Prep for mock code training
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Transcript of Prep for mock code training
P e r i o p e r a t i v e E d u c a t i o n a n d T r a i n i n g
2013
Mock Code Prep
All Children’s Hospital
Perioperative Services
EDUCATION SERIES: CARDIAC
This training document will:
1. Facilitate understanding of roles and responsibilities in dealing with a respiratory
or cardiac crisis in the operating room.
2. Provide you the essential content to prepare you for a mock code
3. Identify key components related to cardiopulmonary resuscitation
4. Discuss the equipment needs during a code
5. Identify the psychomotor skills needed during CPR
6. Identify the necessary medications associated with averting a cardiac crisis
The Basics:
Compression rate of at least 100/minute
Compression depth of at least 2 inches in
adults and at least 1/3 (1 ½ to 2 inches) of the
anterior-posterior diameter of the chest in
infants and children
Allow for complete chest recoil, minimizing
interruptions in compressions but avoiding
excessive ventilation as per new AHA
guidelines
Compressions: CPR is performed on a child if the
child is not breathing and has no
pulse.
1 person rescue Compression Ratio of 30:2
Compressions 30
Breaths: 2
2 person rescue: Ratio of 15:2 Compressions: 15
Breaths: 2
It’s a team approach:
One rescuer will be activating the
emergency response system
Second rescuer begins chest
compressions
3rd rescuer is providing ventilations
or retrieving the bag-mask for resue
breathing
4th rescuer is retrieving the
defibrillator and setting it up
No longer is the “Look Listen and Feel”
assessment necessary, follow the steps
above.
How does this translate for the
Operating Room (OR) personnel?
Adult
Anesthesiologist (Airway)-Responsible for the complete management of the of
the code
o Once assistance is requested, a second anesthesiologist or anesthesia
provider will assist with medication administration and any other airway
management issues as assigned
o Additional anesthesia provider or nurse will also assist in medication
preparation and administration or any other duties as assigned by
Anesthesiologist
Surgeon(Compressions)
o Begins closing incision
o May take on the role of providing compressions or assigns resident to
close while he/she performs compressions
o This skill may or may not be done by the surgeon, but may be done by
the:
PA
RN
Or any healthcare personnel certified in BLS
Surgical Tech:
o starts gathering supplies and equipment to move towards closing the
incision
Assigned Circulator (RN) of the surgical suite:
o Initiates the call for assistance for the code
o Will call for the code cart if not within reach
o Request the presence of the charge nurse.
o Is responsible for ensuring counts are completed and necessary steps
taken for closure and dressing of incision.
Charge Nurse
o Upon receiving notification of code, immediately activates calls for
additional nurse and any and all available assistance
o Records code events and processes
o Assists as needed
RNs and Runner
o Managed by the anesthesiologist running the code
o Assists Charge nurse and Anesthesiologist
In the operating room key personnel includes the following
healthcare providers:
o Assists with transporting labs, drawing up meds and working the
defibrillator
Defibrillator:
The Heartsmart MRX is the defibrillator used at ACH
Here is a great tutorial on how to use the defibrillator if you have never used or checked
it, please review prior to the hands-on competency in November.
If you view this online click below: use the “CTRL” key to access the link (put your
cursor on the link and then press the “CTRL” key and a hand will appear allowing you to
access the link, once the hand appears click on the link).
http://theonlinelearningcenter.com/schtml/mrx/mrx.html
If you have a hard copy of this tool, please copy the above link into your browser. The
tutorial is quite long so please view this in sections and take notes.
Once you have viewed this, please sign up with the educator for the hands-on practice
of the defibrillator. The educator will post a sign-up list on the days the hands-on
training will take place. This tool is just a prep for you to prepare for the upcoming mock
code.
Defibrillator pads:
Use the appropriate pad for the child. Make sure the paddles on the defibrillator are the
pediatric paddles. The tutorial will demonstrate this and the educator will ask you to
change out the paddles as well during the hands-on demonstration.
