WARNING Learners, please complete the Learner Survey - - PowerPoint PPT Presentation

WARNING

Learners, please complete the Learner Survey (ucalgary.ca/codeblue/surveys) before viewing this PowerPoint

1 ¡

INTRO TO CODE BLUE

2 ¡

INTRO TO CODE BLUE

PURPOSE

3 ¡

Experience management of code blues Suggest plans for acute care cases ¡ Practice leadership and teamwork skills ¡ Practice early CPR and defibrillation

INTRO TO CODE BLUE

OBJECTIVES

By the e en end d of

• f Intro
• To
• Code
• de Blue

e (ITC TCB), medi edical al st studen dents s will be be abl able e to:

• :
• Demonstrate an approach to primary and secondary surveys
• Suggest initial management plans for select acute care patient presentations

(ACS, anaphylaxis, tension pneumothorax, and UGIB)

• Demonstrate an approach to the management of cardiac arrest cases
• Discuss the importance of early CPR and defibrillation in cardiac arrest cases
• Demonstrate effective CPR and BVM techniques
• Demonstrate accurate dosing and frequency of epinephrine administration in

cardiac arrest cases

• Select the appropriate defibrillation dose for cardiac arrest cases
• Recognize the following rhythms: VF, VT, PEA, asystole
• Demonstrate the management of VF and pulseless VT
• Demonstrate the management of asystole and PEA
• List causes of cardiac arrest, using H’s and T’s as a mnemonic
• Describe and demonstrate the ACLS elements of effective team dynamics
• Discuss the roles of the interdisciplinary health care team in cardiac arrest cases

4 ¡

INTRO TO CODE BLUE

CASES

5 ¡

ACS | VF ¡ Anaphylaxis | Asystole ¡ Tension PTX | Pulseless VT ¡ Upper GI Bleed | PEA ¡

INTRO TO CODE BLUE

LOGISTICS

6 ¡

SIM ¡

Debrief ¡

TEAM LEADER (MD) ¡ AIRWAY (RT) ¡ CPR (RN) ¡ MEDS/ DEFIB (RN) ¡ RECORDER (RN) ¡

INTRO TO CODE BLUE

OSCE FORMAT

PRIMARY Y SURVEY ¡

Assessment ¡ Action ¡

ABCs ¡ Help, O2, IV, Monitor ¡

SECONDARY Y SURVEY ¡

Assessment ¡ Action ¡

SAMPLE, Vitals, Exam ¡ Targeted Treatment ¡

CODE CODE BLUE BLUE ¡

Assessment ¡ Action ¡

Rhythm, Pulse ¡ CPR/Defib, Epi, Hs&Ts, Team ¡

INTRO TO CODE BLUE

PRIMARY SURVEY

8 ¡

Primar ary Survey ey Assessm ssessmen ent Exam xampl ples es Action

• n

Exam xampl ples es

Immediately life-threatening Airway: patency, secretions, obstruction Breathing: RR, O2 Sat, work of breathing, lung sounds, tracheal deviation Circulation: HR, BP, LOC, bleeding, temperature Call for help O2 IV Monitor Fluids Needle decompression

INTRO TO CODE BLUE

SECONDARY SURVEY

9 ¡

Sec econ

• ndar

dary Survey ey Assessm ssessmen ent Action

• n

Systematic survey SAMPLE Signs and symptoms Allergies Medications PMHx Last oral intake Events prior Vitals Head-to-toe Exam Investigations Differential diagnoses Treatments

INTRO TO CODE BLUE

ARREST RHYTHMS

10 ¡

VF Pulseless VT

Only 2 “shockable” (defib) rhythms

Asystole

Everything else with NO pulse is PEA (Pulseless Electrical Activity)

PEA

All other rhythms, including asystole and PEA, should NOT be defib

INTRO TO CODE BLUE

CODE BLUE ALGORITHMS

Pulseless VT, VF SHOCK SHOCK EPI

2min CPR Rhythm Check 2min CPR Rhythm Check

Nothing Nothing EPI

2min CPR Rhythm Check 2min CPR Rhythm Check

Asystole, PEA

11 ¡

Try 2 rounds of shock/nothing before EPI Give EPI q4min (or after every 2nd rhythm/pulse check)

