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Acls - Megacode
Acls - Megacode
Acls - Megacode
MANAGEMENT
UNSTABLE:
- Synchronized cardioversion
(120J)
WITHOUT PULSE
- Initiate HQCPR first (5 cycles)
- Defibrillation one shock only
(200J)
UNSTABLE SVT
- Synchronized cardioversion
(120J); sedate pt.
PVC
ACLS: MEGACODE
Before saying this, make sure the rhythm presented to you is pulseless
1. CODE LEADER: active code blue
● “Activating code blue”
● Initiating HQCPR
RECORDER: “2 minutes”
7. CODE LEADER: “stop chest compression, analyzing rhythm and switch compressor” – when this is said,
CCs will immediately switch to the next CC
● CODE LEADER: While analyzing the rhythm “at 0600H patient is in vfib”
● CODE LEADER: “Continue HQCPR, charge defibrillator to 200J”
● DEFIBRILLATOR NURSE: “charging defibrillator to 200J, ready to shock”
● CODE LEADER: “shock patient now”
● DEFIBRILLATOR NURSE: “shocking patient now, shocking on 3; *look to self, look across, look
around* 1, 2, 3 … shock delivered”
● CODE LEADER: resume HQCPR
RECORDER: “2 minutes”
8. CODE LEADER: “stop chest compression, analyzing rhythm and switch compressor” – when this is said,
CCs will immediately switch to the next CC
10. CODE LEADER: While analyzing the rhythm “at 0602H patient is in vfib”
● CODE LEADER: “Continue HQCPR, charge defibrillator to 200J”
● DEFIBRILLATOR NURSE: “charging defibrillator to 200J, ready to shock”
● CODE LEADER: “shock patient now”
● DEFIBRILLATOR NURSE: “shocking patient now, shocking on 3; *look to self, look across, look
around* 1, 2, 3 … shock delivered”
● CODE LEADER: resume HQCPR
● CODE LEADER: “Prepare epinephrine 1mg and flush 10ml of PNSS”
● MEDICATION NURSE: “Epinephrine 1mg and flush 10ml of PNSS ready”
● CODE LEADER: “give epinephrine 1mg IVTT now and flush 10ml of PNSS” → (verbalize)
● MEDICATION NURSE: “administering epinephrine 1mg IVTT and flushing 10ml of PNSS”
RECORDER: “2 minutes”
11. CODE LEADER: “stop chest compression, analyzing rhythm and switch compressor” – when this is said,
CCs will immediately switch to the next CC
13. CODE LEADER: While analyzing the rhythm “at 0604H patient is in vfib”
● CODE LEADER: “Continue HQCPR, charge defibrillator to 200J”
● DEFIBRILLATOR NURSE: “charging defibrillator to 200J, ready to shock”
● CODE LEADER: “shock patient now”
● DEFIBRILLATOR NURSE: “shocking patient now, shocking on 3; *look to self, look across, look
around* 1, 2, 3 … shock delivered”
● CODE LEADER: resume HQCPR
● CODE LEADER: “Prepare amiodarone 300mg and flush 10ml of PNSS”
● MEDICATION NURSE: “Amiodarone 300mg and flush 10ml of PNSS ready”
● CODE LEADER: “give amiodarone 300mg IV bolus now and flush 10ml of PNSS” → (verbalize)
● MEDICATION NURSE: “administering amiodarone 300mg IV bolus and flushing 10ml of PNSS”
AT 0605H: CODE LEADER: “Prepare epinephrine 1mg and flush 10ml of PNSS”
MEDICATION NURSE: “Epinephrine 1mg and flush 10ml of PNSS ready”
CODE LEADER: “Administer Epinephrine 1mg and flush 10ml of PNSS”
MEDICATION NURSE: “administering Epinephrine 1mg and flush 10ml of PNSS”
0605H vfib HQCPR, epi 1mg
RECORDER: “2 minutes”
14. CODE LEADER: “stop chest compression, analyzing rhythm and switch compressor” – when this is said,
CCs will immediately switch to the next CC
16. CODE LEADER: While analyzing the rhythm “at 0606H patient is in vfib”
● CODE LEADER: “Continue HQCPR, charge defibrillator to 200J”
