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27 Cards in this Set
- Front
- Back
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Code Team
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Varies with Hospital
ICU nurses frequently on team Better patient management Care according to ACLS standards Other health care workers manage other patients |
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Team Members
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Director usually an MD
Nurses Primary nurse knows patient Second nurse medications and crash cart Supervisor traffic control and beds Anesthesia/anesthetist intubation Respiratory care manage airway/sometimes intubate EKG Pharmacy Runner Pastoral services |
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Equipment
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Crash cart
Backboard Airway supplies/suction Monitor/ defibrillator/pacer AED Medications IV supplies |
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Things to Know
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Where is the cart located?
How to unlock it Know what is stocked on the cart O2 and suction If child sized pieces are available if needed (ER, Peds) |
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Sequence of Events-BCLS
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Circulation- Chest compressions
Airway open Breathing Mouth to mask Bag-valve-device (BVD/mask) |
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Sequence of Events- ACLS
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Primary survey
Circulation Airway, Breathing, Defibrillation Secondary survey Airway management Intubation Manual ventilation IV access Differential Diagnosis |
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Logical flow of Events
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BCLS
ACLS Ongoing assessment: Pulse checks Pulse oximetry ETCO2 ABGs Lab work Crowd control Documentation Notification of family and communication Transfer to ICU |
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ACLS: IV Access
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Large bore IVs
Biggest veins- antecubital best May insert central line Fluids Normal saline |
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ACLS: Drugs
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Use of ET tube if needed: ALE
Atropine Lidocaine Epinephrine Narcan |
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Intubation
Equipment needed |
Laryngoscope blade and handle
Suction set up Syringe/tape Endotracheal tube Adult-size 8 common Peds-the size of the peds patients little finger |
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Premature Ventricular Contractions (PVCs)
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An ectopic foci in the ventricles discharges an impulse before the SA node.
Treatment for PVCs For frequent PVCs (greater than 6/min, multifocal, runs of PVCs) Check electrolytes, oxygenation Give Lidocaine bolus at 1.0-1.5 mg/kg AND Start an Lidocaine infusion at 1-4 mg/min OR Amiodarone 150mg IV over 10 min AND Start Amiodarone drip |
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Ventricular Tachycardia
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An ectopic foci in the ventricles becomes the pacemaker of the heart.
Treatment for VT with a pulse Oxygen Lidocaine IV bolus-0.5-0.75 mg/kg and hang drip OR Amiodarone 150 mg IV over 10 minutes and hang drip Synchronized Cardioversion |
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Ventricular Fibrillation
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Normal electrical conduction is replaced by chaotic activity in the ventricle
Treatment of VF or pulseless VT CABD Shock, Shock, Shock 200, 300, 360 joules Intubate Epinephrine or vasopressin Defibrillate Drug-Shock continues Amiodorone or Lidocaine Defibrillate Epinephrine repeated as needed every 3-5 min Consider other drugs Amiodorone Lidocaine Mag sulfate Procanamide Sodium bicarbonate – only if acidotic |
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Symptomatic Bradycardia
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The SA node discharges impulses more slowly than normal and conduction continues in a normal fashion through the rest of the heart.
Treatment for Symptomatic Bradycardia If the patient is symptomatic (light headed, decreased BP, decreased U. O) Give Atropine IV 0.5mg to 1.0 mg until a maximum of 3.0 mg have been given Consider transcutaneous pacing May need sedation Dopamine infusion at 5-10 mcg/kg/min |
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Pulseless Electrical Activity (PEA)
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The patient has electrical activity on the monitor but no pulse
Treatment for PEA Begin CPR Airway, oxygen, intubate, IV access Epinephrine 1mg IVP (Epinephrine may be repeated every 3-5 minutes) Atropine 1 mg IV (may repeat in 3-5 minutes until a total of 0.04 mg/kg is given) Treat cause (5 H’s and 5 T’s) |
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Asystole
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No electrical activity is happening. No pacemaker is firing
Treatment for Asystole ABC Airway, oxygen, intubate, IV access Confirm in 2 leads Consider transcutaneous pacemaker – last resort Epinephrine Atropine |
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Oxygen
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Indications:
Oxygen should be given to all patients with: Acute chest pain that may be due to cardiac ischemia Suspected hypoxia Cardiopulmonary arrest Prompt treatment of hypoxemia may prevent cardiac arrest Dosage: To administer, use 100% 02 via a bag/valve mask Pulse oximetry helps to maintain oxygen saturation level Precautions: Never withhold oxygen because of possible adverse effects If using pulse oximetry to monitor oxygen saturation levels be aware that decrease cardiac output or vasoconstriction can make the results inaccurate |
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Epinephrine
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Epinephrine effects in the dosage used during arrest are:
