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“Putting it All Together”. Diane E. White RN CCRN PhD. Members of the Code Team. Leader: identifies ECG rhythm and directs team to appropriate actions IV nurse: establish IV access and administers medications
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“Putting it All Together” Diane E. White RN CCRN PhD
Members of the Code Team • Leader: identifies ECG rhythm and directs team to appropriate actions • IV nurse: establish IV access and administers medications • Code Cart Nurse: prepares medications & provides needed equipment, etc.. Monitor of defibrillator, etc.. • Recorder: records events of code; returns cart according to hospital policy • Airway/CPR persons (2)
Primary ABCD • Check unresponsiveness • Activate EMS: may leave adult victim if alone • Call for defibrillator • Airway • Breathing • Circulation: Check Pulse, IV access, CPR • Defibrillation: 200 joules or 360 joules (always yell “clear” prior to defibrillation)!
Ventricular Fibrillation & Pulseless Ventricular Tachycardia • ABCD • Epinephrine 1 mg IVP every 3-5 minutes or Single dose of Vasopressin 40 units • Shock 200 or 360 (monophasic) • CPR • Drug (antiarrhythmics): • Amiodarone 150mg IVP; may repeat • Lidocaine 1mg/kg IVP • MUST begin IV drip of antiarrhythmic that converts patient
Asystole • Rapid Scene Survey • ABCD • Epinephrine 1mg IVP every 3-5 minutes • CPR • Atropine 1mg IVP repeat every 3-5 minutes up to a total dose of .04 mg/kg • CPR • Consider resuscitative efforts
Pulseless Electrical Activity (PEA) • Rhythm on monitor but no pulse • ABCD • Fix Cause: hypothermia, hypoxia, hydrogen ion-acidosis, hyper or hypokalemia, hypovolemia, drug overdose, tamponade, tension pneumothorax, thrombosis coronary, thrombosis pulmonary • Epinephrine 1mg IVP every 3-5 minutes • Atropine 1mg IVP every 3-5 minutes up to .04 mg/kg
Bradycardia • ABC’s • Symptomatic or Asymptomatic? • Yes – Atropine .5-1mg IVP, transcutaneous pacing, Dopamine 5-20mcg/kg/min, Epinephrine 2-10 mcg/min, or Isoprel 2-10 mcg/min • No – Type II second-degree block or Type III prepare for transvenous pacer or if not, just observe patient
Tachycardia • Stable or Unstable? • Stable – determine rapid rhythm and treat accordingly • Unstable – prepare for cardioversion (O2, suction, airway, and IV access) • Synchronized cardioversion -50j - 200j