● DEFIBRILLATOR NURSE: “charging defibrillator to 200J, ready to shock”
● CODE LEADER: “shock patient now”
● DEFIBRILLATOR NURSE: “shocking patient now, shocking on 3; *look to self, look across, look
around* 1, 2, 3 … shock delivered”
● CODE LEADER: resume HQCPR
● CODE LEADER: “Prepare amiodarone 150mg and flush 10ml of PNSS”
● MEDICATION NURSE: “Amiodarone 150mg ang flush 10ml of PNSS ready”
● CODE LEADER: “administer amiodarone 150mg IVTT now and flush 10ml of PNSS” →
(verbalize)
● MEDICATION NURSE: “administering amiodarone 150mg IV bolus and flushing 10ml of PNSS”
AT 0608H: CODE LEADER: “Prepare epinephrine 1mg and flush 10ml of PNSS”
MEDICATION NURSE: “Epinephrine 1mg and flush 10ml of PNSS ready”
CODE LEADER: “Administer Epinephrine 1mg and flush 10ml of PNSS”
MEDICATION NURSE: “administering Epinephrine 1mg and flush 10ml of PNSS”
RECORDER: “2 minutes”
17. CODE LEADER: “stop chest compression, analyzing rhythm and switch compressor” – when this is said,
CCs will immediately switch to the next CC
19. CODE LEADER: While analyzing the rhythm “at 0610H patient is in vfib”
● CODE LEADER: “Continue HQCPR, charge defibrillator to 200J”
● DEFIBRILLATOR NURSE: “charging defibrillator to 200J, ready to shock”
● CODE LEADER: “shock patient now”
● DEFIBRILLATOR NURSE: “shocking patient now, shocking on 3; *look to self, look across, look
around* 1, 2, 3 … shock delivered”
● CODE LEADER: resume HQCPR
● CODE LEADER: “Prepare amiodarone drip 600mg plus 250ml of D5W”
● MEDICATION NURSE: “Amiodarone drip 600mg plus 250ml of D5W ready”
● CODE LEADER: “start amiodarone drip 600mg in 250ml of D5W to run for 24hrs”
● MEDICATION NURSE: “starting amiodarone drip 600mg in 250ml of D5W”
RECORDER: “2 minutes”
20. CODE LEADER: “stop chest compression, analyzing rhythm and switch compressor” – when this is said,
CCs will immediately switch to the next CC
22. CODE LEADER: While analyzing the rhythm “at 0612H patient is in vfib”
● CODE LEADER: “Continue HQCPR, charge defibrillator to 200J”
● DEFIBRILLATOR NURSE: “charging defibrillator to 200J, ready to shock”
● CODE LEADER: “shock patient now”
● DEFIBRILLATOR NURSE: “shocking patient now, shocking on 3; *look to self, look across, look
around* 1, 2, 3 … shock delivered”
● CODE LEADER: resume HQCPR
● CODE LEADER: “administer lidocaine 1mg/kg now”
● MEDICATION NURSE: “administering lidocaine 1mg/kg now”
RECORDER: “2 minutes”
23. CODE LEADER: “stop chest compression, analyzing rhythm and switch compressor” – when this is said,
CCs will immediately switch to the next CC
25. CODE LEADER: While analyzing the rhythm “at 0616H patient is in vfib”
● CODE LEADER: “Continue HQCPR, charge defibrillator to 200J”
● DEFIBRILLATOR NURSE: “charging defibrillator to 200J, ready to shock”
● CODE LEADER: “shock patient now”
● DEFIBRILLATOR NURSE: “shocking patient now, shocking on 3; *look to self, look across, look
around* 1, 2, 3 … shock delivered”
● CODE LEADER: resume HQCPR
● CODE LEADER: “administer lidocaine 0.5mg/kg now”
● MEDICATION NURSE: “administering lidocaine 0.5mg/kg now”
RECORDER: “2 minutes”
26. CODE LEADER: “stop chest compression, analyzing rhythm and switch compressor” – when this is said,
CCs will immediately switch to the next CC
28. CODE LEADER: While analyzing the rhythm “at 0618H, the patient is in sinus bradycardia”
● CODE LEADER: “is there a pulse?”