Equipment
RNs only:
The registered nurse may draw up the medications and administer medications as per
Anesthesiologist’s guidance as needed. Additional meds to be found in Resources
section of the document via online links.
For Bradycardia:
0.01 mg/kg of 1:1000 every 3-5 minutes PRN with a
max max dose of 1 mg.
For Cardiac Arrest IV/IO:
0.01mg/kg of Epi 1ml/kg 1:10,000 every 3-5 minutes
with a max dose of 1 mg.
Indications: Bradycardia, Anaphylaxis, Asthma,
Croup, Cardiac Arrest, Shock.
Loading Dose: 5 mg/kg over 20-60 minutes with a
maximum dose of 300 mg. Can give up to 3
doseswith a max daily dose of 15 mg/kg (2.2g in
adolescents).
Indications: SVT, VT, pulseless VF, Pulseless VT
0.02 mg/kg with a minimum of 0.1 mg and a
maximum single dose of 0.5 mg IV/IO and 0.04 mg/kg
to 0.06 mg/kg via ET for Symptomatic Bradycardia
1 mg IV/IO for PEA/Asystole
MAX DOSE: for child 1 mg and for adolescent 3
mg
Loading Bolus of 1mg/kg
Repeat the loading dose if the infusion was initiated
initiated over 15 minutes AFTER the initial bolus
Maintenance: 20 to 50 mcg/kg per minute (to follow
bolus).
Medications: Top 4
Epinephrine
Amiodarone
Atropine
Lidocaine
Competency Skill Criteria: Mock Code
Name: Date:
Check appropriate box: CST Anesthesia Tech RN
Skill/Criteria Met Not
Met
Validation
Method
Demonstrates how to call for assistance for a Code in
the Operating Room.
Hands-On
Compressions:
Demonstrates proper hand placement
Hands-On
Verbalizes understanding of compression rate for a child
with 2-person rescuer
Demonstrates depth of compressions for a child and
adolescent
Observes for complete chest recoil
Demonstrates how to use defibrillator:
Turns on the defibrillator
Hands-On
Apply defibrillator pads correctly
Places the defibrillator in manual test mode
Identifies and demonstrates joules settings
Demonstrates how to deliver shocks:
Demonstrates changing paddles for
appropriate patient
Hands-On
Demonstrates effective communication skills
regarding:
o Charges
o Safety
o Delivery of shock
Validation Signature_______________________________ Date____________
Practice Rhythm Recognition
Practice Questions:
Answers:
Rhythm strips:
1. Wide Complex Tachycardia 2. Sinus tachycardia 3. Sinus Bradycardia 4. Asystole 5. Ventricular Fibrillation 6. Sinus Tachycardia 7. Supraventricular Tachycardia (SVT) 8. Normal Sinus Rhythm
Practice Questions 1-11
1. D 2. B 3. D 4. C 5. D 6. C 7. C 8. B 9. A 10. D 11. C
Here are a few website that will provide the basics of ECG recognition and the pathophysiology
basics of the heart.
http://learntech.uwe.ac.uk/manacuteill/
http://www.practicalclinicalskills.com/ekg-course-contents.aspx?courseid=301
http://acls-algorithms.com/rhythms
Here is a great website to practice ECG rhythm recognition:
http://www.skillstat.com/tools/ecg-simulator#/-play
MEDICATION REVIEW QUIZLETS:
Quizlet is an online flash cards website where you can find any quizzes related to just
about anything. www.quizlet.com
Here is a link to ACLS medication interventions
http://quizlet.com/24792806/acls-drug-interventions-flash-cards/
Link for ACLS Drug Review:
http://quizlet.com/7991142/acls-drug-review-flash-cards/
Our Mock Code will be completed in the OR Sim Lab dates to be determined for
2013 and 2014.
Education Team and Reviewers:
Will Nelson, MD, Anesthesiologist
Maureen Doyle, RN BA, CNOR Clinical Leader, General Surgery
Marisa Tapia MSN, MA, RN Educator and Certified Instructional Designer
Additional Resources