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

Mock Codes and Debriefing of Real Codes

Questions?