P e r i o p e r a t i v e E d u c a t i o n a n d T r a i n i n g

2013

Mock Code Prep

All Children’s Hospital

Perioperative Services

EDUCATION SERIES: CARDIAC

This training document will:

1. Facilitate understanding of roles and responsibilities in dealing with a respiratory

or cardiac crisis in the operating room.

2. Provide you the essential content to prepare you for a mock code

3. Identify key components related to cardiopulmonary resuscitation

4. Discuss the equipment needs during a code

5. Identify the psychomotor skills needed during CPR

6. Identify the necessary medications associated with averting a cardiac crisis

The Basics:

Compression rate of at least 100/minute

Compression depth of at least 2 inches in

adults and at least 1/3 (1 ½ to 2 inches) of the

anterior-posterior diameter of the chest in

infants and children

Allow for complete chest recoil, minimizing

interruptions in compressions but avoiding

excessive ventilation as per new AHA

guidelines

Compressions: CPR is performed on a child if the

child is not breathing and has no

pulse.

1 person rescue Compression Ratio of 30:2

Compressions 30

Breaths: 2

2 person rescue: Ratio of 15:2 Compressions: 15

Breaths: 2

It’s a team approach:

One rescuer will be activating the

emergency response system

Second rescuer begins chest

compressions

3rd rescuer is providing ventilations

or retrieving the bag-mask for resue

breathing

4th rescuer is retrieving the

defibrillator and setting it up

No longer is the “Look Listen and Feel”

assessment necessary, follow the steps

above.

How does this translate for the

Operating Room (OR) personnel?

Adult

Anesthesiologist (Airway)-Responsible for the complete management of the of

the code

o Once assistance is requested, a second anesthesiologist or anesthesia

provider will assist with medication administration and any other airway

management issues as assigned

o Additional anesthesia provider or nurse will also assist in medication

preparation and administration or any other duties as assigned by

Anesthesiologist

Surgeon(Compressions)

o Begins closing incision

o May take on the role of providing compressions or assigns resident to

close while he/she performs compressions

o This skill may or may not be done by the surgeon, but may be done by

the:

PA

RN

Or any healthcare personnel certified in BLS

Surgical Tech:

o starts gathering supplies and equipment to move towards closing the

incision

Assigned Circulator (RN) of the surgical suite:

o Initiates the call for assistance for the code

o Will call for the code cart if not within reach

o Request the presence of the charge nurse.

o Is responsible for ensuring counts are completed and necessary steps

taken for closure and dressing of incision.

Charge Nurse

o Upon receiving notification of code, immediately activates calls for

additional nurse and any and all available assistance

o Records code events and processes

o Assists as needed

RNs and Runner

o Managed by the anesthesiologist running the code

o Assists Charge nurse and Anesthesiologist

In the operating room key personnel includes the following

healthcare providers:

o Assists with transporting labs, drawing up meds and working the

defibrillator

Defibrillator:

The Heartsmart MRX is the defibrillator used at ACH

Here is a great tutorial on how to use the defibrillator if you have never used or checked

it, please review prior to the hands-on competency in November.

If you view this online click below: use the “CTRL” key to access the link (put your

cursor on the link and then press the “CTRL” key and a hand will appear allowing you to

access the link, once the hand appears click on the link).

http://theonlinelearningcenter.com/schtml/mrx/mrx.html

If you have a hard copy of this tool, please copy the above link into your browser. The

tutorial is quite long so please view this in sections and take notes.

Once you have viewed this, please sign up with the educator for the hands-on practice

of the defibrillator. The educator will post a sign-up list on the days the hands-on

training will take place. This tool is just a prep for you to prepare for the upcoming mock

code.

Defibrillator pads:

Use the appropriate pad for the child. Make sure the paddles on the defibrillator are the

pediatric paddles. The tutorial will demonstrate this and the educator will ask you to

change out the paddles as well during the hands-on demonstration.

