Code & Rapid Response

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  1. Fill in the values for the MEWS scores:

    1. Systolic BP
    +3:
    +2:
    +1:
    0:
    +2

    2. HR
    +2:
    +1:
    0:
    +2:

    3. RR
    +2:
    0:
    +1:
    +2:
    +3:

    4. Temp
    +2:
    0:
    +2:

    5. AVPU
    0:
    +1:
    +2:
    +3:
    • 1. Systolic BP
    • +3: <70 mmHg
    • +2: 71-80 mmHg
    • +1: 81-100 mmHg
    • 0: 101-200 mmHg
    • +2: >200mmHg

    • 2. HR
    • +2: <40
    • +1: 41-50
    • 0: 51-100
    • +1: 101-110
    • +2: 111-129
    • +3: >130

    • 3. RR
    • +2: <9
    • 0: 9-14
    • +1: 15-20
    • +2: 21-29
    • +3: >30

    • 4. Temp
    • +2:<35 (95)
    • 0: 35-38.4 (95-101.1)
    • +2: >38.5 (101.3)

    • 5. AVPU
    • 0: alert
    • +1: reacts to voice
    • +2: reacts to pain
    • +3: unresponsive
  2. You assessed your patient for a signs of an impending cardiopulmonary arrest. After deciding that the pt. does not meet the criteria for RRT, and does not have an elevated early warning score, what should you do next?
    • Contact the appropriate healthcare provider to implement orders. Also seek assistance from lead nurse if needed.
    • Also monitor closely
  3. You have activated the RRT for your patient. List the next steps you need to do from here (4)
    • Initiate CPR
    • Request the crash cart
    • Obtain the pt. medical record and MAR
    • If available, apply AED pads
    • Stay with the patient when the code team arrives to answer questions (SBAR) and assist if needed
  4. What acute significant changes will you look for to meet the criteria for a rapid response? (facility specific) (4)
    • 1. Acute sig. change in pt. baseline RR and/or O2 sat
    • 2. HR
    • 3. BP
    • 4. Neurological status
  5. List the different types of people that could be part of the Resuscitation team
    • ED MD - Lead
    • ED RN - meds / IV / monitor
    • ICU RN - "
    • RT - airway
    • Supervisor - scribe
    • Staff - compresor
  6. List the three medications and doses during an adult cardiac arrest
    • 1. Epinephrine IV/IO: 1mg q3-5m
    • 2. Vasopressin IV/IO: 40 units can replace first or second dose of epinephrine (removed from the adult cardiac arrest algorithm AHA 2015)
    • 3. Amiodarone IV/IO: First dose - 300mg bolus, second dose - 150mg

    AHA states that vasopressin in combination with epinephrine offers no advantage as a substitute for standard-dose epinephrine in cardiac arrest.
  7. List 8 common code meds
    • 1. Amiodarone
    • 2. Adenosine
    • 3. Atropine
    • 4. Dopamine
    • 5. Epinephrine
    • 6. Magnesium
    • 7. Procainamide
    • 8. Vasopressin
  8. For post-cardiac arrest care, which patients are recommended for coronary angiography (detect blockages in the coronary arteries that are caused by plaque buildup)?
    Recommended for all pts with ST elevation and for hemodyamically or electrically unstable patients without this ST elevation.
  9. T or F: a comatose pt. with ROSC after a cardiac arrest should be cooled to 32-34 C for 24 hours.
    False: all comatose patients with ROSC should be maintained between 32-36 C for 24 hours. 

    You also want to actively prevent fever in comatose patints after targeted temp is maintained.
  10. How will you monitor and intervene blood pressure for post cardiac arrest care?
    Avoid and immediately correct hypotension (SBP <90 and MAP <65).
  11. Which drugs do you use in the ACLS algorithm for Ventricular Fib/Tach. Select all that apply:

    a. Adenosine
    b. Amiodarone
    c. Atropine
    d. Dopamine
    e. Epinephrine
    f. Magnesium
    g. Procainamide (Lidocaine)
    h. Vasopressin
    • a. Adenosine
    • b. Amiodarone
    • c. Atropine
    • d. Dopamine
    • e. Epinephrine
    • f. Magnesium
    • g. Procainamide (Lidocaine)
    • h. Vasopressin
  12. Which of these drugs are indicated for Asystole / PEA in the ACLS Algorithm?

    a. Adenosine
    b. Amiodarone
    c. Atropine
    d. Dopamine
    e. Epinephrine
    f. Magnesium
    g. Procainamide (Lidocaine)
    h. Vasopressin
    • a. Adenosine
    • b. Amiodarone
    • c. Atropine
    • d. Dopamine
    • e. Epinephrine
    • f. Magnesium
    • g. Procainamide (Lidocaine)
    • h. Vasopressin
  13. Which of these drugs are used in the ACLS algorithm during bradycardia?

    a. Adenosine
    b. Amiodarone
    c. Atropine
    d. Dopamine
    e. Epinephrine
    f. Magnesium
    g. Procainamide (Lidocaine)
    h. Vasopressin
    • a. Adenosine
    • b. Amiodarone
    • c. Atropine
    • d. Dopamine
    • e. Epinephrine
    • f. Magnesium
    • g. Procainamide (Lidocaine)
    • h. Vasopressin
  14. Which of these drug are used in the ACL algorithm during tachycardia?

