CLINICAL INSTRUCTORS TEACHING SHEET

STATION 5: CRITICAL CARE MANAGEMENT

Instructors Teaching Sheet Greet Introduce Station Good (Morning/Afternoon) At this station, you will be tasked to perform different procedures related to critical care management. It is required that you have read your manual prior to this activity. You will be assigned randomly to one of the following: 1. CODE BLUE TEAM recorder (nurse 1) physician 1 who gives the order (team leader) nurse 2 Anesthesiologists (physician 2) respiratory therapist Nurse 3 Physician 3 (Surgeon-optional)

OBTAIN ECG DO CPR APPLY CARDIAC MONITOR USE MANUAL DEFIBRILLATOR KNOW THE CONTENTS OF AN EMERGENCY CART

Station 5 Critical Care Management: Clinical Instructors Teaching Sheet. M. C. Agra, J. Garcia, F. Mercado. 2010.

Questions Time Limit Show and Tell

Do you have any questions before we proceed to the testing? You each have up to 10 minutes to do a procedure. Before we proceed to the testing, familiarize yourself with the following:

Code Blue Team

Room Set-up

ECG Machine

Location of the Chest Leads

Station 5 Critical Care Management: Clinical Instructors Teaching Sheet. M. C. Agra, J. Garcia, F. Mercado. 2010.

Limb Leads

ECG Paper

Proper Positioning of Client

Know when to call code blue

How to perform CPR

Station 5 Critical Care Management: Clinical Instructors Teaching Sheet. M. C. Agra, J. Garcia, F. Mercado. 2010.

Application of Cardiac Monitor

Manual Defibrillator

Proper placement of paddle

Emergency/Crash Cart

Station 5 Critical Care Management: Clinical Instructors Teaching Sheet. M. C. Agra, J. Garcia, F. Mercado. 2010.

Steps

This is the basic procedure: (Assuming that you have assessed the need for performing the required procedure) 1. Knock on the door. 2. Greet the patient. 3. Explain every step of the procedure to the patient. 4. Refer to the manual for every procedure. 5. Document findings and procedure.

Teaching Points

The procedures are done on a hospital settings wherein the client is critically ill or assessed as pulseless arrest; thus the CODE BLUE will be activated. Code blue activated
A. Medical emergency in which

paramedics are dispatched to aid a person undergoing cardiac arrest.)

A code blue is the term hospitals and medical professionals use to describe a situation where a patient will need to be resuscitated. When a person has stopped breathing a code will be called.

Assessed a pulseless patient Call for code blue Administer oxygen while waiting for the team to arrive and positions patient in supine ready for CPR, attachment of cardiac monitor and application of defibrillation.

I.

Emergency/Crash cart ready at bedside

Overview of ECG

A. In the section about the anatomy and physiology we explained how the cardiac impulse passes through the
Station 5 Critical Care Management: Clinical Instructors Teaching Sheet. M. C. Agra, J. Garcia, F. Mercado. 2010. 6

heart, but while doing so electrical current also spreads from the heart into the adjacent tissues surrounding the heart. B. A small portion of the current spreads all the way to the surface of the body. C. If electrodes are placed on the skin on opposite sides of the heart, electrical potentials generated by the current can be recorded; the recording is known as an electrocardiogram. D. Placement of electrodes for 12 lead ECG RA On the right arm, avoiding bony prominences. LA In the same location that RA was placed, but on the left arm this time. RL On the right leg, avoiding bony prominences. LL In the same location that RL was placed, but on the left leg this time. V1 In the fourth intercostal space (between ribs 4 & 5) just to the right of the sternum (breastbone). V2 In the fourth intercostal space (between ribs 4 & 5) just to the left of the sternum. V3 Between leads V2 and V4. V4 In the fifth intercostal space (between ribs 5 & 6) in the mid-clavicular line (the imaginary line that extends down from the midpoint of the clavicle (collarbone). II. V5 Horizontally even with V4, but in the anterior axillary line. CARDIO PULMONARY RESESCITATION (CPR) .

A. The major role of CPR is to provide oxygen to the heart, brain and other vital organs until medical treatment (Advanced cardiac life support- ACLS) can restore normal hear action.
Station 5 Critical Care Management: Clinical Instructors Teaching Sheet. M. C. Agra, J. Garcia, F. Mercado. 2010. 7

Indicated for respiratory arrest or cardiac arrest. B. The A B C s of CPR

Determine unresponsiveness ( shake and shout) A - Open the AIRWAY Determine breathlessness( Look, listen and feel) B - Breathing Determine Pulslessness C - Circulation

C. The steps of CPR

Assess responsiveness If no Response: Activate code blue or 108 Open the airway: look, listen, and feel for breaths If no breathing; Give 2 rescue breaths Assess for signs for of circulation If no signs of circulation: Begin chest compressions Continue pump and blow for 1 min Reassess

III.

