Day 5 - ACLS

Protected Code Blues:

  1. Don Airborne PPE prior to starting any BLS/ACLS protocol

  2. Wear an N95 mask, limit number of people in the room to only those strictly necessary

  3. Avoid aerosol generating procedures

    • Airway should be addressed only by an experienced specialist

    • No bag mask ventilation

    • Pause CPR during intubation

Important Roles to Establish during Code Blues

  • Code Leader - stands at the head of the bed

  • RN to establish IV access

    • Ideally either IO access or 2-3 large bore IVs

  • RN to administer medications

  • Timer/Recorder - needs to announce pulse check every 2 minutes

  • CPR line-up - monitor closely for fatigue and swap out if CPR quality is deteriorating

  • Airway specialist

    • Usually includes anesthetist/critical care physician + respiratory therapist

  • Pulse checker

    • Should always have hand on femoral pulse even during CPR

  • Cardiac monitor/Defibrillator manager

Identify and treat any reversible causes (Hs &Ts)

  • Hypovolemia - give volume

  • Hypoxia - supplemental oxygen/intubation

  • Hydrogen ions (acidosis) - give bicarbonate

  • Hypo/hyperkalemia - calcium gluconate, D50W & 10units IV insulin to shift (if hyper)

  • Hypothermia - rewarm

  • Tension pneumothorax - needle decompression/chest tube insertion

  • Tamponade (cardiac) - pericaridiocentesis

  • Toxins

  • Thrombosis (pumonary) - thrombolytics

  • Thrombosis (coronary) - thrombolytics

2018 AHA updates to ACLS algorithm

  1. Amiodarone OR lidocaine can be used for VT/VF arrest unresponsive to defibrillation

  2. The routine use of magnesium for cardiac arrest is not recommended

  3. There is insufficient evidence to use beta blockers after achieving ROSC

  4. There is insufficient evidence to support or refute the routine use of lidocaine early (within the first hour) after ROSC.

The Intern at Work -