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NURS 428: Evolution > Rapid Response Teams and transport of the critically ill > Flashcards

Rapid Response Teams and transport of the critically ill Flashcards

Exam 2

1
Q

Rapid Response Team Concept:

A

Identification of clinical deterioration that triggers early notification of a specific team of responders’ rapid intervention by the response team that includes both personnel and equipment that is brought to the patient

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2
Q

Rapid Response Team Concept:

What kind of evaluation occurs?

A

Ongoing evaluation through data collection and analysis to improve prevention and response.

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3
Q

Purpose of Repaid Response Team (RRT):

A

To reduce mortality

Provide early treatment of hemodynamic instability

Improve patient outcomes

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4
Q

Team Members included in RRT:

A

Leader is usually MD skilled in ACLS

Nurses (usually ICU or ER)

Anesthesiologist/anesthetist intubation

Respiratory therapist manages airway, sometimes intubates

Pharmacist prepares medications in some settings

Chaplain

ECG technician

Other personnel to run errands

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5
Q

Team Members included in RRT:

Nurses (usually ICU or ER): Who are the nurses involved?

A

Primary nurse

Second nurse

Another nurse

Nursing supervisor

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6
Q

Team Members included in RRT:

Nurses (usually ICU or ER):

Primary Nurse:

A

Primary nurse knows patient

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7
Q

Team Members included in RRT:

Nurses (usually ICU or ER):

Secondary Nurse:

A

Second nurse gives medications and gets equipment from crash cart

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8
Q

Team Members included in RRT:

Nurses (usually ICU or ER):

Another Nurse:

A

Another nurse records events

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9
Q

Team Members included in RRT:

Nurses (usually ICU or ER):

Nursing supervisor

A

Nursing supervisor provides traffic control and secures ICU bed (if needed)

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10
Q

Equipment for RRT:

A

Crash cart

Backboard

Monitor/ defibrillator/pacemaker

Bag-valve-mask device

Airway supplies/suction

Medications

IV supplies

Nasogastric tube

BP cuff

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11
Q

Equipment for RRT:

Monitor/ defibrillator/pacemaker
What is included?

A

AED

Transcutaneous pacemaker

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12
Q

Criteria for calling RRTs:

A

Call any time a staff member is concerned about changes in a patient’s condition, including:

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13
Q

Criteria for calling RRTs:

Call any time a staff member is concerned about changes in a patient’s condition, including:

How is mental status?

A

Altered Mental Status

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14
Q

Criteria for calling RRTs:

Call any time a staff member is concerned about changes in a patient’s condition, including:

How is HR?

A

Heart rate greater than 140bpm or less than 40bpm

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15
Q

Criteria for calling RRTs:

Call any time a staff member is concerned about changes in a patient’s condition, including:

How is RR?

A

Respiratory rate greater than 22breath/min or less than 8breath/min

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16
Q

Criteria for calling RRTs:

Call any time a staff member is concerned about changes in a patient’s condition, including:

How is SBP?

A

SBP greater than 180 mmHg or less than 90 mmHg,

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17
Q

Criteria for calling RRTs:

Call any time a staff member is concerned about changes in a patient’s condition, including:

How is O2?

A

O2 sat lower than 90%,

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18
Q

Criteria for calling RRTs:

Call any time a staff member is concerned about changes in a patient’s condition, including:

How is urinary output?

A

Urinary output of less than 50ml over 4 hours

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19
Q

Criteria for calling RRTs:

Call any time a staff member is concerned about changes in a patient’s condition, including:

What else could occur?

A

Chest Pain, loss of airway, seizure, uncontrolled pain

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20
Q

Criteria for calling RRTs:

What are code names?

A

Call- Code blue, Code 99, Dr. Heart

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21
Q

Criteria for calling RRTs:

What do some institutions empower family members to do?

A

Some institutions empower family members to activate the RRT

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22
Q

Interfacility transport:

What should you consider?

A

Consider both the method of transport and the people involved in the process.

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23
Q

Interfacility transport:

Why might a transfer occur?

A

Complex diagnostic procedures or sophisticated medical and nursing expertise exceeds what can be provided at a facility

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24
Q

Interfacility transport:

What are other reasons why a might transfer occur?

A

Family requests

Third party payer may require patients to be transported to a facility that is a member of their network

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25
Q

Interfacility transport:

How must a patient be before transport?

