“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 Leader: identifies ECG rhythm and directs team to appropriate actions IV nurse: establish IV access and administers medications IV nurse: establish IV access and administers medications Code Cart Nurse: prepares medications & provides needed equipment, etc.. Monitor of defibrillator, etc.. Code Cart Nurse: prepares medications & provides needed equipment, etc.. Monitor of defibrillator, etc.. Recorder: records events of code; returns cart according to hospital policy Recorder: records events of code; returns cart according to hospital policy Airway/CPR persons (2) Airway/CPR persons (2)

Primary ABCD Check unresponsiveness Check unresponsiveness Activate EMS: may leave adult victim if alone Activate EMS: may leave adult victim if alone Call for defibrillator Call for defibrillator Airway Airway Breathing Breathing Circulation: Check Pulse, IV access, CPR Circulation: Check Pulse, IV access, CPR Defibrillation: 200 joules or 360 joules (always yell “clear” prior to defibrillation)! Defibrillation: 200 joules or 360 joules (always yell “clear” prior to defibrillation)!

Ventricular Fibrillation & Pulseless Ventricular Tachycardia ABCD ABCD Epinephrine 1 mg IVP every 3-5 minutes or Single dose of Vasopressin 40 units Epinephrine 1 mg IVP every 3-5 minutes or Single dose of Vasopressin 40 units Shock 200 or 360 (monophasic) Shock 200 or 360 (monophasic) CPR CPR Drug (antiarrhythmics): Drug (antiarrhythmics): –Amiodarone 150mg IVP; may repeat –Lidocaine 1mg/kg IVP  MUST begin IV drip of antiarrhythmic that converts patient

Asystole Rapid Scene Survey Rapid Scene Survey ABCD ABCD Epinephrine 1mg IVP every 3-5 minutes Epinephrine 1mg IVP every 3-5 minutes CPR CPR Atropine 1mg IVP repeat every 3-5 minutes up to a total dose of.04 mg/kg Atropine 1mg IVP repeat every 3-5 minutes up to a total dose of.04 mg/kg CPR CPR Consider resuscitative efforts Consider resuscitative efforts

Pulseless Electrical Activity (PEA) Rhythm on monitor but no pulse Rhythm on monitor but no pulse ABCD ABCD Fix Cause: hypothermia, hypoxia, hydrogen ion- acidosis, hyper or hypokalemia, hypovolemia, drug overdose, tamponade, tension pneumothorax, thrombosis coronary, thrombosis pulmonary 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 Epinephrine 1mg IVP every 3-5 minutes Atropine 1mg IVP every 3-5 minutes up to.04 mg/kg Atropine 1mg IVP every 3-5 minutes up to.04 mg/kg

Bradycardia ABC’s ABC’s Symptomatic or Asymptomatic? 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 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 No – Type II second-degree block or Type III prepare for transvenous pacer or if not, just observe patient

Tachycardia Stable or Unstable? Stable or Unstable? Stable – determine rapid rhythm and treat accordingly Stable – determine rapid rhythm and treat accordingly Unstable – prepare for cardioversion (O2, suction, airway, and IV access) Unstable – prepare for cardioversion (O2, suction, airway, and IV access) Synchronized cardioversion -50j - 200j Synchronized cardioversion -50j - 200j