Increased heart rate Increased myocardial contractility Increased SVR Increased BP Increased coronary and cerebral blood flow Increased myocardial oxygen requirements Increased automaticity Indications: Elevation of coronary perfusion pressure is a beneficial effect applicable to all forms of cardiopulmonary arrest Used in cardiac arrest: VF, Pulseless VT and PEA Used for symptomatic bradycardia if other therapies are ineffective Used for severe hypotension Dosage of Epinephrine IV dose: 1 mg (10cc of 1:10,000 solution administer every 3-5 minutes during resuscitation. Follow each dose with 20 cc of IV flush. May repeat often Continuous infusion: Add 30 mg epinephrine (30cc of 1:1000 solution) to 250 cc of NS or D5W and run at 100 cc/hr to titrate to the desired effect. Infuse on an infusion pump ET tube route: 2.0-2.5 mg diluted in 10 cc of NS. Insert the suction catheter into the ET tube. Stop compressions. Instill the medication and then ventilate with several quick ventilations Precautions- Epinephrine Should not be added to a bicarbonate infusion Monitor the patient for hypertension and tachyarrhythmias Can precipitate or exacerbate myocardial ischemia Observe the IV site for infiltration |
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Vasopressin
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Non-adrenergic vasopressor
Intense vasoconstriction at high doses May be as effective as epinephrine One-time dose of 40 units IV for ventricular fibrillation/pulseless VTach Usefulness in PEA and asystole being evaluated Atropine Used to treat symptomatic bradycardia. Symptomatic bradycardia includes decreased heart rate, decreased BP, decreased urinary output, ↓LOC. If patient is having PVCs with bradycardia, treat the heart rate first and the PVCs may go away. May be used in the presence of AV block or ventricular asystole Dosage of Atropine Asystole or PEA: 1mg IV push. May repeat in 3-5 minutes for a maximum dose of 0.03-0.04mg/kg Bradycardia: 0.5-1.0mg IV every 3-5 minutes, not to exceed total dose of 0.04mg/kg (or about 3 mg) ET tube administration: 2-3 mg diluted in 10 cc NS. Instilled into the ET followed by several quick ventilations Precautions- Atropine Because Atropine speeds up the heart rate it may be detrimental in patients with acute myocardial ischemia Excessive doses may cause delirium, tachycardia, coma, flushed, hot skin ataxia and blurred vision Should not be used with hypothermic bradycardia, warm patient up instead to increase HR |
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Amiodarone
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Antiarrhythmic
Works by prolonging the action potential and refractory periods. It also inhibits adrenergic stimulation, slows the sinus rate, increases PR and QT intervals and decreases peripheral vascular resistance. Indications-Amiodarone Used for the management of life threatening ventricular arrhythmias May also be used for Atrial fibrillation or flutter Dosage of Amiodarone In pulseless VTach/VFib- 300mg IV- May repeat at 150mg x 1 followed by drip as below For VTach with pulse, other tachydysrhythmias: Initially the patient will receive 150 mg IV over 10 minutes (dilute 150 mg in 100cc of solution). Then using the concentration (900mg in 500cc solution) infuse 1 mg/min for 6 hours. Followed by a continuous infusion 0.5 mg/min via an infusion pump Precautions- Amiodarone Use cautiously in patients with CHF, thyroid disease, and severe pulmonary or liver disease Monitor BP, HR, signs of ARDS (rales, dyspnea, tachypnea) |
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Lidocaine
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Antiarrhythmic
Suppresses ventricular arrhythmias by decreasing depolarization, automaticity, and excitability of the ventricles Because it decreases myocardial irritability it may reduce the instances of sudden cardiac death Used to suppress ventricular ectopy such as VT and VF as well as PVCs especially in patients with ischemic heart disease. Used in VF that has converted with initial defibrillation while reasons for VF is explored Dosage of Lidocaine Initial dose: 1.0-1.5 mg/kg IV. May repeat in 3-5 minutes at half the dose until a maximum dose of 3 mg/kg has been reached. Infusion: 1-4 mg/min ET administration: 2-4 mg/kg Precautions-Lidocaine Excessive dosages may cause myocardial and circulatory depression. Indicators of toxicity include: drowsiness, disorientation, decreased parenthesis and muscle twitching. Grand mal seizures are a serious sign of toxicity. |
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Dopamine
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Dopamine
A catecholamine (sympathomimetic) whose effects are dose related Low doses-0.5-2 mcg/kg/min-produces a vasodilating effect on the renal, mesenteric and cerebral arteries. Urinary output increases while HR and BP stay the same Doses of 2-10 mcg/kg/min-produces beta effects which increases cardiac output due to enhanced myocardial contractility Higher doses-above 10-20 mcg/kg/min-produces alpha effects which cause vasoconstriction Dopamine-Indications Used in hypotension in the absences of hypovolemia. Hypotension should be accompanied by poor tissue perfusion, oliguria, or changes in level of consciousness Should be used at the lowest dose possible. Dosage- Dopamine Usually dose for hypotension is 5-10 mcg/kg/min and titrated to patient’s response Must be given as an infusion on a pump May be mixed with NS, D5W or RL Precautions-Dopamine Should not be added to solutions containing sodium bicarbonate since dopamine is inactivated in an alkaline pH Frequently cause N and V Infiltration may cause tissue necrosis Increase myocardial oxygen demands so it should be given with caution in MI patients Do not decrease abruptly-may cause rebound hypotension Titrate to the BP. Monitor BP, UO, mental status, skin color, capillary refill MAO inhibitors and tricyclic antidepressants may potentiate dopamine’s hypertensive effects. Should be given with caution in patients taking Dilantin since additional hypotension and bradycardia may occur Must hang a new infusion bag every 24 hours. |
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Diltiazem (Cardiazem)
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Calcium channel blocker
Useful in PSVT, especially associated with atrial fibrillation or flutter IV bolus (0.25mg/kg) followed by infusion (5-15mg/hr). |
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Magnesium
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Refractory Ventricular Fibillation - reoccurring
Torsades de Pointes (type of Ventricular tachycardia) Known deficiency IV bolus followed by infusion titrated by magnesium levels |
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Norepinephrine (Levophed)
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Vasopressor
Continuous infusion of 0.5 to 20mcg/min Very potent, can cause loss of digits |
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Calcium Chloride
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Underlying problem
Hypocalcemia Hyperkalemia Calcium channel blocker toxicity IV push |
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Morphine
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Ischemic chest pain
Pulmonary edema Increases venous capitance |
