What is closed loop communication?
when the person receiving instruction or information repeats it back to make sure the message is understood correctly, and the sender confirms to “close the loop.”
How do we know we are performing high quality CPR?
Rate: 100-120 beats per minute, 30 compressions
Depth: 2 inches with complete recoil
Breaths: 2 breaths after every 30 compressions (30:2)
- we go for about 5 cycles (2 minutes) of compressions and then switch.
What is the chain of survival?
- early recognition and prevention
- activation of emergency response
- high quality CPR
- defibrillation
- post cardiac arrest care
- recovery
What is the cardiac arrest algorithm w/ a shockable rhythm?
- Begin CPR
- check for a shockable rhythm.
- Ventricular Fib & Ventricular Tachycardia are shockable. - Shock the patient and then continue with CPR for 2 minutes. Re-check the rhythm.
- If there are signs of ROSC follow post cardiac algorithm.
If it’s shockable, shock the patient again and administer epinephrine, establish advanced airway and continue CPR for 2 more minutes
- Re-check the rhythm and start the cycle over or follow post cardiac arrest algorithm for ROSC.
What is the cardiac arrest algorithm w/o a shockable rhythm?
- Begin CPR
- Check the rhythm. Is it shockable? - Asystole & Pulseless Electrical Activity (PEA) are NOT shockable.
- Continue CPR for another 2 minutes, administer epinephrine and establish advanced airway.
- re- check the rhythm, if there are signs of ROSC then follow post cardiac arrest algorithm
If it’s a shockable rhythm then you will follow shockable rhythm algorithms.
If it is not a shockable rhythm you will continue CPR for another two minutes and administer epinephrine again.
- Re check the rhythm and then start the cycle over based on the rhythm noted, or start the post cardiac arrest protocol if ROSC occurs.
What is ROSC? What does it mean?
Return of spontaneous circulation (ROSC) is the restart of a sustained heart rhythm that permeates the body after a cardiac arrest.
What are the team roles during a code?
- Team Leader - the physician
- Code Recorder - writes everything that happens down
- Compressors - 2-5 people
- Defibrillator - 1 person only
- Airway - Respiratory or RN
- Medications - pharmacy or ACLS certified nurse
- Bedside RN - Information about the patient
- Runner - to get supplies.
- Charge nurse
What is the goal in a code?
Establish a pulse, and treat the underlying cause!
What is PEA and how do we treat it?
pulseless electrical activity is when the patient has a normal rhythm but no pulse.
we can’t shock this rhythm, we have to do CPR and give medication.
What is asystole and how so we treat it?
this rhythm has no p wave and no QRS complexes.
we can’t shock this rhythm, we just do CPR and give medications.
What is a 3rd degree heart block and how do we treat it?
this rhythm has irregular P-R intervals and may have many p waves, the R may also skip or be flat.
we can’t shock this rhythm, it needs to be paced.
What is v-tach and how do we treat it?
monomorphic ventricular tachycardia has no p waves and a wide QRS complex that resembles a saw, the beats look the same each time.
polymorphic ventricular tachycardia is similar to mono but the QRS complex can vary each time and the saw look is distorted.
pulse: we give medications and then shock
no pulse: we do CPR, shock and give medications
What is torsades de pointes and how do we treat it?
it is another form of ventricular tachycardia, that appears as if its twisting around like a tornado.
we treat this with iv magnesium, and have a defibrillator ready
What is v-fib and how do we treat it?
ventricular fibrillation has no p wave and no pulse, the heart is quivering (looks like little waves)
we can shock the rhythm and perform CPR with medications.
What is a-fib and how do we treat it?
atrial fibrillation is irregular and has too many p waves to count, but the QRS is normal.
we can shock this rhythm
What is epinephrine used for?
to speed up the heart and increase the blood pressure.
it’s the first medication to be given in a code and can be given every 3-5 minutes
What is amiodarone used for?
used as an antiarrhythmic for VT & VF with or without a pulse.
used only after defibrillation and epinephrine, max dose of 300mg and then 150mg initial dose.
What is lidocaine used for?
used as an antiarrhythmic for VT & VF to block sodium channels.
used only after amiodarone
What is atropine used for?
gasoline for the heart, it speeds up the heart rate, first line treatment for bradycardia, will not work in asystole.
max does is 3mg
What are the H’s of cardiac arrest?
hypoxia, hypovolemia, hypothermia, hyper/hypokalemia, and hydrogen ions (acidosis)
What are the T’s of cardiac arrest?
tension pneumothorax, tamponade, toxins,
thrombosis: pulmonary or coronary.
What is I-STAT ?
i-stat is used at the bedside for quick critical care tests of a patients blood to check things such as blood gases, electrolytes, metabolites, and coagulation.
What is the post cardiac arrest alogrithm?
- ROSC is obtained
- Manage airway and monitor respiratory status
- ECG
- determine if the patient is comatose or arousable/awake
- Treat any underlying causes
What is TTM?
targeted temperature management - cool the patient down to 30-36 C for 24 hours and them warming them up slowly by 1/2 degree every hour to preserve brain/neuro function.