A

Patient must be stable before transporting.

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26
Q

Physician Responsibility:

What does the sending physician do in patient transfers?

A

The sending physician performs the patient assessment and determines the appropriate level of care during transfer.

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27
Q

Physician Responsibility:

What does the receiving physician do in patient transfers?

A

The receiving physician ensures that his or her facility is capable of providing necessary patient services to care for the patient.

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28
Q

Physician Responsibility:

What does the medical director of the critical care transportation agency do:

What do they provide?

A

Provides medical direction during transport

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29
Q

Physician Responsibility:

What does the medical director of the critical care transportation agency do:

What do they provide oversight for?

A

Medical oversight of the transportation operation includes determining minimal team composition and equipment requirements, education and practice.

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30
Q

Modes of Interfacility Transport:

A

Ground transport

Air transport

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31
Q

Modes of Interfacility Transport:

What should you consider?

A

Distance

The safety of the transport environment

Patient’s “out of hospital” time

The patient’s condition and the potential for complications

The patient’s need for critical or time-sensitive intervention

Traffic conditions

Weather conditions

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32
Q

Transfer Guidelines and Legal Implications:

What law exists

A

COBRA act of 1985; “antidumping” law

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33
Q

Transfer Guidelines and Legal Implications:

Provisions: What must hospitals provide?

A

Hospitals must provide screening examinations for every person who comes to the emergency department and requests care

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34
Q

Transfer Guidelines and Legal Implications:

Provisions:
If the patient has an emergency medical condition, what must the hospital provide? What must the provider do?

A

If the patient has an emergency medical condition, the hospital must provide stabilizing treatment or transfer the patient to another medical facility.

The physician must document that the medical benefits outweigh the risks of the transfer

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35
Q

Transfer Guidelines and Legal Implications:

Provisions:
Who is the transfer conducted by?

A

The transfer is conducted by qualified personnel, and appropriate equipment needed to provide care during the transfer is available.

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36
Q

Transfer Guidelines and Legal Implications:

Situations in which a patient is not stabilized, yet conditions are appropriate for transfer occur when:

A
  1. Risks of remaining at the initial facility are outweighed by the benefits of transfer
  2. The patient or family requests the transfer
  3. A physician is not present at the initial facility, but a qualified medical person certifies that the benefits outweigh the risks
  4. The transfer occurs with appropriate equipment and qualified personnel.
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37
Q

Phases of Interfacility Transport:

How many phases are there?

A

Five phases of transport have been identified.

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38
Q

Phases of Interfacility Transport:

Five phases of transport have been identified.

A
  1. Notification and acceptance by the receiving facility
  2. Preparation of the patient by the transport team
  3. The actual transport
  4. Turnover of the patient to the receiving hospital
  5. Continuous quality improvement monitoring after transport
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39
Q

Interfacility Transport

What must occur? Who is involved?

A

Benefits of the transport outweigh the risks

Specially trained transport team

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40
Q

Interfacility Transport

The SCCM guidelines: Who is involved?

A

Competent critical care nurse and at least one other person (respiratory therapist, RN, or critical care technician) accompany the patient.

Physician with training in airway management, advanced cardiac life support, and critical care or equivalent accompanies any unstable

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41
Q

Intrafacility Transport:

What is it also known as?

A

Also called intrahospital transport

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42
Q

Intrafacility Transport:

What does it include?

A

Includes the movement of patients out of the ICU to diagnostic procedure areas

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43
Q

Intrafacility Transport:

What does it not include?

A

Does not include transporting patients from the OR to an ICU or from the ICU to a step-down patient care area.

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44
Q

Intrafacility Transport:

What are patients vulnerable to?

A

Patients are vulnerable to acute changes in their clinical condition, and transport may further exacerbate their deterioration.

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45
Q

Intrafacility Transport:

What can reduce adverse event risk?

A

Use of a well-developed pretransport checklist can help reduce adverse event risk.

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46
Q

Intrafacility Transport:

What must we need to make sure about this kind transfer?

A

In this situation, we need to make sure a qualified nursing personnel follows the patient.

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47
Q

Logical Flow of Events

A

BLS

ACLS/AED

Ongoing assessment

Crowd control

Notification of family and communication

Family presence in code

If successful code, transfer to ICU

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48
Q

Logical Flow of Events:

What is included in ongoing assessment?

