Week 2: Role in a Code Flashcards
what are the various roles in a code blue?
- lead: usually physician directing interventions
- recorder: taking note of which interventions were done at what time
- airway: bagging patient
- medications
- compressions
- crash cart
- runner
we have a RACE and CODE team
what are the 3 modes of a Defibrillator
- cardiovert - big energy
- shock - defibrillation (big energy)
- pacing - little energy
what is defibrillation
method of terminating ventricular fibrillation / pulseless VT
- passes electrical shock to depolarize the cells of myocardium to allow SA node to resume pacemaker role
- ensure that after shock, chest compressions are restarted
Monophasic vs biphasic defibrillators
mono = delivers energy in one direction
bi = deliver energy in 2 directions
What is synchronized cardioversion
used for hemodynamically unstable ventricular or supraventricular tachydysrhythmias
- delivers a counter shock on R wave of QRS
- it marks the ST segment to avoid shock during relative refractory period
when do you use defibrillation
- pulseless ventricular tachycardia
- ventricular fibrillation
when do you use cardioversion
- unstable atrial fibrillation
- unstable atrial flutter
- unstable atrial tachycardia
- unstable supraventricular tachycardia
- medication failure
what does pacing do? when do we use it?
paces heart when normal conduction pathway is damaged or diseased (very bradycardic)
- used to prevent bradycardia or tachycardia rhythms
what is a pacemaker spike and what do we want after it
application of energy
- want a complex after each spike to show depolarization present
- if there is no complex, we need to increase the energy to cause contraction
4 types of pacemakers
- temporary transcutaneous pacemaker (pads through tissue)
- temporary transvenous pacemaker (cardiac surgery to implant)
- permanent pacemaker (implanted under skin and collar bone, wires implanted into heart areas)
- implantable cardioverter defibrillator (ICD) - implanted in case of cardiac arrest to dfib person right away
what are we assessing if checking if patient is stable?
- Circulation
- Airway
- Breathing
What is the basic first assessment
- temperature
- oxygen saturation
- blood pressure
- heart rate
- respiratory rate
what are some normal neurological check assessment findings
- alert/easily aroused
- oriented
- responds appropriately
- interacts meaningfully
what are some abnormal neurological check assessment findings
- lethargic: drowsy, appropriate but slow thinking, inattentive, decrease in spontaneous movement
- obtunded: difficult to arouse, confused, mumbled speech, incoherent, monosyllabic, requires constant stimulation
- stupor/semi-coma: only responds to physical stimulation, pain, groans, reflexes present
- coma: completely unconscious, no response to pain
- light coma: some reflex activity, no purposeful movement
- deep coma: no motor response
what is the glasgow coma scale
measure of consciousness
- 15 = fully alert and oriented
- 8 or less = endotracheal intubation to protect airway (coma)
potential neurological causes of unresponsiveness
stroke
seizure
trauma
potential cardiovascular causes of unresponsiveness
myocardial infarction
cardiac arrhythmia
cardiac arrest
potential respiratory causes of unresponsiveness
pulmonary embolism
respiratory arrest (choking, opioid overdose)
potential endocrine causes of unresponsiveness
hypoglycemia
you walk into a patient’s room, and they are unresponsive. what do you do?
feel for pulse, try to awake them
- take vitals
- no pulse start chest compressions
what do you do if there is a definite pulse and normal breathing? what are some examples that can lead to this state?
- vital signs
- assess responsiveness
- glasgow coma scale
- bloodwork/imaging tests
examples: stroke/TIA, slow brain bleed, medication
what do you do if there is a definite pulse and no breathing? what are some examples that can lead to this state?
“C” - pulse check, check respirations
“A” - Airway check
“B” - breathing via bag valve mask
- 1 breath every 5-6 seconds
- pulse check every 2 min
examples: obstruction, inadequate respiratory effort, medications
what do you do if there is no pulse and no breathing?
Immediate chest compressions
- hard & fast (100-120 compressions per minute)
- depth of at least 2 inches (5cm)
- allow chest recoil
- minimize interruptions in compressions
- open the airway
- breathing bia bag valve mask (30 compressions: 2 breaths)
what do you do when the code team arrives?
provide appropriate report
