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Comprehensive Guide to Cardiac Emergency Response Protocols

This informative guide outlines essential roles and protocols for responding to cardiac emergencies. Key team members include the Leader, IV Nurse, Code Cart Nurse, and Recorder, each with specific responsibilities in order to stabilize the patient. Procedures for recognizing ECG rhythms, administering medications, performing CPR, and utilizing defibrillation techniques are detailed. The document also emphasizes the importance of continuous assessment, intervention, and correcting reversible causes during cardiac events. This ensures a coordinated and effective response to restore patient safety and health.

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Comprehensive Guide to Cardiac Emergency Response Protocols

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  1. “Putting it All Together” Diane E. White RN CCRN PhD

  2. Members of the Code Team • Leader: identifies ECG rhythm and directs team to appropriate actions • IV nurse: establish IV access and administers medications • Code Cart Nurse: prepares medications & provides needed equipment, etc.. Monitor of defibrillator, etc.. • Recorder: records events of code; returns cart according to hospital policy • Airway/CPR persons (2)

  3. Primary ABCD • Check unresponsiveness • Activate EMS: may leave adult victim if alone • Call for defibrillator • Airway • Breathing • Circulation: Check Pulse, IV access, CPR • Defibrillation: 200 joules or 360 joules (always yell “clear” prior to defibrillation)!

  4. Ventricular Fibrillation & Pulseless Ventricular Tachycardia • ABCD • Epinephrine 1 mg IVP every 3-5 minutes or Single dose of Vasopressin 40 units • Shock 200 or 360 (monophasic) • CPR • Drug (antiarrhythmics): • Amiodarone 150mg IVP; may repeat • Lidocaine 1mg/kg IVP • MUST begin IV drip of antiarrhythmic that converts patient

  5. Asystole • Rapid Scene Survey • ABCD • Epinephrine 1mg IVP every 3-5 minutes • CPR • Atropine 1mg IVP repeat every 3-5 minutes up to a total dose of .04 mg/kg • CPR • Consider resuscitative efforts

  6. Pulseless Electrical Activity (PEA) • Rhythm on monitor but no pulse • ABCD • Fix Cause: hypothermia, hypoxia, hydrogen ion-acidosis, hyper or hypokalemia, hypovolemia, drug overdose, tamponade, tension pneumothorax, thrombosis coronary, thrombosis pulmonary • Epinephrine 1mg IVP every 3-5 minutes • Atropine 1mg IVP every 3-5 minutes up to .04 mg/kg

  7. Bradycardia • ABC’s • Symptomatic or Asymptomatic? • Yes – Atropine .5-1mg IVP, transcutaneous pacing, Dopamine 5-20mcg/kg/min, Epinephrine 2-10 mcg/min, or Isoprel 2-10 mcg/min • No – Type II second-degree block or Type III prepare for transvenous pacer or if not, just observe patient

  8. Tachycardia • Stable or Unstable? • Stable – determine rapid rhythm and treat accordingly • Unstable – prepare for cardioversion (O2, suction, airway, and IV access) • Synchronized cardioversion -50j - 200j

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