Paris Hotel and Casino Las Vegas, Nevada
Resuscitation Officer Program Building the Infrastructure 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 *Joint statement by the Resuscitation Council (UK), College of Anaesthetists, Royal College of access to expert help. Royal Physicians (London) and the Intensive Care Society, “Cardiopulmonary resuscitation, standards for clinical practice and training”, 2004 (updated 2008).
Survey of Equipment
* 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.
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
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 Accelerometer (CPR Guidance)
Arterial and Central Lines
Ultrasound for Diagnosis
Mechanical CPR
VA ECMO
Cerebral Oximetry
Therapeutic Hypothermia
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
Medications used in Cardiac Arrest and Post-Cardiac Arrest Medication
Indication
Dose
Administration
Cardiac Arrest Epinephrine Vasopressin Amiodarone
Cardiac Arrest Cardiac Arrest VF, VT
Magnesium
Torsade, Hypomagnesemia Hypovolemia
Fluid Calcium Gluconate Sodium Bicarbonate
Hyperkalemia Hyperkalemia, Severe Acidosis Hyperkalemia Hyperkalemia
Dextrose Insulin (short acting) Albuterol
Hyperkalemia
Lasix
Hyperkalemia
Potassium Chloride
Hypokalemia
1 mg 40 U 300 mg, Repeat 150 mg 1-2 G 10% solution
IV push IV push IV push
1-2 liters of 4o C. fluid 10 ml of 10% solution 1 mEq/kg
IV Infusion
50ml of 50% 10 units (with Dextrose) 10 - 20mg in 4 ml saline 40 - 80 mg
IV over 20-30 minutes IV push
Guided by serum K+ concentration
Over 1-2 minutes
IV over 10 minutes IV push
Nebulized over 10 20 minutes IV to all patients who can produce urine IV infusion
Return of Spontaneous Circulation (ROSC) Normal Saline or Lactated Ringers Epinephrine
Hypotension, Therapeutic Hypothermia, Hypovolemia Hypotension
Dopamine
Hypotension
Norepinephrine
Hypotension
Oxygen
Hypoxemia
Ventilation
Hypocarbia
1-2 liters of fluid, cooled to 4o C for Therapeutic Hypothermia 0.1 – 0.5 mcg/kg/minute 5-10 mcg/kg/minute 0.1 – 0.5 mcg/kg/minute Titrate Fio2 to Spo2 94-96% Titrate ETCO2 to 35-40 mm Hg
IV Infusion
IV infusion IV infusion IV infusion Ventilator Ventilator
Resuscitation Quick Reference Card
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 Monitor with CPR Accelerometer and ECG Filtering
Rescue Airway Equipment
Mechanical CPR
Cerebral Oximeter
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 **
Equipment for the 4 New Code Carts
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
Mock Codes and Debriefing of Real Codes
Questions?
