Rapid Response And Code Management Flashcards
Types of arrest
Respiratory:
Not breathing
Cardiac:
No pulse
Members of code team
Leader
RN role
Anesthesiologist or CRNA
Nursing supervisor
RT pharmacy
UAP/Chaplain/Lab
Members of code team (what they do)
Leader
RN roles
Leader:
-ACLS RN or MD
RN roles:
-documentation/time keeper
-medications
-start IV
-coordinate use of crash cart & defibrillator
Members of code team (what they do)
Anesthesiologist/CRNA
Nursing supervisor
RT
Anesthesiologist/CRNA
-advanced airway
Nursing supervisor
-crowd control and assist
RT
Ventilations/assist w/ intubation
Crash cart supplies
Intubation kit
Backboard
Monitor/defibrillator
IV equipment
ACLS meds
Suction
O2 ambu bag
Code sheets
NGT/chest tube/gloves/central line/ABG kits
CPR steps
1st assess responsiveness (if none call for help)
2nd assess presence of pulse
(Absent=CPR)
(Present but agonal or no breathing= rescue breaths)
(Check pulse every 2 mins not longer than 10 secs)
2:30 ratio
ACLS
What to use until intubation
Compressions to breaths ratio when intubated
How to confirm intubation
How to confirm intubation after code
Airway bag valve mask
ETT w/ 100% O2
-dont stop compressions for ventilations if intubated
Placement:
-bilateral breath sounds
-CO2 detector
-waveform capnography
After code: CXR
ACLS circulation
-compression depth and rate
Attach what
When to identify rhythm on defibrillator
100-120 at 2 inch depth
Attach monitor/defibrillator
Identify rhythm during pulse check
Assess for reversible causes: H and T’s
5 H’s
Hypovolemia
Hypoxia
Hydrogen ion (acidosis)
Hypo or hyperkalemia
Hypothermia
Assess for reversible causes: H and T’s
6 T’s
Tension pneumothroax
Tamponade
Toxins (drug OD)
Thrombus-pulmonary
Thrombus-cardiac
Trauma
Rapid response vs code
RR:
-prevent arrest
Code:
no pulse
Difference between cardiovert vs defirbillation
C:
Weird rhythm need back to NSR
D:
Vfib or pulseless VT
Monophasic vs biphasic defibrilation
-how many joulse
Yell all clear
monophasic: 360 joules
Biphasic: 200 joules (can go higher)
Where are pads placed for cardioversion and defibrillations
Anterior chest
Left lateral chest wall
When to resume CPR after shock delivered in defibrillation
Immediate after for 2 minutes
(next pulse/rhythm check)
Cardioversion
Synchronized with what?
What rhythms can we cardiovert?
What setting do we change on the monitor?
Synchronized w/ rhythm
Cardiovert unstable rhytms w/ a pulse:
-afib & aflutter
-SVT
-vtach w/ pulse
Change setting from Defib to synchronous (puts it synchronized with R wave)
Cardio version
-meds to give
-joules usually set to?
Yell what
What is a risk of cardioversion
Moderate/conscious sedation
50-100 joules
Yell all clear
Risk for R on T phenomenon (causes vfib)
AED
-what age can get an AED
What not to do with the pads
Over 1yoa
Dont place over pacemaker or AICD
AICD (automated impantable cardioverter defibrillator)
Delivers shock directly where?
Location of device
Dont place what over site
Directly to heart muscle
Location:
Upper chest
Abdomen
Dont place pads over site
Transcutaneous cardiac pacing
Indications
Set mode to what
Hr set to what
Set output of mA until what
What to give for discomfort?
Symptomatic bradycardia
Set mode: demand
Set rate: 70-80
Set output mA until capture
(increase until pacer recognizes heart and works)
Sedation/analgesic
Treatments of symptomatic bradycardia
Atropine
Transcutaneous pacer
How often to switch compressions
What L to set bag ETT on wall
2min
15L
Meds to lower blood pressure
Nicardipine
Nipride
Nitroglycerin
Post CODE care: return of spontaneous circulation (ROSC)
ETCO2 at what
Continue monitor what
Maintain airway how?
Labs
Foley
IV access (need central line for what)
ETCO2: 35-45
Monitor ECG continuous
ETT secured
Central line if using vasopressors
Post CODE care: return of spontaneous circulation (ROSC)
Titrate meds to maintain hemodynamic stability
SBP > 90
MAP >65
HR >60
Therapeutic hypothermia after cardiac arrest:
TTM (targeted temperature management)
-what its used to treat
-body temp wanted (for how long)
Control what
Monitor for what
Hypothermia after cardiac arrest (Vfib, pulseless VT)
32-36C for 24hrs
(Control shivering with sedation)
Monitor:
Arrhythmias
Hyperglycemia
Bleeding/infection
Metabolic/electrolyte issues
Therapeutic hypothermia after cardiac arrest:
TTM (targeted temperature management)
What to do after the 24hours of maintaining 32-36C?
Monitor for what
Rewarm slowly:
-0.25-0.5C/hr
Monitor:
Vasodilation/Hypotension
Shock
Complication with TTM 5
Hyperglycemia
Electrolyte imbalance
Bradycardia
Infection/Bleeding