A

Pulse oximetry

ETCO2

Pulse checks

ABGs

Lab work

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49
Q

ACLS Summary

A

Treat patient, not monitor

CPR throughout

Early defibrillation essential

Use ETT as needed for medication administration

Provide treatment according to algorithms

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50
Q

ACLS Summary

What is important to do early?

A

Early defibrillation essential

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51
Q

ACLS Summary

What is done throughout?

A

CPR throughout

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52
Q

ACLS Summary

What is used for med administration?

A

Use ETT as needed for medication administration

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53
Q

Defibrillation: What does it do?

A

Completely depolarize the heart

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54
Q

Defibrillation: What does it allow for?

A

Allow for the resumption of rhythm

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55
Q

Defibrillation: What important when doing this?

A

Safety is essential

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56
Q

Defibrillation: What are complications of it?

A

Skin burns

Damage to heart muscle

57
Q

Defibrillation: what is it called?

A

Automatic implantable cardioverter-defibrillator (AICD)

58
Q

Defibrillation:

Automatic implantable cardioverter-defibrillator (AICD): What does it recognize?

A

Recognizes ectopy

59
Q

Defibrillation:

Automatic implantable cardioverter-defibrillator (AICD): What does it deliver?

A

Delivers countershock

60
Q

Defibrillation:

Automatic implantable cardioverter-defibrillator (AICD): What does it prevent?

A

Prevents episodes of sudden death

61
Q

Defibrillation:

Automatic implantable cardioverter-defibrillator (AICD):

What should be avoided?

A

Placement of the paddles near the ICD is to be avoided

Do not touch patient while analyzing because it could pick up your own rhythm.

62
Q

Procedure for Defibrillation:

A

Paddle or defibrillation pad placement

Good contact with skin (protect from burns)

Charge defibrillator to desired setting

“I’m clear, you’re clear, everyone clear, oxygen clear”

Adequate pressure with paddles

Shock

Continue CPR 2 minutes, then assess rhythm

63
Q

Automated External Defibrillation (AED):

What does it do?

A

External defibrillator with rhythm analysis capabilities

For cardiac arrest

64
Q

Automated External Defibrillation (AED):

Procedure:

A

Place two adhesive pads

Analysis by AED

Shock advisory

65
Q

Cardioversion:

What is it?

A

Electrical current

66
Q

Cardioversion:

How much power is used?

A

Lower joules (e.g., 50) compared to defibrillator

67
Q

Cardioversion:

What occurs?

A

Synchronized delivery on R wave (prevents “shock on T”)

68
Q

Cardioversion:

What does it disrupt?

A

Disrupts ectopic foci

Ectopic foci- the release of electrolyte stimuli in other places where it should be released.

69
Q

Overviewof Medications used in a Rapid Response?

A

Oxygen

Epinephrine

Vasopressin

Atropine

Amiodarone

Lidocaine

Adenosine

Magnesium

Sodium Bicarbonate

Dopamine

70
Q

Oxygen: What does it treat?

A

Treat hypoxemia

71
Q

Oxygen: What does it improve?

A

Improve tissue oxygenation

72
Q

Oxygen: How is it delivered?

A

Delivered via mouth to mask or bag-valve device (BVD) to mask or ETT

73
Q

Oxygen: During a cardiopulmonary arrest how much is oxygen is used?

A

During a cardiopulmonary arrest 100% oxygen (15 L/min via BVD)

74
Q

Epinephrine: What is it?

A

Potent vasoconstrictor

75
Q

Epinephrine: What kind of effect does it have?

A

Alpha- and beta-adrenergic effects

76
Q

Epinephrine: What kind of heart rhythms is it given for?

A

Ventricular fibrillation (VF),

pulseless ventricular tachycardia (VT),

and asystole

77
Q

Epinephrine:

How is it given?

A

1 mg (10 mL of a 1:10,000 solution) IV push every 3 to 5 minutes

Can also be given via ETT

78
Q

Epinephrine:

How is it given via ETT?

A

(through the ETT the dilution is 2 to 2.5 mg
diluted in 19 mL of NS or sterile water).

79
Q

Epinephrine:

How is it infused?

A

Continuous infusion begins at 1 mcg/min (1 mL in 250 or 500 mL of D5W or NS); infuse at 2-10 mcg/min and titrate as needed.

80
Q

Vasopressin: What is it?

A

Nonadrenergic vasopressor/alternative to epinephrine

81
Q

Vasopressin: What does it cause?

A

Intense vasoconstriction at high doses

82
Q

Vasopressin: How effective is it?

A

May be as effective as epinephrine

83
Q

Vasopressin: What is the dosing?

A

Onetime dose of 40 units IV for VF/pulseless VT

84
Q

Vasopressin: What is another way it can be given?

A

Can be given via ETT (dilute in 10 mL of NS)

85
Q

Atropine: What does it do?

A

Decreases vagal tone

86
Q

Atropine: What is it used to treat?

A

Symptomatic bradycardia

87
Q

Atropine:

Symptomatic bradycardia: What is the dosing?

A

0.5 mg every 3 to 5 min IV push
Maximum of 3 mg

88
Q

Atropine:

How else can this medication be given?

A

Can be given via ETT (2-3 mg diluted in 10 mL of NS or sterile water

89
Q

Amiodarone (Cordarone): What does it do?

A

Reduces membrane excitability

Prolongs the action potential and retards the refractory period;

90
Q

Amiodarone (Cordarone):

It prolongs the action potential and retards the refractory period; what does this lead to?

A

Prolongs the action potential and retards the refractory period; thus facilitates the termination of VT and VF

91
Q

Amiodarone (Cordarone):

What other properties does this drug have?

A

Alpha-adrenergic and beta-adrenergic blocking properties

92
Q

Amiodarone (Cordarone):

What is the dosing during a cardiac arrest?

A

During cardiac arrest 300 mg IV loading bolus

93
Q

Lidocaine: What is it?

A

Antidysrhythmic

94
Q

Lidocaine: What does it do?

A

Suppresses ventricular ectopy

95
Q

Lidocaine: What is the dosing?

A

Bolus 1 to 1.5 mg/kg; additional bolus 0.5 to 0.75 mg/kg every 5 to 10 minutes up to 3 mg/kg

96
Q

Lidocaine:

Bolus 1 to 1.5 mg/kg; additional bolus 0.5 to 0.75 mg/kg every 5 to 10 minutes up to 3 mg/kg

What should you follow with?

A

Follow with infusion at 2 to 4 mg/min (1 g in 250 mL 5% dextrose in water)

97
Q

Lidocaine:

Bolus 1 to 1.5 mg/kg; additional bolus 0.5 to 0.75 mg/kg every 5 to 10 minutes up to 3 mg/kg

Follow with infusion at 2 to 4 mg/min (1 g in 250 mL 5% dextrose in water)

What is the concentration?

A

Concentration: 1 mg/min = 15 mL/hr

98
Q

Lidocaine:

What should you always assess for?

A

Assess for lidocaine toxicity

99
Q

Lidocaine:

How else can it be administered? What is the dosing of this?

A

Can be administered via ETT tube (2-4 mg/kg diluted in 10 mL of NS or sterile water)

100
Q

Adenosine:

What does it do?

A

Slows conduction through AV node

101
Q

Adenosine:

What is the primary use of this drug?

A

Primary use for paroxysmal supraventricular tachycardia

102
Q

Adenosine:

How is it given?

A

Rapid IV push through port nearest insertion site of IV followed by rapid flush of 20 mL NS

103
Q

Adenosine:

What is the dosing?

A

The initial dose is a 6 mg IV push over 1 to 3 seconds, followed by a 20-mL rapid saline flush. Expect short pause in rhythm after administration

A second and third dose of 12 mg may be given 1 to 2 minutes later

104
Q

Magnesium: What is it given for?

A

Refractory VF, torsades de pointes (type of VT)

Known deficiency of magnesium

105
Q

Magnesium

What is the dosing given for VF/pulseless VT cardiac arrest?

A

When VF/pulseless VT cardiac arrest is associated with torsades de pointes, 1 to 2 g of magnesium sulfate diluted in 10 mL of D5W is given IV/IO over 5 to 20 minutes.

106
Q

Magnesium

What is the dosing given nonarrest situations?

A

In nonarrest situations, a loading dose of 1 to 2 g mixed in 50 to 100 mL of D5W is given over 5 to 60 minutes.