    a. Adenosine
    b. Amiodarone
    c. Atropine
    d. Dopamine
    e. Epinephrine
    f. Magnesium
    g. Procainamide (Lidocaine)
    h. Vasopressin
    • a. Adenosine
    • b. Amiodarone
    • c. Atropine
    • d. Dopamine
    • e. Epinephrine
    • f. Magnesium
    • g. Procainamide (Lidocaine)
    • h. Vasopressin
  15. Fill in: __a__ is primarily used for vasoconstriction, which is important during CPR because it will help increase blood flow to the brain.
    Epinephrine or Vasopresors
  16. Bradyarrhythmia is defined as:

    A. any rhythm disorder with a heart rate less than 60 beats per minute 
    B. any rhythm disorder with a heart rate less than 40 beats per minute
    C. any rhythm disorder with a heart rate less than 50 beats per minute
    D. any symptomatic rhythm disorder with a heart rate less than 50 beats per minute
    A.
    (this multiple choice question has been scrambled)
  17. The primary decision point in the bradycardia algorithm is the determination of:

    A. heart rate
    B. blood pressure
    C. adequate perfusion
    D. rhythm
    C. Adequate perfusion is the primary decision point for determining if use of the bradycardia algorithm is necessary.
    (this multiple choice question has been scrambled)
  18. What is the first-line agent for treatment of symptomatic bradycardia?

    A. vasopressin
    B. lidocaine
    C. atropine
    D. epinephrine
    C. AHA ACLS Provider Manual pg. 125 “Give Atropine as first-line treatment.”
    (this multiple choice question has been scrambled)
  19. The primary ACLS treatment for VF and Pulseless VT is: 

    A. high-energy unsynchronized shocks 
    B. lidocaine 
    C. epinephrine
    A. AHA ACLS provider manual pg. 97. Successful conversion from VF and Pulseless VT is accomplished by the use of high-energy unsynchronized shocks.
    (this multiple choice question has been scrambled)
  20. If using a monophasic defibrillator for Pulseless VF/VT the first dose and all subsequent doses should be _______J.

    A. 360
    B. 300
    C. 260
    D. 200
    A.
    (this multiple choice question has been scrambled)
  21. What is the goal of step one of the Deterioration algorithm? (voice thread)
    Step 2?
    Step 3?
    • Step 1: 
    • Do you need to call a code blue by looking for:
    •  - no breathing
    •  - no pulse
    •  - unresponsive
    • Step 2: Does pt meed criteria for rapid response?
    •  - acute sig. change in baseline VS or neurological status?
    • Step 3: This is when pt. did not meet criteria for above steps
    •  - next consult MD for orders and/or charge nurse
    •  - monitor closely
  22. Once rapid response has been activated, what are you next steps?
    • Stay with pt. and provide appropriate care (within scope)
    • request for the EMR to be present at bedside
    • Be prepared to give SBAR and things done for the patient that day
  23. The initial energy dose delivered in Pulseless Arrest (VF/VT) with a biphasic defibrillator is typically _________:

    A. 180-240
    B. 90-110
    C. 120-200
    C.
    (this multiple choice question has been scrambled)
  24. Who provides the "time cues" during a code?
    Scribe: which is often initially the lead nurse or house supervisor
  25. List the job of the "Monitor RN"
    • should know how to use monitor, defib, pacer
    • interpret rhythms
    • monitor pt
    • deliver shock
    • may assist with meds
  26. List the jobs of the Med Nurse/IV during a RRT/CB
    • Knowledge of meds, doses/delivery methods
    • Starts additional lines
    • Admin meds per order/protocol (ACLS protocols)
  27. List the jobs of the "Monitor RN"
    • Knowledge on the monitor, defibrillator, and pacer
    • Interpret rhythms
    • Monitor patients
    • Delivery shocks 
    • May assist with meds
  28. Which of these common code meds do you give for torsades de pointes

    A. Amiodarone
    B. Adenosine
    C. Epinephrine
    D. Vasopressin
    E. Magnesium

    (specific form of polymorphic ventricular tachycardia in patients with a long QT interval. It is characterized by rapid, irregular QRS complexes, which appear to be twisting around the ECG baseline.)
    E.
    (this multiple choice question has been scrambled)
  29. Fill in: __a__% of people who have a cardiopulmonary arrest will survive, and less than __b__ of children who have them will survive.
    • a. 15%
    • b. <5% 

    Even less than these numbers will regain full baseline neurological fxn
  30. What is pre-arrest and how many hours prior will these hospitalized patients exhibit signs of clinical deterioration before a cardiac arrest?
    • Pre-cardiopulmonary arrest occurs when there is a life threatening event that requires rapid identification and intervention to prevent cardiopulmonary arrest.
    • - up to 8 hours prior will patients exhibit signs indicating impending cardiac arrest.
Author:
edeleon
ID:
336608
Card Set:
Code & Rapid Response
Updated:
2018-05-04 00:11:58
Tags:
code management nursing
Folders:
ADN-C,MS,Exam4
Description:
ADN-C MSE4 Code management
Show Answers: