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Resuscitation Officer Program Building the Infrastructure
Paris Hotel and Casino Las Vegas, Nevada
Presented by: Scott Johnson, MD FACEP
Presenter Disclosure Information
1. Scott Johnson, MD FACEP
2. Resuscitation Officer Program -Building the Infrastructure
3. No relevant financial relationship (s) exist
Resuscitation Officer Program Building the Infrastructure
Code Cart and Response Cart Key equipment
Signage Response (elevators, carts, staff location)
Equipment standards RC-UK • All clinical service providers must ensure that their staff have
immediate access to appropriate resuscitation equipment and drugs to facilitate rapid resuscitation of the patient in cardiorespiratory arrest.
• Standardisation of the equipment used for cardiopulmonary resuscitation (including defibrillators and emergency suction equipment), and the layout of equipment and drugs throughout an organisation is recommended.
• It is recognised that planning for every eventuality is complex; therefore, organisations must undertake a risk assessment to determine what resources are required given their local circumstances. Risk factors to consider include patient group (e.g. adults, children), incidence of cardiac arrest, training of staff, and access to expert help.
*Joint statement by the Resuscitation Council (UK), Royal College of Anaesthetists, Royal College of Physicians (London) and the Intensive Care Society, “Cardiopulmonary resuscitation, standards for clinical practice and training”, 2004 (updated 2008).
* Hospital cardiac arrest resuscitation practice in the United States: A nationally representative survey; J Hosp Med. 2014 Feb 19. Edelson DP, Yuen TC, Mancini ME, Davis DP, Hunt EA, Miller JA, Abella BS.
Survey of Equipment
Joint statement by the Resuscitation Council (UK), Royal College of Anaesthetists, Royal College of Physicians (London) and the Intensive Care Society, “Cardiopulmonary resuscitation, standards for clinical practice and training”, 2004 (updated 2008).
Equipment and Infrastructure
• Resuscitation Carts
• Basic and Advanced Airway Equipment
• Monitors – Cardiac Monitor with Compression feedback
– Cerebral Oximetry
– ETCO2
• IV/IO and Medications
• Mechanical CPR
• Ultrasound
Key Clinical Innovations Mechanical CPR Accelerometer (CPR Guidance)
Cerebral
Oximetry Arterial and Central Lines
Ultrasound for Diagnosis Therapeutic
Hypothermia
VA
ECMO
Training and Simulation • Video Presentation: Code Management
• Review of the Latest Science of Resuscitation
• Perfusion Targeted Resuscitation
• Demonstration and Practice with Mechanical CPR
• Monitoring During Cardiac Arrest with ETCO2 and Cerebral Oximetry
• Use of Therapeutic Hypothermia/Artic Sun in-service
• Repeated Simulation Practice in Code Management
• Introduction to the use of Ultrasound in Cardiac Arrest
Resuscitation
Quick Reference
Card
Medications used in Cardiac Arrest and Post-Cardiac Arrest Medication Indication Dose Administration
Cardiac Arrest Epinephrine Cardiac Arrest 1 mg IV push
Vasopressin Cardiac Arrest 40 U IV push
Amiodarone VF, VT 300 mg, Repeat 150 mg
IV push
Magnesium Torsade, Hypo-magnesemia
1-2 G 10% solution Over 1-2 minutes
Fluid Hypovolemia 1-2 liters of 4o C. fluid
IV Infusion
Calcium Gluconate
Hyperkalemia 10 ml of 10% solution
IV over 10 minutes
Sodium Bicarbonate
Hyperkalemia, Severe Acidosis
1 mEq/kg IV push
Dextrose Hyperkalemia 50ml of 50% IV over 20-30 minutes
Insulin (short acting)
Hyperkalemia 10 units (with Dextrose)
IV push
Albuterol Hyperkalemia 10 - 20mg in 4 ml saline
Nebulized over 10 - 20 minutes
Lasix Hyperkalemia 40 - 80 mg IV to all patients who can produce urine
Potassium Chloride
Hypokalemia Guided by serum K+ concentration
IV infusion
Return of Spontaneous Circulation (ROSC) Normal Saline or Lactated Ringers
Hypotension, Therapeutic Hypothermia, Hypovolemia
1-2 liters of fluid, cooled to 4o C for Therapeutic Hypothermia
IV Infusion
Epinephrine Hypotension 0.1 – 0.5 mcg/kg/minute
IV infusion
Dopamine Hypotension 5-10 mcg/kg/minute
IV infusion
Norepinephrine Hypotension 0.1 – 0.5 mcg/kg/minute
IV infusion
Oxygen Hypoxemia Titrate Fio2 to Spo2 94-96%
Ventilator
Ventilation Hypocarbia Titrate ETCO2 to 35-40 mm Hg
Ventilator
Prepare Room Place Thumper Backboard on
bed.
Prepare Oximetry, ETCO2 and
ITD.
Check Thumper Battery.
Prepare IO, CVP Arterial Line
Prepare Airway Equipment.
Arrival of EMS Check ECG rhythm and defibrillate
before moving patient.
Transfer patient from EMS to
hospital stretcher.
Replace EMS pads with Hospital
pads (Anterior Placement).
Attach Cerebral Oximeter.
ET/LMA , ETCO2, ITD
IV and/or IO.
Epinephrine Q 3-5 minutes.
Groin CVP and Arterial Line.
Mobile Code Cart
Mechanical
CPR
Cerebral
Oximeter
Monitor with
CPR
Accelerometer
and
ECG Filtering
Rescue
Airway
Equipment
Equipment for the 4 New Code Carts
Life-Stat Thumper with respiratory valve and hose and straps
R-Zoll Defibrillator and R pads
Brain Oximeter/2 disposable probes
ET CO2 with brick/adapter
EZ I/O device and needles 2 Airway exchange catheters
I-LMAs Central line kit
4 sets of blood tubing
Yankauer suction
ResQ POD 9F Arrow Cordis/ 5F Cook CVC
Tru-Close vent procedure tray
Needle Cricothyroidotomy kit Chest Tube kit
Thoracotomy kit
Temperature probe for hypothermia
2 foley catheter kits (temperature probe capable)
Extra “M” and “R” zoll pads Bedside ultrasound **
Getting the expertise and equipment to the bedside
* Hospital cardiac arrest resuscitation practice in the United States: A nationally representative survey; J Hosp Med. 2014 Feb 19. Edelson DP, Yuen TC, Mancini ME, Davis DP, Hunt EA, Miller JA, Abella BS.
Response Strategy Code Blue • Code Blue called for all units; closed units? • Strategic Location of Code Carts
– 4 “specialized” resuscitation carts – Geography, patient population, staff expertise
• Dedicated cart response by floor – Replacement delivered immediately
• Paging system – Overhead “Code Blue” + code team beeper
• Rapid Response “Smart” Elevators • Signage on wards for calling code and elevators • Mock codes/deliberate practice- test the system’s
effectiveness