Code Management Flashcards
Basic Life Support
external support of circulation and ventilation for a patient with cardiac or respiratory arrest through CPR
RAPID INTERVENTION is the key to success
Advanced Cardiac Life Support (ACLS)
specific protocols followed by specially trained healthcare personnel
systemic approach to tx of cardiac emergencies w/ knowledge and skill
Algorithms for the treatment of dysrhythmias; institute effective tx based on pt assessments and appropriate judgment
guidelines for the management of MI, acute MI, pulmonary edema, shock, stroke, drowning, hypothermia and drug OD
Pneumatic to remember which drugs can be administered via ETT
NAVEL
Narcan, Atropine, Vasopressin, Epinephrine and Lidocaine
lidocaine isn’t used much anymore – usually amiodarone now!
Vasopressin
ventricular fibrillation/pulseless ventricular tachycardia
has a limit of doses; if doesn’t work after 1 dose, usually switch to Epinephrine
Epinephrine
V-fib, pulseless v-tach; asystole, PEA
can keep giving; no limit
Lidocaine
ventricular dysrhythmias
not used much anymore!
Amiodarone
Vfib, Vtach, SVT, Afib/Aflutter
used instead of lidocaine now
Atropine
bradycardia only!!
Dopamine
hypotension, shock
Norepinephrine (Levophed)
hypotension, shock
will maintain a BP usually once they are back from the code and are starting to get stable
Defibrillation
Pulseless!!! Vtach/Vfib
completely depolarizes the heart disrupting the impulses that are causing dysrhytmias
Monophasic: one direction
Biphasic: two directions
Cardioversion
SVT; Atrial tachycardias; VTACH w/ pulse
need to put on a monitory and it will pick up everything and tell when to shock
delivery of counter shock that is SYNCHRONIZED with the patient’s rhythm
purpose: to disrupt the ectopic pacemaker and allow the SA node to take control of the heart rhythm
Pacing
bradycardia; heart blocks
Internal Paddles
“spoons” used in cardiac surgery and open chest CPR
lower joules
Automatic implantable cardioverter-defibrillator (ICD)
recognizes ectopy
delivers countershocks
prevents episodes of sudden death
Vfib/pulseless ventricular tachycardia
CAB (CPR), defibrillate (continue CPR) while simultaneously you team will be inserting IVs, bagging and preparing to intubate
intubate: rechecking a pulse; no pulse -> meds
Epi or vasopressin: CPR this helps circulate meds, check a pulse, no pulse after 2min/5cycles - defib if still Vtach/Vfib
antidysrhythmic drugs: amiodarone, lidocaine, mag
Drug-shock continues: eli and vasopressin repeated as needed; consider other drugs
Symptomatic Tachycardia V-tach w/ a pulse
ABCD; airway, oxygen, IV access
determine the rhythm (v-tach, SVT, rapid afib, rapid aflutter)
meds (adenosine works for SVT, but will slow down rapid a fib or a flutter to help determine what it is)
cardioversion: when to sedate w/ cardioversion (if they are awake)
Therapeutic Hypothermia
preserve or reduce brain injury from ischemia
suppresses chemical reactions from reperfusion
indicated for unresponsive patients
cool to 32-34C via ice packs, cooling blankets, cooling pads, IV or catheters
Pacemaker
an electronic device used to pace the heart when the normal conduction pathway is damaged/disrupted
Basic pacing circuit consists of a power source (battery-operated pulse generator), one or more conduction leads (pacing leads) and the myocardium
Temporary Pacemakers
External (transcutaneous), Epicardial (transthoracic), endocardial (transvenous)
External (transcutaneous) Pacemaker
energy diverted through the thoracic musculature to the heart through 2 electrode patches placed on the skin
requires large amounts of electricity, which can be painful to pt
used only in emergency resuscitation of a client who doesn’t have pacing wires inserted
Epicardial (transthoracic) Pacemaker
energy diverted through the thoracic musculature to the heart through lead wires
commonly used during and immediately following open heart surgery
Endocardial (transvenous) Pacemaker
energy delivered through lead wires that are threaded through a large central vein (subclavian, jugular, or femoral) and lodged into the wall of the right ventricle
Atrial Pacing
sharp spike before the P wave
Ventricular pacing
sharp spike before the QRS
AV sequential pacing
sharp spikes before the P wave and QRS
Capture
depolarization of the chamber following the pacer spike
Undersense
failure to sense
the pacer doesn’t sense spontaneous myocardial depolarization so there is then a competition between pacer and hearts intrinsic rhythm
Oversense
failure to sense
pacer senses extraneous electrical signals that causes unnecessary firing of the pacer or inhibition of stimulus output
- fix by adjusting setting on pacer
