ROLES (Everyone will rotate) Intravenous/intraosseous Access

Leader Hook pt to PNSS via IV or IO.

Nurse 1 and Nurse 2 – CPR and Shock
Timer Nurse Treatment
Medication Nurse For Sinus Bradycardia
BVM Nurse >Atropine (1 mg for 3 doses)
(Say everything here) >TCP
If in the situation the patient is conscious >Dopamine (2-20 mcg/kg/min) (Renal dose 2,
and breathing. 11-15 Vasopressor, 5-10 Cardiac dose)
Verbalize >Epinephrine (2-10 mcg/min)
(Patient’s Name) I am Student Nurse (Leader, For Sinus Tachycardia
Name) and I am here to help you. How are you
Narrow
feeling today?
>Vagal Maneuver
Patient: I am not feeling well, I have chest pain
and bloating from undigested food in my >Adenosine (1st Dose - 6mg, 2nd dose - 12mg)
stomach. very fast push
Visualize >Sedate
The patient appears pale and restless. >Synchro Cardioversion
Vital signs Wide
I will take your vital signs. (BP, HR, RR, Temp, >Adenosine (1st Dose - 6mg, 2nd dose - 12mg)
O2 sat) very fast push
Example scene: >Amid Infusion
>O2 sat is 95%, do not give oxygen yet. >Sedate
>O2 sat is 94% below, give oxygen via >Synchro Cardioversion
available device.

The patient suddenly lost consciousness.

Monitor
If the patient is unconscious, BLS survey.
Attach patient to cardiac monitor.
1. Check for responsiveness.
White on right, smoke (black) over fire (red) 2. Check for carotid pulse. (Count 11000,
21000, 31000, 41000, 51000, 61000),
Select lead II.
no pulse
Sample Scene: 3. Activate Emergency Response System
4. Initiate CPR 30 chest compressions, 2
>The monitor shows Sinus Bradycardia.
rescue breaths.
If needs switching, hover hand over the chest. Nurse 2 now provides CPR.
Here’s the conversation:
Nurse 1: I’m here to help. (Hover over the
2 minutes SAS
chest)
Timer Nurse: 15 seconds before 2 minutes.
Leader: Let me see your hand.
Leader: Stop, Analyze, and Switch. (Reads the
*Switch Fast*
Monitor, if shockable)
Then continue compressions.
Leader: Please give another shock at 360
joules, and please give 1st dose of epinephrine
1 mg (1:10,000) after the shock.
Meanwhile, the Timer needs to take note of the
time and remind 15 sec before 2 minutes for Nurse 2: *Turn the dial to 360* Clear! Gel!
SAS.
Still Nurse 2
*Step Backward* paddle on chest, sternum,
2 minutes, Stop-Analyze-Switch apex
The leader will check the monitor, then if the Charging…
reading is shockable, then the leader will order
Shocking in
SHOCK at 360 J. CPR after shock.
3 – One foot out
Conversation:
2 – Look at the surroundings
Timer Nurse: 15 seconds before 2 minutes.
1 – Look at the Monitor, still shockable
Leader: Stop, Analyze, and Switch. (Reads the
Monitor, if shockable) Shocking…
Leader: Please give shock at 360 joules, and Shock delivered.
please prepare 1st dose of epinephrine 1 mg
(1:10,000) Leader: Please resume high quality CPR.

Nurse 1: *Turn the dial to 360* Clear! Gel! Medication Nurse: Giving Epinephrine 1 mg
(1:10,000), then flush (for 10-1000).
Still Nurse 1 Epinephrine 1 mg (1:10,000) given.
*Step Backward* paddle on chest, sternum, Nurse 1 now provides the CPR.
apex
Charging…
2 minutes SAS
Shocking in
Timer Nurse: 15 seconds before 2 minutes.
3 – One foot out
Leader: Stop, Analyze, and Switch. (Reads the
2 – Look at the surroundings Monitor, if shockable)
1 – Look at the Monitor, still shockable Leader: Please give shock at 360 joules, and
give Amiodarone 300 after shock.
Shocking…
Medication Nurse: Preparing Amiodarone 300
Shock delivered.
Nurse 1: *Turn the dial to 360* Clear! Gel!
Leader: Please resume high quality CPR.
Still Nurse 1 Leader: Please resume high quality CPR.
*Step Backward* paddle on chest, sternum, Medication Nurse: Giving Epinephrine 1 mg
apex (1:10,000), then flush (for 10-1000).
Epinephrine 1 mg (1:10,000) given.
Charging…
Shocking in
2 minutes SAS
3 – One foot out
Timer Nurse: 15 seconds before 2 minutes.
2 – Look at the surroundings
Leader: Stop, Analyze, and Switch. (Reads the
1 – Look at the Monitor, still shockable
Monitor, if shockable)
Shocking…
Leader: Please give shock at 360 joules, and
Shock delivered. give Amiodarone 150 after shock.