IV bolus followed by infusion titrated by magnesium levels

107
Q

Sodium Bicarbonate:

When is this given?

A

According to ABGs

108
Q

Sodium Bicarbonate:

What is this used to treat?

A

Treatment of metabolic acidosis

109
Q

Sodium Bicarbonate:

What is important to remember about this medication?

A

Do not mix with other medications (precipitate)

110
Q

Sodium Bicarbonate:

How often is this given? Why?

A

Rarely given; limited data available to support administration during arrest.

111
Q

Sodium Bicarbonate:

What is the dosing?

A

Initial dosage of sodium bicarbonate is 1 mEq/kg by IV push.

112
Q

If Sodium Bicarbonate is mixed with Mg, what happens?

A

Sb reduces effect of mg if mixed together.

113
Q

Dopamine:

What is it used to treat?

A

Symptomatic hypotension

114
Q

Dopamine:

What does it do?

A

Vasoactive (vasoconstrictor) to increase BP

115
Q

Dopamine:

How is it administered?

A

Continuous drip

116
Q

Dopamine:

Continuous drip

A

2 to 5 mcg/kg/min (learn calculations)

117
Q

Dopamine:

What is the dose dependent on?

A

Dose is dependent on blood pressure control

118
Q

Dopamine:

In doses greater than 20 mcg/kg/min, what happens?

A

In doses greater than 20 mcg/kg/min, marked vasoconstriction occurs

119
Q

Dopamine:

Why do effects occur?

A

Effects dose related

120
Q

Dopamine:

What do moderate doses do?

A

Moderate doses = cardiac doses

121
Q

Dopamine:

What do higher doses do?

A

Higher doses = vasopressor doses

122
Q

Dopamine:

What should you consider before giving dopamine?

A

Consider need for fluids versus dopamine

123
Q

Lifestyle Considerations:

What should older adults have?

A

Advance directives for the older patient

124
Q

Lifestyle Considerations:

What so older adults have an increased incidence of?

A

Older adults have an increased incidence of complications during an arrest (rib fractures)

125
Q

Lifestyle Considerations:

What occurs with people with renal or hepatic disease?

A

Higher drug concentrations with renal and or hepatic disease

126
Q

Lifestyle Considerations:

What kind of responses differ?

A

Differing responses to beta-adrenergics

127
Q

Lifestyle Considerations:

What is important to remember about some meds?

A

Narrow therapeutic range of some medications

128
Q

Lifestyle Considerations:

What is less effective in older adults?

A

CPR is less effective with older adults with comorbidities.

129
Q

Documentation of Events

What should someone be assigned to do during a code?

A

Assign someone to document events during the code and record rhythm strips

130
Q

Documentation of Events

Assign someone to document events during the code and record rhythm strips:

What is included?

A

Time started

Actions taken and patient’s response

Intubation and airway management

Vital signs

Team members present

131
Q

Documentation of Events

Assign someone to document events during the code and record rhythm strips:

Actions taken and patient’s response can include?

A

Defibrillation

Medications

Procedures

Pacemakers

132
Q

Postresuscitation:

What are the goals?

A

Optimize cardiopulmonary function

Transport to critical care unit

Determine cause of arrest to prevent

133
Q

Postresuscitation:

What is there management of?

A

Management of patient care continues

134
Q

Post-CPR Interventions:

What is included?

A

12-lead ECG

Arterial line

Pulmonary artery catheter

Indwelling urinary catheter for hourly output

NG tube if bowel sounds are absent or if patient is mechanically ventilated

Serial neurological exams

135
Q

Post-CPR Interventions:

Why is an indwelling urinary catheter put in?

A

Indwelling urinary catheter for hourly output

136
Q

Post-CPR Interventions:

Why is an NG tube put in?

A

NG tube if bowel sounds are absent or if patient is mechanically ventilated

137
Q

Post-CPR Care:

What is included?

A

Palliative comfort care

Head CT scan and EEG if comatose

Blood glucose levels (may be hyperglycemic)

138
Q

Post-CPR Care:

Palliative comfort care: What is included?

A

Pain management

Sedation

Anxiety management

139
Q

Supporting the Family:

Should they be present during a code?

A

Providing information

Active communication

Visitation after a code

Support from chaplain and nursing staff

NURS 428: Evolution (17 decks)

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