Paging
How does the OR staff know to come to a D-CALS code?
They are part of the 400 pager
Who is able to order emergency release?/
A physicians name needs to be on paper
Epi is not included in the D-CALS protocol. True or false?
True! Epinephrine can be called for by the team leader to augment the MAP if needed
When a D-CALS patient codes, what should be done with the ventilator by the airway/bagging person?
Turn up the Fi02 to 100%!
You can not have a D-CALS code on the SDU. True or false?
True. D-CALS refers to the protocol implementation, you can re-open a chest on the SDU, under the surgeon's direction, but the protocol is not implemented
Why do you have to press the code bell during a D-CALS code?
so the HUC knows to send the 400 page
How can you activate the mass transfusion protocol?
Call Transfusion and make sure you have an order
Can you delay compressions in asystole while you try to optimize the pacemaker?
Yes! You should! For up to one minute
ECMO patients can be on the D-CALS protocol. True or false?
Yes, it is up to the surgeon
There are 5 open chest carts in the hospital. True or false?
True! 2 on 7W (across from bed 3 and bed 30), one on 6E (across from 6E13), one on 3100 (behind the HUC) and one on 3300 (behind the HUC)
When is ECMO deployed in a D-CALS code?
After 2 minutes
Where is Esmark and Ioban kept?
The green cart
Why are external compressions not effective for someone in tamponade?
The heart can not fill due to the clot/blood compressing the right atrium, so there is no stroke volume
As well as the arterial/PA/CVP waveforms being flat, what would you notice on the ETC02 monitor if your patient was not being perfused?
A rapid decline
Could a VAD EVER be on the D-CALS protocol
A durable VAD can never be on the protocol! A temporary VAD may be able to be on the protocol if the surgeon decides it is appropriate
Who is responsible for deploying ECMO during a D-CALS code?
The charge nurse on the side that the patient is not on
What is the only drug included in DCALS Protocol?
Amiodarone
In the PEA algorithm, why do we turn off the pacer (if it's on?)
To exclude fine VF - we could shock VF!!
What level could you change the PEEP to in a D-CALS code?
Zero
Patients who have an open chest can be on the D-CALS protocol. True or false?
Yes, but you skip the CPR!!
Who is on the 400 pager?
The fellows, surgeons who did their fellowship at Duke, the OR staff
If all your waveforms are flat, you can skip the pulse check
Yes, only check a pulse if you have serious doubts about your waveforms
Is adjusting the pacemaker the only time you can delay compressions in a D-CALS code?
No, you also delay in VT/VF while you are getting the defibrillator.
What do you do with the IABP in a D-CALS code?
Place it on pressure trigger, this co-ordinates the IABP with CPR and inflation during diastole
Your D-CALS patient becomes asystolic in the CT scan. Do you implement the protocol?
No, D-CALS is only while the patient is in the CTICU, where equipment is readily available