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A Cardiac Arrest System Judith D. Personett R.N., BSN, MA
V.A. Hospital , Madison, Wis., USA Published online: 13 Jul 2010.
To cite this article: Judith D. Personett R.N., BSN, MA (1976) A Cardiac Arrest System, Hospital Topics, 54:3, 19-21, DOI: 10.1080/00185868.1976.9950334 To link to this article: http://dx.doi.org/10.1080/00185868.1976.9950334
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A&heteVre4tS* BY Judith D. Personett R.N., BSN, MA, V.A. Hospital, Madison, Wis. am+&
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he call by the central page operator sets in motion a highly sophisticated system to respond t o the call for help. The Cardiac Arrest System is composed of two subsystems. The first subsystem deals with the professional people who comprise the Cardiac Arrest Teem. The second subsystem is composed of the necessary supplies and equipment. The Cardio-Pulmonary Resuscitation Committee (CPR)is vested with the primary responsibility of designing, implementing, and evaluating the Cardiac Arrest System. The CPR Committee members are representative of the services involved in cardiac arrests, a cardiologist, a nurse, an anesthetist, a pharmacist, chief medical resident, and a representative from Central Supply. After the Cardiac Arrest System is implemented, the CPR Committee evaluates each cardiac arrest by auditing the Resuscitation Flowsheet. The committee makes recommendations t o improve the system, evaluates the written Cardiac Arrest Protocol, and participates in the ongoing training programs for hoscdtal staff members.
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Composition of the Cardiac Arrest Team is the cardiologist, anesthetist, and Cardiac Arrest Team nurse. The team may be augmented by the nurse who initiates the cardiac arrest call and an inhalation therapist. Other personnel may or may not participate or observe depending on personnel and space availability. Training of the cardiac arrest team is done according to the latest guidelines published by the American Heart Association. Multidisciplinary training by physicians and nurses, for physicians and nurses has proven t o be the most effective way t o ensure a smooth team effort during a cadiac arrest. After the initial training in cardio-pulmonary resuscitation, skills are upgraded every six months in the .classroom. Mock cardiac arrest drills are held once a month either on a patient care unit or in ancillary areas such as diagnostic x-ray or laboratory. The nursing educators teach the course in CPR in conjunction with physicians. Because of their expertise in resuscitation, the nursing educators are assigned as Cardiac Arrest Team nurses. The rationale of the assignment is twofold: 111 By active participation in cardiac arrests their expertise and credibility ramein high, and 12)continuity of care is maintained because the nurses on the Cardiac Arrest Team remain constant. Thispoint is especially important in a taaching hospital where residents rotate frequently thereby changing the membership of the CardiacArrest Teem.
The responsibilities of the Cardiac Arrest Team nurse are rotated on a weekly basis during administrative hours which are7:30 a.m. - 4:W p.m., Monday through Friday. During non-administrative hours the responsibilities are more constant. For example: Nurmhg Members of the Cardiac Arrest Team 1. Non-administrativeHours: a. Evening Supervisor or delegate 6. Night Supervisor or delegate c. Week-end Supervisor 2. Administrative Hours: a. Director of Nursing Education b. Nursing Instructors c. Patient Care Co-ordinetors
The Cardiac Arrest Team is on call 2A hours a day, 7 days a week.
