CODE BLUE Flashcards
First drug to use in pulseless cardiac arrest (asystole/PEA)
* Dose and Route
1 mg every 3-5 min
- 0.1 mg/ml 10 ml syringe
- No max amount of epi during a code
Anaphylaxis
- 3 to 0.5mg IM every 5 minutes
* 1mg/ml (vial) or auto-ready devices
* If anaphylaxis refractory to IM admin, may give 0.1 mg IV over five min (FURTHER DILUTED IN 9 ML OF NS)
Bradycardia - if atropine is ineffective, what do you give next?
Atropine 0.5mg -1mg q 3-5min, give 1mg if severe bradycardia. Max of 3mg.
Epinephrine
- IV infusion
- 2 to 10 mcg/min
- 2mg/100 ml NS or 10mg/500 ml NS (conc 2mcg/ml or 0.02 mg/ml)
Hypotension or septic shock
epinephrine
- IV infusion
- 0.1 to 0.5 mcg/kg/min
- 2mg/100 ml NS or 10mg/500 ml NS (conc 2mcg/ml or 0.02 mg/ml)
VTach/Vfib
- IVP/IO
- 1 mg every 3 to 5 min
- 0.1mg/ml 10ml syringe
- *same as ASYTOLE/PEA
Side effects of epinephrine and what to monitor
epinephrine’s B-1 receptor effects can result in myocardial ischemia and potentially fetal arrhythmias. Monitor during administration for tachycardia and HTN
* Epi is not compatible with sodium bicarb and may not be as effective in acidotic states
MOA of Epinephrine during a code
Acts as a peripheral vasoconstrictor and coronary artery vasodilator
For reture of spontaneous circulation during cardiac arrest - which one is the first choice epinephrine or vasopressin
epinephrine
- vasopression (antidiuretic) is non-inferior to epinephrine in improving return of spontaneous circulation during cardiac arrest, it has been removed for the simplicity.
- vasopressin may work better than epinephrine in acidotic and low oxygen states **
When do you use vasopressin during a cardiac arrest?
- Following return of spontaneous circulation, the prescriber may request a vasopressin drip to help decrease infusions of adrenergic agonists
- ** vasopressin may work better than epinephrine in acidotic and low oxygen states **
For VTach/Vfib that is unresponsive to two prior cycles of CPR/shock/epinephrine, what do you use?
*dose and route
- Amiodarone 300 mg IV push
- If still unresponsive give 2nd dose at 150 mg iv push. flush the line afterwards with 10 ml ns
- after pt has recovred spontaneous circulation, start an amiodarone iv infusion at a rate of 1mg/min x 6 hrs, then decrease to 0.5 mg/min x 18 hrs for a total infusion duration of 24 hrs
Massive Pulmonary Embolism
Obtain 100 mg alteplase if the pateint has an acute PE and any of the following: hypotension and profound bradycardia (<40 beats per min)- cardiac arrest
For respiratory failure (intubation): For Induction
- prefer *Etomidate 0.3 mg/kg IV (max 20mg)
- Propofol 1.5 mg/kg once (continuous infusion may be started if sedation is required)
- Ketamine 1.5 mg/kg IV
Etomidate: onset 60 secs, duration 3-5 min, may cause myoclonic activity, lower sz threshold in pt with known seizures
Propofol: may cause hypotension
Ketamine:
- 100 mg/ml must be diluted w/equal part NS if given IV
- Might cause hallucinations
- drip may be used to lower narcs
Agents for induction: etomidate, ketamine, midazolam, propofol
For respirator failure (paralytics):
- Succinylcholine 1-2 mg/kg IVP (common dose in ER 100mg = 5 ml)
onset 30-60 sec, duration 30-60 min - Rocuronium 0.6-1.2 mg/kg (common dose 60-100mg = 6-10 ml)
- Vecuronium 10 mg vial: 0.1-0.25 mg/kg ivp. Reconstitute with 10ml NS = 1mg/ml. Common dose in ER 10 mg = 10 ml. Onset 2.5-5 min, duration 30-40 min
St. Joe Hospital paralytics (2 step process if pt is transport to CT)
- ) Intubation: Rocuronium 1-1.2 mg/kg IVP
2) for trans to CT: half the dose of the original dose 0.5-0.6 mg/kg ivp
For respiratory failure (intubation): Sedation
- Loading dose fentanyl: 1.0 mcg/kg IVP
- Infusion dose: fentanyl 1 mcg/kg/hr IV gtt (consider increase if opioid tolerant)
3. Loading dose: Versed 2mg IVP
4. Infusion dose: Versed 2mg/hr IV gtt
