Equipment & Monitoring
How many 3's do you dial for a code?
5
How long should checking for breathing and a heart rate take?
Les than 10 seconds.
What is the first medication you should administer in a code situation?
Epinephrine
Which 2 heart rhythms are a shockable rhythm?
V-Fib and Pulseless V-tach
What is your role in a code if it is not your patient or even your unit and you are there to help?
a.Ask if Tele Critical Care needs to be called
b.Stand outside the door and wait for direction for the Nurse or MD
c.Look for family members phone numbers in the chart if needed
d.Be a runner for supplies
e.Get in line to do compressions
f.All of the above
g.A, C, D, E
G- Call Tele Critical Care, Call SW, look for family phone numbers and supply them to a nurse in charge, direct traffic, be a runner, answer call lights, get in line to do compressions.
*Do not wait for someone to tell you what to do. Look for ways to be helpful!
Who can defibrillate a patient?
Anyone who is BLS certified. The Zoll Defibrillator has an AED mode that any BLS Provider can use.
What is the compression/ventilation ratio for adults for 2 person CPR?
A. 30:2
B. 15:2
C. You don't have to worry about counting in the hospital setting. Just make sure your breaths are every 5-6 seconds.
A. 30:2
What is the dosage of Epinephrine that you should administer in a code situation?
1mg every 3-5 minutes
What is the acronym we use to assess for signs of a stroke?
BE FAST
Balance, Eyes, Face, Arms, Speech, Time
What is your role in a code if you are the bedside nurse?
a.Push meds
b.Provide details of the patient history and what let up to the event
c.Record the code
d.Make sure the IV lines are patent
B- Provide details of the patient history and what led up to the event.
Your 3-year-old patient has gone into cardiac arrest. You call a code blue and the crash cart arrives. What is one thing you need to do before applying the pads to the patient?
Remove the adult pads and hook up the pediatric pads.
Name 5 things you can do to ensure you are giving high quality CPR.
Push hard (at least 2 inches on an adult) and fast and allow chest to recoil.
Minimize interruptions in compressions
Avoid excess ventilation
Rotate compressors every 2 minutes
Use capnography
You are in a code blue situation and have administered 2 doses of Epinephrine. What is the next medication that you should administer?
Amiodarone
Which of the following can you use to treat tachycardia?
a.Vagal maneuvers, synchronized cardioversion, Adenosine
b.Vagal maneuvers, Adenosine, Procainamide
c.Adenosine, Procainamide, Amiodarone, Sotalol
d.All of the above
D- All of the above. See Adult Tachycardia with a Pulse Algorithm located on the crash cart?
You are working on the floor and things have been slow. There is a code in the ER. You arrive to the ER and find CPR in progress on a child around 10 years of age. They want you to take over compressions. The patient has an advanced airway in place. You understand on a child you are supposed to compress at what depth?
a.¼ the depth of the chest size around 2 inches
b.1/3 the depth of the chest size around 2 inches
c.¼ the depth of the chest size around 1.5 inches
d.1/3 the depth of the chest size about 1.5 inches
B- 1/3 the depth of the chest size about 2 inches
What is the 4:1 button used for when pacing a patient?
To see the patient's under lying rhythm without loosing capture.
You are completing your hourly rounding when you notice your patient sitting in the chair slumped over. He is unresponsive. You quickly call a code and together you get the patient to the floor. You start CPR while someone is grabbing the crash cart. As soon as the crash cart arrives you shock the patient and resume CPR. What do you do next? (choose all the apply)
A.Ensure the patient has IV access, administer 300mg IV Amiodarone, continue CPR for 2 minutes
B.Continue CPR for 2 minutes and recheck the rhythm
C. Consider advanced airway and capnography
D. Administer Epinephrine 1mg every 3-5 minutes
Answer: B, C, D
Continue CPR, have respiratory consider an advanced airway with capnography, administer Epinephrine.
You should try Epinephrine before Amiodarone.
You are about to administer Amiodarone for the first time in a code situation. What is the dosage you are supposed to administer?
300mg. Any dosage after that would be 150mg.
Which of the following is the correct drug used to treat Bradycardia?
a.Atropine-first dose 1mg repeated every 3-5 minutes until you reach a max of 3mg
b.Dopamine IV infusion 2-15mcg/kg/min, titrate to patient response
c.Epinephrine IV infusion 2-10mcg/kg/min, titrate to patient response
C- Epinephrine IV infusion 2-10mcg/kg/min
Atropine dosage starts at 0.5mg bolus
Dopamine’s usual infusion rate is 2-20mcg/kg/min
If all else fails, consider transvenous pacing
You are taking care of Mr. Rogers an obese patient with a heart history here for DKA. You are going in to complete an hourly rounding when you noticed him slumped over in his chair. He is unresponsive. You check for a pulse and breathing and find none. You quickly call a code blue. Help arrives with the crash cart and you assist Mr. Rogers onto the floor to begin CPR. As you do so his IV comes out and there is now blood and IV fluid everywhere! What should you do next?
The blood and the IV fluid become the priority. This actually happened to me once! You cannot shock the patient with all that fluid surrounding the scene. Work together to do CPR as you clean up the fluid and start a new IV.
Can you name the order of the crash cart drawers?
IV Supplies, Medications, Respiratory Supplies, Solutions, and Pediatric Supplies
1. Medications
2. Respiratory
3. IV supplies
4. IV Solutions
5. Pediatric Supplies
You are taking care of Mr. Rogers, a 73-year-old man here with cellulitis. Mr. Rogers has a history of diabetes, CAD, HTN, and obesity. You are giving his 0900 meds when he is sweating and complains of severe chest pain. You immediately check his vital signs BP 180/90, HR 120, RR 30 and Sats 88% on room air. You immediately call a rapid response. What orders will you anticipate seeing?
A.ECG, Dilaudid IV, BMP, Cardiac Markers, and coagulation studies
B.Apply oxygen to maintain Sats above 90%, Aspirin 81mg, ECG, Labs and Morphine
C.Stat ECG, Oxygen to maintain Sats above 90%, Nitroglycerin SL, Aspirin 325mg, Morphine IV, Labs
D.Immediate transfer to outside facility
C- See Acute Coronary Syndrome Algorithm
Stat ECG, Oxygen to maintain Sats above 90%, Nitroglycerin SL, Aspirin 325mg, Morphine IV, Labs
What is the dosage of the first dose of Lidocaine that you should administer in a code situation?
1-1.5 mg/kg
What is the usual capture rate on a patient when you are in pacing mode?
40-80 milliamps
Can you name 5 H's or T's
Hypovolemia
Hypoxia
Hydrogen Ion (acidosis)
Hypokalemia/hyperkalemia
Hypothermia
Tension Pneumo
Tamponade, cardiac
Tonxins
Thrombosis, pulmonary
Thrombosis, coronary