INTRO TO CODE BLUE

CODE BLUE EXAMPLE

12 ¡

Mon

• nitor
• r

Pulse se Assessm ssessmen ent Action

• n

VT None Pulseless VT arrest Start compressions 200J shock/defib 2 minutes of CPR VF None VF arrest Start compressions 200J shock/defib 1mg epi 1:10,000 IV 2 minutes of CPR Asystole None Asystole Start compressions No shock/defib 2 minutes of CPR Bradycardia None PEA Start compressions No shock/defib 1mg epi 1:10,000 IV 2 minutes of CPR No response, not breathing

INTRO TO CODE BLUE

EARLY CPR, EARLY DEFIBRILLATION

13 ¡

INTRO TO CODE BLUE

Hs AND Ts

Hypovolemia Tension PTX Hypoxia Tamponade Hydrogen ion Toxins Hyper/hypoK Thrombosis (pulmonary) Hypothermia Thrombosis (coronary)

14 ¡

INTRO TO CODE BLUE

ACUTE CORONARY SYNDROME (ACS)

15 ¡

O2 nitroglycerin morphine

Chew ASA 162mg Anti-PLT #2 (e.g. clopidogrel

• r ticagrelor)

e.g. UFH or LMWH TNK PCI CABG

RISK REDUCTI TION

βB ACEi/ARB Statin Aldo antagonist Quit smoking

INTRO TO CODE BLUE

ANAPHYLAXIS

16 ¡

57% unrecognized or not labeled in ED Multisystem syndrome Distributive shock

(widespread vasodilation)

Hypovolemic shock

(fluid extravasation, reduced venous return)

INTRO TO CODE BLUE

ANAPHYLAXIS SYMPTOMS

Derm (80-90%): flushing, itching, urticaria, angioedema Resp (70%): nasal sx, throat sx, cough, wheeze, SOB GI (45%): N/V/D, abd pain, dysphagia CVS (45%): faint, tachycardia, hypotension, collapse

CNS (15%): dizziness, headache, LOC Other: metallic taste in mouth

17 ¡

INTRO TO CODE BLUE

ANAPHYLAXIS DX

18 ¡

2+ sBP Adults <90 Decrease 30% Exposure to allergen & either:

INTRO TO CODE BLUE

ANAPHYLAXIS TX

19 ¡

1st

st L

LINE INE = E = EPINE PINEPHRINE PHRINE ADJU JUNCTS TS PREVENTI TION OF 2n 2nd d LONG-TE TERM

1:1000 epinephrine IM anterolateral thigh Adults: 0.3 mg Peds: 0.15 mg Shock/CVS: fluids Resp: oxygen, salbutamol Derm: H1 and H2 blocker Steroids may prevent biphasic or protracted anaphylaxis (controversial) Epinephrine injector Wear/carry allergy identification

INTRO TO CODE BLUE

EPINEPHRINE IS FIRST LINE

20 ¡

Vasoconstriction Increased peripheral vascular resistance Decreased mucosal edema and membrane leakage

α1 β1 β2

Increased inotropy (contractility) Increased choronotropy (heart rate) Bronchodilation Decreased mast cell and basophil mediator release

INTRO TO CODE BLUE

TENSION PNEUMOTHORAX

21 ¡

Needle decompression: 14G needle 2nd ICS mid-clavicular line

INTRO TO CODE BLUE

TENSION PNEUMOTHORAX

22 ¡

Chest tube: 5th ICS just anterior to mid-axillary line

INTRO TO CODE BLUE

Acute Upper GI Bleed

23 ¡

Fluids Crossmatch (1 unit = 10 Hb) Blood (Hb < 70)

Manage Consults Early Intubation Meds

PPI (ulcers) and octreotide (varices): not shown to decrease mortality Consider if:

• 1. Ongoing hematemesis
• 2. Altered respiratory status
• 3. Altered mental status

Consider:

• 1. GI
• 2. ICU
• 3. General Surgery
• 4. Interventional radiology

INTRO TO CODE BLUE

ACLS EFFECTIVE TEAM DYNAMICS

Re-evaluation and summarizing*

24 ¡

Closed-loop communication*

Clear messages*

Clear roles and responsibilities*

Knowing one’s limitations

Knowledge sharing Constructive intervention

Mutual respect