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CODE BLUE SLIDE PRESENTATION BY ALEX TUMUHAISE
- 1. CODE BLUE PRESENTATION BYALEX TUMUHAISE R/N ACCIDENT $ EMERGENCY tumuhaisealex08@gmail.com
- 2. CRASH CART A setof shelves or drawers on wheels that contains medical equipment and drugs to treat people experiencing sudden, severe medical problems, especially cardiac arrest, used by hospital workers.
- 3. CRASH CART a cartstocked with emergency medical equipment, supplies, and drugs for use by medical personnel especially during efforts to resuscitate a patient experiencing cardiac arrest
- 4. The crash cartis the commonly used term to describe a self- contained, mobile unit that contains virtually all of the materials, drugs, and devices necessary to perform a code. The configuration of crash carts may vary, but most will be a waist high or chest high wheeled cart with many drawers. Many hospitals will also keep a defibrillator and heart monitor on top of the crash cart since these devices are also needed in most codes. Since the contents and organization of crash carts may vary, it is a good idea for you to make yourself aware of
- 5. Medications are usuallykept in the top drawer of most crash carts. These need to be accessed and delivered as quickly as possible in emergent situations. Therefore, they need to be available to providers very easily. The medications are usually provided in a way that makes them easy to measure and dispense quickly. The common set of first drawer medications might be:
- 6. •Alcohol swabs •Amiodarone 150mg/3ml vial •Atropine 1mg/10 ml syringe •Sodium bicarbonate 50mEq/50 ml syringe •Calcium chloride 1gm/10 ml syringe •Sodium chloride 0.9% 10 ml vial Inj. 20 ml vial
- 7. Dextrose 50% 0.5mg/ml 50 ml syringe Dopamine 400 mg/250 ml IV bag Epinephrine 1 mg/10 ml (1:10,000) syringe Sterile water Lidocaine 100 mg 5ml syringes Lidocaine 2 gm/250 ml IV bag Povidone-Iodine swabstick Vasopressin 20 units/ml 1 ml vial
- 8. PEDIATRIC DRAWER Atropine 0.5mg/ 5 ml syringe Sodium bicarbonate 10 mEq/10 ml syringe Saline flush syringes Sodium chloride 0.9% 10 ml flush syringe
- 9. THE ADULT INTUBATIONDRAWER WILL CONTAIN Endotracheal tubes of various sizes Nasopharyngeal and perhaps oropharyngeal airways Laryngoscope handle and blades of different sizes A flashlight with extra batteries A syringe of sufficient size to inflate the cuff on it endotracheal tube Stylets Bite block Tongue depressors Newer setups may also include the materials needed to start quantitative waveform capnography like a nasal filter line
- 10. PEADIATRIC INTUBATION MATERIALS 2.5mm uncuffed endotracheal tube 3.0 mm – 5.5 mm microcuff endotracheal tubes Pediatric Stylet (8 Fr) Neonatal Stylet (6 Fr) Nasopharyngeal and perhaps oropharyngeal airways, Laryngoscope blades Disposable Miller blades Disposable Macintosh blades
- 11. CONTINUATION OF THEPEAD CRASH CART Armboards of various sizes Vacutainers for blood collection Spinal needles Suction catheters of various sizes Bone marrow needles of various sizes Feeding tubes Umbilical vessel catheter Disinfectants (swab sticks) Pediatric IV kits
- 12. The IV drawer(s)usually contain the following: IV Start Kit Angiocatheters 14 Ga and/or 16 Ga Disinfectants (Chloraprep, Betadine, povidone-iodine) Luer lock syringes of various sizes Tourniquet tubing Insyte autoguards of various sizes Vacutainers
- 13. THE PROCEDURE DRAWER ECGelectrodes Sterile gloves of various sizes Sutures of various sizes and materials Suction supplies Salem pump Cricothyroidotomy kit Adult and pediatric cut down pack
- 14. Yankauer suction Drapes tocreate a sterile field Large bore needle and syringe (for tension pneumothorax) Suction Cath Kit 14 Fr & 18 Fr Lumbar puncture kit
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- 17. An infusion pumpinfuses fluids, medication or nutrients into a patient's circulatory system. It is generally used intravenously, although subcutaneous, arterial and epidural infusions are occasionally used.