Equipment

RNs only:

The registered nurse may draw up the medications and administer medications as per

Anesthesiologist’s guidance as needed. Additional meds to be found in Resources

section of the document via online links.

For Bradycardia:

0.01 mg/kg of 1:1000 every 3-5 minutes PRN with a

max max dose of 1 mg.

For Cardiac Arrest IV/IO:

0.01mg/kg of Epi 1ml/kg 1:10,000 every 3-5 minutes

with a max dose of 1 mg.

Indications: Bradycardia, Anaphylaxis, Asthma,

Croup, Cardiac Arrest, Shock.

Loading Dose: 5 mg/kg over 20-60 minutes with a

maximum dose of 300 mg. Can give up to 3

doseswith a max daily dose of 15 mg/kg (2.2g in

adolescents).

Indications: SVT, VT, pulseless VF, Pulseless VT

0.02 mg/kg with a minimum of 0.1 mg and a

maximum single dose of 0.5 mg IV/IO and 0.04 mg/kg

to 0.06 mg/kg via ET for Symptomatic Bradycardia

1 mg IV/IO for PEA/Asystole

MAX DOSE: for child 1 mg and for adolescent 3

mg

Loading Bolus of 1mg/kg

Repeat the loading dose if the infusion was initiated

initiated over 15 minutes AFTER the initial bolus

Maintenance: 20 to 50 mcg/kg per minute (to follow

bolus).

Medications: Top 4

Epinephrine

Amiodarone

Atropine

Lidocaine

Competency Skill Criteria: Mock Code

Name: Date:

Check appropriate box: CST Anesthesia Tech RN

Skill/Criteria Met Not

Met

Validation

Method

Demonstrates how to call for assistance for a Code in

the Operating Room.

Hands-On

Compressions:

Demonstrates proper hand placement

Hands-On

Verbalizes understanding of compression rate for a child

with 2-person rescuer

Demonstrates depth of compressions for a child and

adolescent

Observes for complete chest recoil

Demonstrates how to use defibrillator:

Turns on the defibrillator

Hands-On

Apply defibrillator pads correctly

Places the defibrillator in manual test mode

Identifies and demonstrates joules settings

Demonstrates how to deliver shocks:

Demonstrates changing paddles for

appropriate patient

Hands-On

Demonstrates effective communication skills

regarding:

o Charges

o Safety

o Delivery of shock

Validation Signature_______________________________ Date____________

Practice Rhythm Recognition

Practice Questions:

Answers:

Rhythm strips:

1. Wide Complex Tachycardia 2. Sinus tachycardia 3. Sinus Bradycardia 4. Asystole 5. Ventricular Fibrillation 6. Sinus Tachycardia 7. Supraventricular Tachycardia (SVT) 8. Normal Sinus Rhythm

Practice Questions 1-11

1. D 2. B 3. D 4. C 5. D 6. C 7. C 8. B 9. A 10. D 11. C

Here are a few website that will provide the basics of ECG recognition and the pathophysiology

basics of the heart.

http://learntech.uwe.ac.uk/manacuteill/

http://www.practicalclinicalskills.com/ekg-course-contents.aspx?courseid=301

http://acls-algorithms.com/rhythms

Here is a great website to practice ECG rhythm recognition:

http://www.skillstat.com/tools/ecg-simulator#/-play

MEDICATION REVIEW QUIZLETS:

Quizlet is an online flash cards website where you can find any quizzes related to just

about anything. www.quizlet.com

Here is a link to ACLS medication interventions

http://quizlet.com/24792806/acls-drug-interventions-flash-cards/

Link for ACLS Drug Review:

http://quizlet.com/7991142/acls-drug-review-flash-cards/

Our Mock Code will be completed in the OR Sim Lab dates to be determined for

2013 and 2014.

Education Team and Reviewers:

Will Nelson, MD, Anesthesiologist

Maureen Doyle, RN BA, CNOR Clinical Leader, General Surgery

Marisa Tapia MSN, MA, RN Educator and Certified Instructional Designer

Additional Resources