Cardiac Monitoring

A. The electrocardiography (EKG) is a device used to measure cardiac electrical current. Electrical currents will provide important information about heart contractions and can identify potential problems.

IV.

DEFIBRILLATION

A. Defibrillation consists of delivering a therapeutic dose of electrical energy to the affected heart with a device called a defibrillator. V. PERFORMING BASIC CODE MANAGEMENT
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Station 5 Critical Care Management: Clinical Instructors Teaching Sheet. M. C. Agra, J. Garcia, F. Mercado. 2010.

Purpose To establish an airway To initiate breathing To maintain circulation and advance life support guidance Activate code blue "Code Red" "Code Blue", "Code Black"...people sometimes wonder what these terms mean if they happen to hear them used in a hospital. Technically, there's no formal definition for a "Code", but doctors often use the term as slang for a cardiopulmonary arrest happening to a patient in a hospital or clinic, requiring a team of providers (sometimes called a "code team") to rush to the specific location and begin immediate resuscitative efforts. C. Prepare emergency/crash cart A crash cart is a wheeled cart with drawers stocked with medical supplies used for emergencies outside of an emergency room. They are most commonly used to help medical personnel quickly respond to people who have gone into cardiac arrest, which is often referred to as the patient having "crashed," or cardiac/pulmonary arrest A cart carrying emergency equipment and supplies, such as medications, suction devices, sutures, scalpels, surgical needles, sponges, swabs, retractors, hemostats, forceps, airways, O2 supplies, IV supplies, tracheal tubes, and often a cardiac monitor with a defibrillator. Contents: TOP: Defibrillator Gloves 6-1/2 3 Electrodes Gloves 7-1/2 3 Suction Machine Tape Adult & Pedi Ambu Bags Introcan 22ga 2 Stethoscope Introcan 20ga 2 CPR Board Tourniquet 1 CPR Book Alcohol Swabs Oxygen Tanks w/one Regulator Syringes 60ml 2 Syringes 20ml 2 FIRST DRAWER: Syringes 10ml 5 Atropine 1/mg/10ml 1 Syringes 5ml 5 Adenosine 6mg/2cc -- 2 Syringes 3ml 5
Station 5 Critical Care Management: Clinical Instructors Teaching Sheet. M. C. Agra, J. Garcia, F. Mercado. 2010. 9

A. B.

Calcium 1gm/10ml 1 Needles 18ga 10 Epinephrine 1:1000/1ml 4 Conductivity Gel Dexamethasone 4mg/1ml 1 KY Gel Neo-Synephrine 10mg/1 ml 1 Injectable Saline 30ml 2 Epinephrine 1:10,000/10ml 10 Lanoxin 0.5mg/2ml 1 Diltiazem 3 (refrigerated) Benadryl 50mg/1ml 1 L Romazion 1mg/10ml (anesthesia cart) Narcan 0.4mg/1ml (anesthesia cart) Tongue Blades 5 Oxygen Wrench Thermal Paper SECOND DRAWER: Airways 6 1 Glucagon Emergency Kit 1 Airways 8 1 Vasopressin 20 units/cc 2 Batteries C 2 Dextrose 50gm/50ml 1 Amiodarone 150mg/3ml 2 Nitroglycerine 50mg/10ml 1 Sodium Bicarb 8.4%/50ml 1 Dopamine 400mg/10ml 1 Microshield 2 Yankeur Tip 2 Suction Tubing 2 THIRD DRAWER: Lasix 40mg/10ml 2 Mag Sulfate 5gm/10ml 1 FOURTH DRAWER: Gloves 6-1/2 3 Gloves 7-1/2 3 Tape Introcan G22/G20 2 each Torniquet 1 Alcohol swabs Syringes 60ml 2 Syringes 20ml - 2 Syringes 10ml - 5 Syringes 5ml - 5 Syringes 3ml - 10 Needles G18 10 Conductivity Gel KY Gel Injectable Saline 30ml - 2 FIFTH DRAWER: Dantrium 20mg 36
Station 5 Critical Care Management: Clinical Instructors Teaching Sheet. M. C. Agra, J. Garcia, F. Mercado. 2010. 10

Laryngoscope Handle Miller Blade #2 1 Miller Blade #3 1 Macintosh Blade #2 1 Macintosh Blade #3 1 ET Tubes 4 1 ET Tubes 7 1 ET Tubes 8 1 Airways 6 1 Airways 8 1 Batteries C 2 SIXTH DRAWER: Cric Kit w/Trach Tube (adult) 1 D5 NS 250cc 1 Lactated Ringers 500cc 2 NACL 0.9% 500cc 2 IV tubing - 5 D. Starts procedures

Station 5 Critical Care Management: Clinical Instructors Teaching Sheet. M. C. Agra, J. Garcia, F. Mercado. 2010.

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