Leader: Please resume high quality CPR. Medication Nurse: Preparing Amiodarone 150

Nurse 2 now provides CPR. Nurse 1: *Turn the dial to 360* Clear! Gel!

Medication Nurse: Giving Amiodarone 300, Still Nurse 1

then flush (for 10-1000). Amiodarone 300
*Step Backward* paddle on chest, sternum,
given.
apex
Charging…
2 minutes SAS
Shocking in
Timer Nurse: 15 seconds before 2 minutes.
3 – One foot out
Leader: Stop, Analyze, and Switch. (Reads the
2 – Look at the surroundings
Monitor, if shockable)
1 – Look at the Monitor, still shockable
Leader: Please give another shock at 360
joules, and please give 2nd dose of epinephrine Shocking…
1 mg (1:10,000) after the shock.
Shock delivered.
Nurse 2: *Turn the dial to 360* Clear! Gel!
Leader: Please resume high quality CPR.
Still Nurse 2
Nurse 2 now provides CPR.
*Step Backward* paddle on chest, sternum,
Medication Nurse: Giving Amiodarone 150,
apex
then flush (for 10-1000). Amiodarone 150
Charging… given.
Shocking in
3 – One foot out The leader reads the monitor. Reading turns
to PEA/Asystole.
2 – Look at the surroundings
Leader: Please continue high quality CPR, no
1 – Look at the Monitor, still shockable
shock, and give Epinephrine 1mg (1:10,000)
Shocking… every 3-5 minutes.

Shock delivered.
Timer Nurse notes of the time and informs Secondary Assessment (Capnograph)
the Medication Nurse to give Epinephrine.
>Colorometer (Qualitative)
Leader: Please give Epinephrine now.
BVM for 6 times, if yellow, you are in lungs, if
Timer Nurse still notifies 15 secs before 2 purple, not in lungs.
minutes for SAS.
>Waveform Capnography (Quantitative)
Confirmed in lungs if 35-45 mmHg.
CI: What are the possible reversible cause H’s
Ask the BP of the patient to the CI. If there
and T’s
is no BP:
• Hypovolemia
>Check if there are crackles before giving
• Hypoxia
fluids. If no crackles, give 1-2L PNSS.
• Hydrogen ion excess (acidosis)
• Hypoglycemia >If there are crackles, only give inotropes
• Hypokalemia (Dopamine 10-20mcg/kg/min, Epinephrine 2-
• Hyperkalemia 10mcg/min, Norepinephrine 2-10mcg/min)
• Hypothermia Leader: (Patient’s Name) Can you squeeze my
• Tension pneumothorax hand? *If the patient cannot squeeze, coma)
• Tamponade – Cardiac
• Toxins Proceed to TTM
• Thrombosis (pulmonary embolus) TTM Protocol
• Thrombosis (myocardial infarction)
>4-degree Celsius PNSS
>for 12-24hours
>32-34 degrees
There is a RETURN OF SPONTANEOUS
>30cc/kg
CIRCULATION
>Check temp via esophageal/bladder
Leader: *Checks the femoral pulse* There is
thermometer
breathing.
Post Cardiac Arrest Care
Leader: Is the patient breathing on its own?
>Insert NGT
BVM Nurse: No.
>Foley Cath
Leader: Try BVM.
>12 Lead ECG (Stemi: Cath Lab, Non-Stemi:
BVM Nurse: *Rescue breathing 1q 5-6 sec, no
ICU)
rise and fall of chest, advance airway na*
>Chest X-Ray and CVP
Do the primary assessment of tube
placement.
5-point auscultation
Epigastric Area – no gurgling sound
(2x) Lower lobe – good air
(2x) Upper lobe – good air