Responding to a Code
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Transcript of Responding to a Code
04/19/23 2
Today’s Objectives…
Identify clinical situations in which a code would be called. Differentiate a code for respiratory arrest versus cardiac arrest. State emergency measures when initiating a code before the
code team arrives. Identify dysrhythmias and interventions experienced in a code
situation. Discuss the specific roles of each of the emergency team
members. Discuss the role of the patient’s assigned nurse in a code
situation. Practice responding to a code including recording on a code
record. State actions for using a portable defibrillator.
04/19/23 3
Today’s Schedule…
Past experiences with codes Discussion of legal and ethical issues Code team membership Responsibility of each member Equipment and safety issues Brief review CPR protocols/defibrillation Implementation of code scenarios/debriefing Post code issues
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Legal & Ethical Issues
DNR order No DNR order Advanced directives Organ donation Code review Ethic Committee
Code Team Responsibilities
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Primary nurse caring for patient Second nurse (possibly from code team/defibrillator certified) Rapid response nurse Medication nurse Scribe (nurse/manager/supervisor) Respiratory/Anesthesia Team leader Ancillary departments (EKG, I.V. Team) Patient representative and/or clergy Runner Security
04/19/23
04/19/23 6
Basic Life Support: Primary Survey
Airway • Open airway, look, listen, and feel for breathing.
Breathing • If not breathing, slowly give 2 rescue breaths.
Circulation • Check pulse. If pulseless, begin chest compressions at 100/min
30:2 ratio. • Consider precordial thump with witnessed arrest and no
defibrillator nearby• Attach monitor, determine rhythm. If VF or pulseless VT: shock 1
time Defibrillate
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Primary Survey continued priorities
Airway • Establish and secure an airway device (ETT, LMA, COPA,
Combitube, etc.). Breathing
• Ventilate with 100% O2. Confirm airway placement (exam, ETCO2, and SpO2). Remember, no metabolism/circulation = no blue blood to lungs = no ETCO2.
Circulation • Evaluate rhythm, pulse. If pulseless continue CPR, obtain IV
access, give rhythm-appropriate medications (see specific algorithms). PIV preferred initially vs. central line.
Differential Diagnosis • Identify and treat reversible causes.
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ACLS Medications
Adenosine Atropine sulfate Amiodarone Cardizem (diltiazem) Dopamine HCL Dobutamine hydrochloride Epinephrine HCL (Adrenalin)
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ACLS Medications
Levophed (Norepinephrine) Lidocaine HCL Magnesium Nitroglycerine (NTG) Oxygen Sodium Bicarbonaate Vasopressin
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ACLS Rhythms: Most Common
VT-VF Asystole Tachycardia
• AFib w/RVR (symptomatic)• SVT
Bradycardia (symptomatic)