- 18. Infusion pumps canadminister fluids in ways that would be impractically expensive or unreliable if performed manually by nursing staff. For example, they can administer as little as 0.1 mL per hour injections (too small for a drip), injections every minute, injections with repeated boluses requested by the patient, up to maximum number per hour (e.g. in patient-controlled analgesia), or fluids whose volumes vary by the time of day. Because they can also produce quite high but controlled pressures, they can inject controlled amounts of fluids subcutaneously (beneath the skin), or epidurally (just within the surface of the central nervous system – a very popular local spinal anesthesia for childbirth).
- 19. RUNNING A SUCCESSFULCODE BLUE Running a successful code blue is a bout teamwork and communication Code blue Sudden loss of pulse ,drop in blood pressure and loss of perfusion Death will result in around 5 mins with out proper resuscitation Obviously is a medical emergency Your first step is to always initiate CPR 30 Strong chest pump (staying in Alive ,), 2 breath 9 look for symmetrical chest rise) Ensure full chest recoil during pumps!! Some one qualified should meanwhile be attempting to place an airway(endotracheal )
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- 21. Qualities ofa good CPR Positioning of the arms and hands which involve extending the elbows placing the heel of one hand on the patient`s sternum and the other hand on top of the first with fingers interlaced Chest compressions should go as deep as at least 6cm ( 2 in) and should be fast obtaining 100 – 120 / min
- 22. Allow chest recoil Compressionto ventilation ratio should be 30 : 2 Don’t hyperventilate, rather do a head tilt and chin lift and bag mask ventilate 1 breath every 6 seconds obtaining 10 breaths per minute In case of advanced airway, ensure ventilation of the patient at a rate of 10 – 12 breaths per minute
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- 24. . Unresponsive? Not breathing or onlyoccasional gasps
- 25. In pulseless patient,CPR is always the first step
- 26. Expose the ptchest to observe chest movt compressions are performed between the nipples
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- 34. This Photo byUnknown Author is licensed under CC BY-SA-NC
- 35. READING EKG While CPRis being administered some one should be reading THE EKG When you are reading the EKG,the first thing you need to do is to determine whether or not the rhythm is shockable Pulselessness can occur with any rhythm Shockable ,ventricular fibrillation ( v-fib)and ventricular tachycardia (v-tach) Non shockable ;pulseless electrical activity and a systole Pulseless electrical activity is any rhythm besides v-fib,v tach and asystole that is occurring with out a pulse
- 36. PULSE RHYTHMS 1. Nonshockable rhythm Asystole Pulseless electrical activity (PEA) 2. Shockable rhythm Ventricular fibrillation (VF) Pulseless Ventricular tachycardia (pVT)
- 37. INTRAVENOUS MEDICATIONS Ensure IV/IOaccess Adrenaline 1mg Amiodarone 300mg as 1st dose over 10 min (after 3 shocks), then 150mg as 2nd dose (after 5 shocks) Lidocaine 1 – 1.5mg/kg (100 mg) as 1st dose, then 0.5 - 0.75mg/kg as 2nd dose Thrombolytic drugs Given in PE patients (suspected/confirmed)
- 38. V-fib or pulselessv-tach Administer iv epinephrine 1mg (2- 3min) if there is no pulse in second shock Consider administering of iv amiodarone 300mg or iv magnesium 2g over 1-2mins Amiodarone is preferable to lidocaine Schock Check for pulse ,rhythm and resume CPR 30/2 If necessary, repeat ….. If you have asystole or PEA Non shockable rhythms During cpr ,administer iv epinephrine 1mg and iv atropine 1 mg Repeat epinephrine every 3-5 mins Atropine may be given up to 3mgs Every 3-5mins check pulse ,rhythm
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- 40. REFERENCES European Resuscitation CouncilGuidelines 2021 American Heart Association 2020 Save A Life by NHCPS, The Resuscitation Team