEA(pulseless electrical activity) asystole unlikely to have benefit NOT recommended
Na bicarbonate
Alkalinizing agent
Indicated: Hyperkalemia, pre-existing metabolic acidosis, TCA OD
Reverses metabolic acidosis, Increases CO2 and pH.
Drugs not recommended for routine use in cardiac arrest
Na bicarbonate
Calcium chloiride 10%
Flumazenil
Naloxone
Calcium Chloride 10%
Electrolyte
Indicaiton: hypocalcemia, hyperkalemia, hypermagnesemia, CCB overdose
maintains cardiac contractility, platelet aggregation
Dextrose
Carbohydrate
Indication: Hypoglycemia -newborn 10% -infant/child 25% -Adults 50% Hyperkalemia (with insulin)
Flumazenil dose
0.2 mg, inc to 0.3 and 0.5 mg q 1 min. Max of 3 mg
Flumazenil
Acute W/D sx including chrnoic user
Benzo OD
Binds to GABAa receptor/ prevents attachement of benzodiazepines to their receptor
Adenosine dose
6 mg IV x1
MR w/12 mg for 2nd dose
Adenosine Indication
Antiarrhythmic
Indication:
- stable narrow complex regular tach
- unstable narrow complex regular tach
- stable, regular, monomorphic wide complex tach
as a therapeutic diagnostic tool
Adenosine actions
*Blocks AV node conduction
depresses sinus node *Automaticity
brief period of *systole/bradycardia
Naloxone dose
0.04 -0.4 mg IV
MR q 2-3 mins
Naloxone
Opioid reversal
Indicaition: narcotic OD
Action: potent opioid receptor antagonist
acute W/D: pain, HTN, Tachycardia
Rapid Sequence Intubation
Etomidate -short acting hypnotic agent
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
Rapid Sequence Intubation
Ketamine-general anesthetic
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
RSI-Paralytics
Succinylcholine
Succinylcholine
Dose: 1-1.5 mg/kg
Onset: 30-60 secs
Duration : 5-15 mins
AE: Hyperkalemia
(avoid ESRD)
Inc ICP, Respiratory depression
RSI-Paralytics
Rocuronium
dose: 0.6-1.2 mg/kg
(usually 1mg/kg
Onset: 1-2 mins
duration: 30-90 mins
AE: Respiratory depression
RSI-Paralytics
Vecuronium
(in med tray)
dose:0.1-0.2 mg/kg
Onset: 2-4 mins
Duration: 30-45 mins
AE: Respiratory depression
