Code Management

Question 1

Basic Life Support

Answer 1

external support of circulation and ventilation for a patient with cardiac or respiratory arrest through CPR

RAPID INTERVENTION is the key to success

Question 2

Advanced Cardiac Life Support (ACLS)

Answer 2

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

Question 3

Pneumatic to remember which drugs can be administered via ETT

Answer 3

NAVEL

Narcan, Atropine, Vasopressin, Epinephrine and Lidocaine

lidocaine isn’t used much anymore – usually amiodarone now!

Question 4

Vasopressin

Answer 4

ventricular fibrillation/pulseless ventricular tachycardia

has a limit of doses; if doesn’t work after 1 dose, usually switch to Epinephrine

Question 5

Epinephrine

Answer 5

V-fib, pulseless v-tach; asystole, PEA

can keep giving; no limit

Question 6

Lidocaine

Answer 6

ventricular dysrhythmias

not used much anymore!

Question 7

Amiodarone

Answer 7

Vfib, Vtach, SVT, Afib/Aflutter

used instead of lidocaine now

Question 8

Atropine

Answer 8

bradycardia only!!

Question 9

Dopamine

Answer 9

hypotension, shock

Question 10

Norepinephrine (Levophed)

Answer 10

hypotension, shock

will maintain a BP usually once they are back from the code and are starting to get stable

Question 11

Defibrillation

Answer 11

Pulseless!!! Vtach/Vfib

completely depolarizes the heart disrupting the impulses that are causing dysrhytmias

Monophasic: one direction
Biphasic: two directions

Question 12

Cardioversion

Answer 12

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

Question 13

Pacing

Answer 13

bradycardia; heart blocks

Question 14

Internal Paddles

Answer 14

“spoons” used in cardiac surgery and open chest CPR

lower joules

Question 15

Automatic implantable cardioverter-defibrillator (ICD)

Answer 15

recognizes ectopy
delivers countershocks
prevents episodes of sudden death

Question 16

Vfib/pulseless ventricular tachycardia

Answer 16

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

Question 17

Symptomatic Tachycardia V-tach w/ a pulse

Answer 17

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)

Question 18

Therapeutic Hypothermia

Answer 18

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

Question 19

Pacemaker

Answer 19

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

Question 20

Temporary Pacemakers

Answer 20

External (transcutaneous), Epicardial (transthoracic), endocardial (transvenous)

Question 21

External (transcutaneous) Pacemaker

Answer 21

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

Question 22

Epicardial (transthoracic) Pacemaker

Answer 22

energy diverted through the thoracic musculature to the heart through lead wires

commonly used during and immediately following open heart surgery

Question 23

Endocardial (transvenous) Pacemaker

Answer 23

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

Question 24

Atrial Pacing

Answer 24

sharp spike before the P wave

Question 25

Ventricular pacing

Answer 25

sharp spike before the QRS

Question 26

AV sequential pacing

Answer 26

sharp spikes before the P wave and QRS

Question 27

Capture

Answer 27

depolarization of the chamber following the pacer spike

Question 28

Undersense

Answer 28

failure to sense

the pacer doesn’t sense spontaneous myocardial depolarization so there is then a competition between pacer and hearts intrinsic rhythm

Question 29

Oversense

Answer 29

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