● SIR: “yes, we have pulse”
● CODE LEADER: “patient revived with return of spontaneous circulation, begin post cardiac arrest
care”
● CODE LEADER: “give atropine 1mg IVTT now and flush 10ml of PNSS”
● MEDICATION NURSE: “administering atropine 1mg IVTT now and flushing 10ml of PNSS”
● CODE LEADER:
○ “Check vital signs, check bp”
○ “Maintain O2 sat > or equal to 95%”. Intubate if low O2
○ “regulate PNSS, call labs- CBC, ABG, crea, Na, K, SGPT, CBG”
RECORDER: “2 minutes”
7. CODE LEADER: “stop chest compression, analyzing rhythm and switch compressor” – when this is said,
CCs will immediately switch to the next CC
● CODE LEADER: While analyzing the rhythm “at 0608H patient is in ventricular tachycardia”
● CODE LEADER: “is there a pulse?”
● SIR: “no pulse”
● CODE LEADER: “Continue HQCPR, charge defibrillator to 200J”
● DEFIBRILLATOR NURSE: “charging defibrillator to 200J, ready to shock”
● CODE LEADER: “shock patient now”
● DEFIBRILLATOR NURSE: “shocking patient now, shocking on 3; *look to self, look across, look
around* 1, 2, 3 … shock delivered”
RECORDER: “2 minutes”
8. CODE LEADER: “stop chest compression, analyzing rhythm and switch compressor” – when this is said,
CCs will immediately switch to the next CC
● CODE LEADER: While analyzing the rhythm “at 0610H patient is in ventricular tachycardia”
● CODE LEADER: “is there a pulse?”
● SIR: “yes, we have a pulse”
● CODE LEADER: “What's the BP sir?”
● SIR: “<90”
● CODE LEADER: “prepare synchronized cardioversion to 120J”
● DEFIBRILLATOR NURSE: “charging defibrillator to 120J, ready to shock”
● CODE LEADER: “shock patient now”
● DEFIBRILLATOR NURSE: “shocking patient now, shocking on 3; *look to self, look across, look
around* 1, 2, 3 …. 1, 1002, 1003, 1004, 1005, 1006 then remove; shock delivered”
● CODE LEADER: resume HQCPR
RECORDER: “2 minutes”
9. CODE LEADER: “stop chest compression, analyzing rhythm and switch compressor” – when this is said,
CCs will immediately switch to the next CC
● CODE LEADER: While analyzing the rhythm “at 0612H patient is in supraventricular
tachycardia”
● CODE LEADER: “is there a pulse?”
● SIR: “yes, we have a pulse”
● CODE LEADER: “What's the BP sir?”
● SIR: “>90”
● CODE LEADER: “administer adenosine 6mg, rapid IV bolus flushed with 20ml PNSS”
● MEDICATION NURSE: “administering adenosine 6mg, rapid IV bolus and flushing with 20ml
of PNSS”
● CODE LEADER: resume HQCPR
RECORDER: “2 minutes”
10. CODE LEADER: “stop chest compression, analyzing rhythm and switch compressor” – when this is said,
CCs will immediately switch to the next CC
● CODE LEADER: While analyzing the rhythm “at 0614H patient is still in supraventricular
tachycardia”
● CODE LEADER: “is there a pulse?”
● SIR: “no pulse”
● CODE LEADER: “Continue HQCPR and administer 1mg of epinephrine IVTT and flush with
10ml of PNSS”
● MEDICATION NURSE: “administering epinephrine 1mg IVTT and flushing 10ml of PNSS”
● CODE LEADER: resume HQCPR