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Code Blue Competency 2015

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by

Heidi Mack

on 11 November 2015

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Transcript of Code Blue Competency 2015

Misc Drugs
Tachycardia
Bradycardia
H & T's
PEA/Asystole
& BLS

Ventricular
Arrythmias

When is bicarbonate therapy appropriate?
What drug was given?
Adenosine
Pre-existing metabolic acidosis
Patients with known hyperkalemia
TCA overdose patients
Known base deficit from ABG
What are the 2 most common drug options for treatment of bradycardia?
Atropine- 0.5mg IV Q3min (max 3 mg)
Dopamine- begin drip @ 3-5mcg/kg/min
Name 4 of the H & T's
H & T's
Hypovolemia Toxins
Hypoxia Tamponade (cardiac)
Hydrogen-Ion Acidosis Thrombosis (PE or ACS)
Hyper/hypokalemia Trauma
Hypothermia Tension Pneumothorax
Hypoglycemia


What is the appropriate CPR rate/min per guidelines?
100 compressions/min
Are all ventricular arrhythmia's pulseless?
No!
What is the pneumonic to help remember medications that can be administered via ET tube?
NAVEL
List the 10 Items needed to properly restock a code cart
Tray, White Lock, 3 code sheets, code blue record, Code blue drug sheet, Red dots, Red lock, Emergency Treatment orderset
What is the most common initial rhythm in cardiac arrests at Mission?
PEA
What % of patients code outside of the ER/ICU's?
36%- which is why its important that all pharmacists feel comfortable in a code situation
DAILY DOUBLE
Send 1 member of your team to the code cart to find:
Calcium Gluconate vial
Lidocaine syringe
Intubation kit
Will atropine help in a post cardiac transplant patient with bradycardia?
NO
Is hyperglycemia a concern?
No- only hypoglycemia
Is atropine recommended for PEA?
No longer recommended in newest guidelines, will still see in practice
List the order of therapy you would give over 10 minutes in a patient in pulseless v-fib
CPR
Shock
EPI/Vasopressin
Shock
Antiarrythmic- Amiodarone or Lidocaine
Epi/Vasopressin

Is digoxin recommended as part of ACLS guidelines?
No
Daily Double
Send 1 member of your team to your code cart and find:
Epinephrine 30ml vial
Tubing for IV pump
Norepinephrine vial
List 3 drugs that can be used to treat hyperkalemia DURING ACLS
Calcium - stabilizes membrane
Sodium Bicarbonate - pushes K+ into cells
Insulin/Dextrose - pushes K+ into cells
Albuterol - pushes K+ into cells
Daily Double
Send 1 member of your team to your designated code cart and find:
1L bolus of NS
Code Blue Debriefing Sheet
ABG kit
Outside of shocking, what is your primary drug therapy for Ventricular Arrythmias?
Epinephrine
Per Guidelines:
90 year old, 45 kg patient: what dose of diltiazem would you give?
1st bolus: 0.25 mg/kg= 11mg
2nd bolus: 0.35 mg/kg=15 mg
Begin drip @ 5mg/hr
What is the preferred non-pharmacologic therapy for treatment of bradycardia?
Transcutaneous pacing
What is appropriate TPA dosing for a Code Stroke patient?
0.9 mg/kg up to 90 mg max
10% given as a bolus and remainder over 1 hour
What is the drug of choice for PEA?
Epinephrine
What is the electrolyte that may be beneficial w/ ventricular arrhythmias?
Magnesium
Your patient has a narrow complex tachycardia, MD wants to use lidocaine for treatment, is this appropriate?
No, Why?
List 3 common drugs that a patient could take that could potentiate bradycardia
Beta blocker
Non-dihydropyridine Calcium Channel Blockers
Digoxin
Your patient presents with an opioid overdose in cardiac arrest- what drug would you use to treat this toxin?
Narcan- 0.4-2 mg IVP, repeat Q2-3 min as needed
You're grabbing a coffee at the bean shop and witness a patient collapse. What number do you call to activate a code?
5-1-1 if in Mission
9-1-1 if outside of Mission
How do you administer amiodarone to a patient in pulseless arrest?
Draw 300 mg (2 vials) up into a syringe and push undiluted.
Flush with 10 cc NS syringe.
Code Blue Jeopardy 2015
Make sure to check a patients pulse before starting CPR!
Patients can have a stable v-tach (with pulse)
Think of songs:
Staying Alive
Another One Bites The Dust
Drug Dosing:
Epinephrine: 1mg IV/IO Q3-5min
Vasopressin: 40 units IV/IO to replace 1st or 2nd dose of Epinephrine
Amiodarone (1st line): 300mg IV/IO x1, repeat dose of 150mg IV/IO in 3-5 minutes if needed
Lidocaine: 1-1.5mg/kg IV x 1, repeat dose of 0.5-0.75 mg/kg IV (max dose 3mg/kg total)
Naloxone
Atropine
Vasopressin
Epinephrine
Lidocaine
Remember: Dose is 2-2.5 times the IV dose
(for all except vasopressin)
Stimulates alpha adrenergic receptors on smooth muscle of peripheral vessels which leads to:
Arterial vasoconstriction---> increases coronary blood flow, cerebral blood flow and cerebral perfusion pressure (CPP)
May promote defibrillation

Does improve rate of ROSC, but no difference in rates of survival
Lidocaine works on sodium channels, predominately found in the ventricles
Adenosine dosing:
6mg IVP, flush immediately after administration
Repeat 12 mg IVP, flush
Repeat 12 mg IVP, flush
Patient will go asystolic for a few beats after administration- warn the patient before giving if they are awake enough
Cardiac transplant patients:
Atropine will likely be ineffective as the transplanted heart lacks vagal innervation
Per Mission protocol:
1st bolus: 20 mg
2nd bolus: 25 mg
Begin drip @ 5 mg/hr
Changes to the code blue carts:

Amiodarone-
B-Braun 100ml NS bags will be replaced with a PVC 100ml D5W bag for 150mg dose administration.
Will still need to obtain premade drip from pharmacy or pyxis machine once bolus doses are complete
Changes to the code blue cart:

Epinephrine 30 ml vials will not be removed from code carts at Mission- will have additional labeling added to improve safety
Remember its a 1mg/ml concentration- so draw up 1 ml at a time!!!!!

Vasopressin: Will be removed from code carts and placed in refrigerators
This is due to new product and storage information

Magnesium Sulfate during cardiac arrest - 2 gram IV push (or over 5 minutes)
Let's practice!

Mr. Jones is an 80 kg man who just had a stroke and Dr. Larson has requested tPA immediately to the bed side!


Questions?
Magnesium Sulfate:
Vials are still on backorder
Known struggle to pull medication from bag
FIX!!!!
These pins will hopefully be added to code cart soon
Full transcript