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Responding to a Code

Responding to a Code. Keith Rischer RN, MA, CEN. 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.

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Responding to a Code

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  1. Responding to a Code Keith Rischer RN, MA, CEN

  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.

  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

  4. Legal & Ethical Issues • DNR order • No DNR order • Advanced directives • Organ donation • Code review • Ethic Committee

  5. 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 Code Team Responsibilities

  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 • YouTube - • YouTube – • YouTube -

  7. 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.

  8. ACLS Medications • Adenosine • Atropine sulfate • Amiodarone • Cardizem (diltiazem) • Dopamine HCL • Dobutamine hydrochloride • Epinephrine HCL (Adrenalin)

  9. ACLS Medications • Levophed (Norepinephrine) • Lidocaine HCL • Magnesium • Nitroglycerine (NTG) • Oxygen • Sodium Bicarbonaate • Vasopressin

  10. Defibrillation • Patho • Bi-phasic • Nursing Responsibilities

  11. ACLS Rhythms: Most Common • VT-VF • Asystole • Tachycardia • AFib w/RVR (symptomatic) • SVT • Bradycardia (symptomatic)

  12. Ventricular Tachycardia

  13. Ventricular Fibrillation/Asytole

  14. Post Code Concerns • Autopsy • Family presence • Survival • Saving life is priority regardless • Seen in less experienced nurses, MD’s • Holistic • Save life • Addressing needs of the family • Seen in more experienced providers and those who were sensitive to their own spirituality

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