It can be scary to go into a RRT or Code Blue.Check your own pulse and remember the tips below!
Important tips we reviewed today:
–Introduce yourself when you come into the room and identify one person as the RRT or Code Blue Leader
–Avoid AIR orders-tell specific people what you want done and have them confirm when it is actually done. “John, please hang one liter of NS wide open and let me know when it is done”
-In Code Blue, press the code blue button in the room and put a backboard under the patient!
-The Team Leader should stand at the head of the bed so he/she can see everyone
–SHOCK Vfib or pulseless Vtach, then can resume CPR unless waiting for pads or charging-know which side of the ACLS algorithm you are on (the crash carts have the card hanging if you don’t have it!)
-Don’t forget about maintaining adequate IV access, cycling vitals, and giving fluid or O2 as needed.
Assign specific roles to each person
1)Airway (Respiratory Therapist/Anesthesia)- Remember that intubation is NOT an emergency if able to get good bag-valve ventilation and CPR needs to be interrupted. It is more important to avoid interrupting CPR, and intubation can be done during a pulse check.
2)Medications (RN)- Avoid air orders!
3)Time Recorder and Charting (RN)- Ask him/her to alert you every 2 minutes and when epinephrine or amiodarone is due
4)CPR (anyone who is available)- Don’t forget to have at least 2-3 people who can rotate through CPR as it can be very tiring!
After ROSC, check a blood pressure and assess neurologic status (is this patient a candidate for therapeutic hypothermia or simply avoiding hyperthermia)?
Case 1 (AMS with hypoglycemia)-take home points
1)Always consider hypoglycemia on the differential for altered mental status and check finger stick for any patient who is unresponsive
2)Review recent medications to see if contributing to AMS
3)For on-going hypoglycemia that is refractory to glucose ampules push, start D5W or D10W drip and consider glucagon
Case 2 (COPD exacerbation)-take home points
1)Know the contraindications to Bipap for COPD exacerbations
2)Avoid excessive ventilation in patient with COPD as can lead to auto-peep (air trapping) so set RR low. Otherwise risk of causing PTX and PEA arrest. Remember these patients may have some chronic hypercapnia so do not correct their CO2 all the way to “normal” range.
3)If inadequate ventilation, patient may need heavy sedation and/or use of paralytic agents.