Transcript “Putting it All Together”

“Putting it All Together”
Diane E. White RN CCRN PhD
Members of the Code Team
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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
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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
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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
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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,
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Dopamine 5-20mcg/kg/min, Epinephrine 2-10 mcg/min,
or Isoprel 2-10 mcg/min
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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
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