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 Experience management of code blues Suggest plans for acute care cases ¡ Practice leadership and teamwork skills ¡ Practice early CPR and defibrillation 3 ¡

INTRO TO CODE BLUE OBJECTIVES By the e en end d of of Intro o To o Code ode Blue e (ITC TCB), medi edical al st studen dents s will be be abl able e to: o: � 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 Tension PTX | Pulseless VT ¡ ACS | VF ¡ Anaphylaxis | Asystole ¡ Upper GI Bleed | PEA ¡ 5 ¡

INTRO TO CODE BLUE LOGISTICS SIM ¡ Debrief ¡ TEAM LEADER (MD) ¡ MEDS/ CPR AIRWAY DEFIB (RN) ¡ (RT) ¡ (RN) ¡ RECORDER (RN) ¡ 6 ¡

INTRO TO CODE BLUE OSCE FORMAT Y SURVEY ¡ PRIMARY Assessment ¡ Action ¡ ABCs ¡ Help, O2, IV, Monitor ¡ Y SURVEY ¡ SECONDARY Assessment ¡ Action ¡ SAMPLE, Vitals, Exam ¡ Targeted Treatment ¡ BLUE ¡ CODE CODE BLUE Assessment ¡ Action ¡ Rhythm, Pulse ¡ CPR/Defib, Epi, Hs&Ts, Team ¡

INTRO TO CODE BLUE PRIMARY SURVEY Primar ary Survey ey Assessm ssessmen ent Action on Exam xampl ples es Exam xampl ples es Immediately Airway: patency, Call for help life-threatening secretions, obstruction O2 Breathing: RR, O2 Sat, work of breathing, lung IV sounds, tracheal deviation Monitor Circulation: HR, BP, Fluids LOC, bleeding, temperature Needle decompression 8 ¡

INTRO TO CODE BLUE SECONDARY SURVEY Sec econ ondar dary Survey ey Assessm ssessmen ent Action on Systematic survey SAMPLE Investigations Signs and symptoms Allergies Differential diagnoses Medications PMHx Treatments Last oral intake Events prior Vitals Head-to-toe Exam 9 ¡

INTRO TO CODE BLUE ARREST RHYTHMS VF Only 2 “shockable” (defib) rhythms Pulseless VT Asystole All other rhythms, including asystole and PEA, should Everything else with NO pulse is PEA NOT be defib PEA (Pulseless Electrical Activity) 10 ¡

INTRO TO CODE BLUE CODE BLUE ALGORITHMS Give EPI q4min (or after every 2 nd rhythm/pulse check) Try 2 rounds of shock/nothing before EPI Pulseless VT, VF SHOCK EPI SHOCK 2min CPR 2min CPR Rhythm Check Rhythm Check Asystole, PEA Nothing EPI Nothing 2min CPR 2min CPR Rhythm Check Rhythm Check 11 ¡

INTRO TO CODE BLUE CODE BLUE EXAMPLE No response, not breathing Mon onitor or Pulse se Assessm ssessmen ent Action on 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 12 ¡

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) Chew ASA 162mg O2 nitroglycerin Anti-PLT #2 morphine (e.g. clopidogrel or ticagrelor) TNK e.g. UFH or β B PCI LMWH ACEi/ARB CABG Statin Aldo antagonist Quit smoking RISK REDUCTI TION 15 ¡

INTRO TO CODE BLUE ANAPHYLAXIS 57% unrecognized or not labeled in ED Multi system syndrome Distributive shock (widespread vasodilation) Hypovolemic shock (fluid extravasation, reduced venous return) 16 ¡

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 Exposure to allergen & either: sBP 2+ Adults <90 Decrease 30% 18 ¡

INTRO TO CODE BLUE ANAPHYLAXIS TX 1 st st L LINE INE = E = EPINE PINEPHRINE PHRINE ADJU JUNCTS TS 1:1000 epinephrine IM Shock/CVS: fluids anterolateral thigh Resp: oxygen, salbutamol Adults: 0.3 mg Derm: H1 and H2 blocker Peds: 0.15 mg PREVENTI TION OF 2n 2nd d LONG-TE TERM Steroids may prevent Epinephrine injector biphasic or protracted Wear/carry allergy anaphylaxis identification (controversial) 19 ¡

INTRO TO CODE BLUE EPINEPHRINE IS FIRST LINE α 1 Vasoconstriction Increased peripheral vascular resistance Decreased mucosal edema and membrane leakage β 1 Increased inotropy (contractility) Increased choronotropy (heart rate) β 2 Bronchodilation Decreased mast cell and basophil mediator release 20 ¡

INTRO TO CODE BLUE TENSION PNEUMOTHORAX Needle decompression: 14G needle 2 nd ICS mid-clavicular line 21 ¡

INTRO TO CODE BLUE TENSION PNEUMOTHORAX Chest tube: 5 th ICS just anterior to mid-axillary line 22 ¡

INTRO TO CODE BLUE Acute Upper GI Bleed Manage Early Fluids Intubation Crossmatch (1 unit = 10 Hb) Blood (Hb < 70) Consider if: 1. Ongoing hematemesis Consults 2. Altered respiratory status 3. Altered mental status Consider: 1. GI Meds 2. ICU 3. General Surgery PPI (ulcers) and octreotide (varices): 4. Interventional radiology not shown to decrease mortality 23 ¡

INTRO TO CODE BLUE ACLS EFFECTIVE TEAM DYNAMICS Closed-loop communication* Clear messages* Clear roles and responsibilities* Knowing one’s limitations Knowledge sharing Constructive intervention Re-evaluation and summarizing* Mutual respect 24 ¡