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Protocol for cardiac arrest varies according t o the physical plant and individual resources of the hospital. The general format of the protocol follows certain guidelines. A protocol written i n phases is similar t o the following sample:
Protocol: Cardiac Arrest PHASEI. Discovery of Patient Upon discovery of the patient act immediately as irreversible brain damage is imminent. HESITATION IS FATAL. Diagnose and treat arrest on the principles suggested below: A. DO NOT LEAVE THE PATIENT. Call for help but do not leave the patient. Send anyone t o telephone for the arrest team and bring any help that is immediately available. Begin CPR measures immediately - continue such measures until the team arrives. B. The arrest team is summoned by dialing on any hospital phone. Clearly state, "Cardiac arrest, Room #-,Ward #-." Repeat three times. This call alerts the Operator. C. DO NOT HESITATE - PROCEED 1. Unwitnessed cardiac arrest - begin cardio-pulmonary resuscitation immediately. 2. Witnessed cardiac arrest - a blow to the sternum may reinstate cardiac activity. If not, initiate CPR. 3. Airway obstruction - clear the airway, begin CPR. PHASE II. Consolidationof Forces lOccurs simultaneously with Phase I.) A. Operator should: 1. Dial t o again alert all cardiac team members. 2. Team consists o f a. Cardiologist, Medical Resident, Anesthesiologist, Cardiac Arrest Team nurse, Ward nurse, and Respiratory Therapist. b. Until team arrives, all trained personnel should institute immediate CPR. 3. Operator should state in page, "Cardiac arrest, Room #-,and Ward #-." B. Arrest cart will be brought b y the ward nurse. Defibrillators willbe brought by CardiacArrest Team nurse. Defibrillatorsare located on each floor. C. D. Emergency Elevator Service - operating on Elevator N o.PHASE 111. ResuscitationProcedure As help arrives one person only should assume overall command t o direct efforts of the team, and discharges unassigned or surplus personnel. Assuming a full complement of aid, proceed as follows: A. General 1. One member for continuous external massage at a rate of 60-80compressions per minute. Do not pause for respiration. 2. One member oxygenatesthe patient between each five sternal compressions, checking efficacy of inflations and clearness of airway and report to record keeper. B. Doctors: 1. One assists nurses with activation of arrest card and interprets ECG. 2. Onestarts I.V. loo0 cc. with5Yo Dextrose in water. Preferably C.V.P. intracath or cutdown in arm, saphenous, femoral, jugular, or any available vein. Immediately give 1 amp. (50 CC.'S) of Sodium Bicarbonate. Add vasopressor if deemed necessary.
Nurses Isimultaneously with doctorsl: 1. Activate ECG and attach leads t o patient. DO
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2. Make available in labeled syringes (one nurse ONLY for this job): a. Sodium bicarbonate two 50 cc. syringes (50 cc.’s = 1 AMP = 44mEq.) b. Lidocaine 1% 10.0 cc. c. Epinephrine (Adenelin) 1:lOOO 1.0 cc. in 9.0 cc. normal salinewith and without intracardiac needle. d. Calcium chloride 10.0 cc. (1Ampule = 1.0 Gm.) On order. a. lsoproterenol (Isuprel) on Order: 2.0 mgm. (2Ampules) in 5lNl cc. (1) with5Yo Dextrose in water for use in I.V. drip. 0.2 mgm ampule in 9 ml. normal (2) saline in syringewith intracardiac needle. Team Captain: 1. Assign record keeper, who will record pertinent information (time, vital signs, arrhythmias, medications, etc.) on arrest cart worksheet or assume role himself. 2. Send otherwise unassigned help t o deliver blood for blood gases. 3. Coordinate efforts at intubation if proficient operator present. 4. Order administration of intravenous or intracardiac medication. 5. Order use of defibrillator and confer with senior cardiologyfellow about special techniques such as cardiac pacing. 6. Confer with managing service (if available) about duration of attempt at revival. General Rules: 1. After arrival of team, no orders t o be carried out unless they come from Team Captain. Senior physician should assume this role until arrival of team. 2. Continuous massage and oxygenation unless stopped by Team Captain t o allow implementation of other procedures. 3. Sodium bicarbonate 50 cc. I.V. every 8-10 minutes or by continuous I.V. drip (44.6 mEq. per 10 minutes). 4. Speedandefficiencyaremost important. Eliminate unnecessary procedures.
Team Members Role
Member Teem Leader
Cardiology Fellow or Senior Physician
Decision. Assigns others end clears aree of unessigned personnel. Orders drugs, duties, etc. No orders followed unless from Team Captain. Inserts Pacemaker (if Cardiology Fellow) - Gives Meds.
Cardiac Massage. Performs cutdown, i f necessary. Checks efficacyof CPR.
Anesthesia b Respiratory
lntubates patient. Controls Ventilation. Airway Management.
Therapy Nurse # 1
Nursing Supervisor or CCU Nurse
Assists with resuscitation. if necessary. Brings cart. Defibrillates i f from CCU.
