Float Nurse

Drug Therapy: Antiarrhythmics ·          Amiodarone ·          Lidocaine Note:  When VF/pulseless VT persists after 2 to 3 shocks plus CPR and administration of a vasopressor, consider administering an antiarrhythmic such as Amiodarone.  If Amiodarone is unavailable, Lidocaine may be considered. Consider magnesium for torsades de pointes associated with a long QT interval. You should administer the drug during CPR, as soon as possible after rhythm analysis Amiodarone ·          First antiarrhythmic ·          Initial dose 300mg IV/IO diluted in 20cc of NS or D5W ·          May repeat in 5 minutes with 150mg IV/IO diluted in 20cc of NS or D5W ·          Max dose 2.2g/24h After 2 minutes of CPR defibrillate at 200J an...

IV Access · Peripheral IV · Central line · Intraossious · Intratracheal Peripheral IVs · Adults peak drug concentrations are lower and circulation times longer · Does not require interruption of CPR · Administer the drug by bolus injection and follow with a 20-mL bolus of IV fluid · Elevate the extremity for 10 to 20 seconds to facilitate drug delivery to the central circulation. Endotracheal Drug Administration ·          Results in lower blood concentrations than the same dose given via intravascular route ·          Give 2 to 2½ times the recommended IV dose. ·          Providers should dilute the recommended dose in 5 to 10 ml of water or normal saline and inject the drug directly into the endotracheal tube Note:   If IV or IO access cannot be established, epinephrine, va...

Paddle Placement · Avoids pacemakers and ICDs · Avoid medication patches · Avoid letting paddles touch · Apex-anterior position · Anterior-posterior position Secondary Survey • Intubate • Secure airway device. • IV access • If IV access delayed- repeat defibrillation and continue CPR Note : Once an advanced airway (eg, endotracheal tube, esophageal-tracheal combitube [Combitube], laryngeal mask airway [LMA]) is placed, 2 rescuers no longer deliver cycles of compressions interrupted with pauses for ventilation. Instead, the compressing rescuer should deliver 100 compressions per minute continuously, without pauses for ventilation. The rescuer delivering the ventilations should give 8 to 10 breaths per minute and should be careful to avoid delivering an excessive number of ventilations Ways of Confirming ET Tube Placement •       Direct cord visualization •    ...

Pulseless Ventricular Tachycardia and Ventricular Fibrillation The Rhythms ·          Ventricular Tachycardia ·          Ventricular Fibrillation ·          Torsades de Pointe   Ventricular Tachycardia characteristics ·          Rate: The atrial rate can't be determined. The ventricular rate is 150 - 250. If the rate is below 150, it is called a slow VT ·          Rhythm: The rhythm is usually regular. ·          P Wave: Not usually visible. ·          PRI: There is no PRI, as the focus is ventricular. ·          QRS: The QRS is wide and bizarre, usually 0.12 or greater. It is sometimes difficult to differentiate betwee...

Out, out, brief candle! Life's but a walking shadow, a poor player, That struts and frets his hour upon the stage, And then is heard no more.    Macbeth Act 5, scene 5 CPR Rhythm 1.  What is the initial dose of Amiodarone in treating pulseless VT/VF? 2.  What are the ECG characteristics of Torsades de pointes? 3. Magnesium is the drug of choice in the treatment of what dysrhythmia? 4. When using a biphasic defibrillator, what is the joule setting when delivering the initial shock to an adult victim in VT/VF? 5. What is the initial dosage of Lidocaine used in the treatment of pulseless VT/VF? 6. What is the first vasoconstrictor that is administered during a pulseless arrest? 7.  What is the dosage of magnesium used in the treatment of torsade de pointe? 8. What is the dose of bicarbonate in a cardiac arrest? 9. What is the treatment of choice for pulseless VT/VF? 10. What are some precautions that...

Post Arrest Goals Optimize the patient’s ventilation status ·          Avoid excessive ventilations ·          Oxygenate 10-12 breaths per minute ·          Target PETCO2 35-40 mm Hg ·          Titrate FIO2 to keep spo2 >94% ·          Avoid using ties that pass circumferentially around the patient’s neck ·          Elevate the head of the bed 30 to reduce cerebral edema and aspiration ·          Correct placement of airway monitored using waveform ·          Oxygenation monitored continuously with pulse oximetry. ·          Pao2/FIO2 ratio to follow acute lung injury ·      ...