Nurse # 2
Ward Nurse who initiated CPR
Activates crash cart. Prepares Meds. Summons doctors. Cardiac Massage PRN. Sets up cutdown for doctor. Maintains record of CPR.
A l l available personnel should initiate CPR, however, only personnel with assigned duties should stay in t h e cardiac arrest area once procedure is in progesss. To summarize the first subsystem, a reiteration of the salient points is as follows: The Cardio-Pulmonary Committee is vested with the responsibility of design, implementation and ongoing evaluation of the cardiac arrest system. The Cardiac Arrest Team is composed of a cardiologist, anesthetist and Cardiac Arrest Team nurse w h o perform CPR according t o guidelines o f the American Heart Association and are available 24 hours a day, 7 days a week. The Cardiac Arrest Protocol is written, taught, implemented and evaluated o n an ongoing basis.
A cardiac arrest cart is available t o each patient care area, including admitting area, and x-ray and laboratory areas. These carts should be stocked, cleaned and re-stocked in a systematic manner. The contents of the cart are the responsibility of the CPR Committee. The kinds and quantities of drugs and supplies is dictated by users of these items, the CPR Committee. Several kinds of carts are available for cardiacarrest carts. Generally, a bright red metal cart with five drawers and a deep storage area serves the purpose. The basic cart can be accessorized with an I.V. pole, clamps for an E oxygen cylinder, a cardiac arrest board, a clip board containing the resuscitation record, and the locater list. The locater list serves a dual purpose It outlines the exact contents of each drawer. It also provides a check list so that the carts are stocked correctly and signed o f f by the accountable person. The responsibility for cleaning and re-stocking the cart is divided between Central Supply and Pharmacy. The used cart is first taken t o Central Supply where the cart is cleaned and re-stocked with supplies. The locater list is checked and signed b y the accountable employee i n Central Supply. The cart is then taken t o Pharmacy where the drugs are checked and replaced. The cart is secured with a paper lock by the pharmacist. The locater list is then signed off. Pharmacy is responsible for dating each cart and replenishing out-of-date medications. HOSPITAL TOPICS
LOCATER LIST PHARMACY DRAWER 1 Adrenalin 1:10001ml Atropine SO4 0.4mgIml Calcium Chloride 1Gm lOml Dextrose5Wh 50ml Dextrose 5% -Water 150ml , Dilantin lOOmg Dilution Table i Epinephrine 1:10,000 ! lntropin (Dopamine) 200mg 5ml lntropin Flow Rate Calculator I lsuprel l m g 5 m l ! Lanoxin 0.5mg 2ml ! Levophed 0.2%4ml I Lidocaine2Gm 50ml I Lidocaine HCI 50mg Bolus I Normal Saline30ml ! Potassium Chloride 20mEq/10ml I PronestyllOOmg/ml ! Valium 10mg 2ml i IVLabels
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I Sodium Bicarbonate Bristojets 44.6mEq each
2ENTRAL SUPPLY DRAWER 3 EKG Paste Redux Paste 3 Surgilube Packets 1 I Medium Adult Airway-Berman I Large Adult Airway-Berman
I Laryngoscope I # 3 Curved Blade I # 3 Straight Blade Endotrach Tube 10 Endotrach Tube 9 Endotrach Tube 8 12tubes) Endotrach Tube 7 1 Copper Stylette Yankaur Suction 1 l8French Suction Catheters 1 McGill Forceps 1 NGTube18F External All-Purpose Clamp
DRAWER 4 1 Vacutainer Sleeve and Needle 2 Red Top Blood Tubes 3 Green Top Blood Tubes 1 Lavender Top Blood Tube 2 Blue Top Blood Tubes 1 Tourniquet 2 ACUDyne Swabs 5 18 gauge needles 5 20 gauge needles 5 22 gauge needles 3 20~3% cardiac needles 3 Tuberculin Syringes 1 3cc non leur lock syringe 3 3cc syringes - no needle 10 lOcc syringes - no needle 3 35cc syringes - no needle 2 6Occ syringes - no needle 2 Blood Gas Kits 1 CultureTube 1 Large Surgeons Glove 1 Medium Surgeons Glove 1 Small Surgeons Glove
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