Megacode – NurseCheung.com https://nursecheung.com From "You're Not Good Enough" To "Look At Me Now!" Wed, 06 Dec 2023 15:10:01 +0000 en-US hourly 1 https://wordpress.org/?v=6.4.3 https://2hya11.p3cdn1.secureserver.net/wp-content/uploads/2023/01/nurse-cheung-logo-Logo-1000-×-1000-px-2-150x150.png Megacode – NurseCheung.com https://nursecheung.com 32 32 The Adult BLS 1-Rescuer Megacode: How to Perform CPR and Use an AED https://nursecheung.com/blsmegacode-1rescuer/ Sat, 07 Jan 2023 17:14:43 +0000 https://nursecheung.com/the-adult-bls-1-rescuer-megacode-how-to-perform-cpr-and-use-an-aed/

The BLS 1 Rescuer Megacode is a set of guidelines for how to provide CPR and use an AED. This code was developed by the American Heart Association and provides step-by-step instructions for rescuing someone who is experiencing cardiac arrest.

In this blog post, we will discuss the steps involved in performing CPR and using an AED.

We will also provide a video demonstration of how to perform these procedures.

Adult 1-Rescuer Megacode Scenario

The following is a scenario in which you would use the Adult BLS Megacode:

You are a bystander who witnesses an adult collapse. The person is unresponsive and not breathing.

Demonstrate what you would do next

  1. Check for scene safety: If the scene is not safe, move the person prior to starting interventions
  2. Check responsiveness: Tap the shoulders and shout, “Are you okay?”
  3. Activate the Emergency Response System: Call for help. If you are with someone, have them find an AED and call 911. If you are by yourself, perform a round of CPR then call for help and obtain an AED.
  4. Check for breathing: Look for visible chest rising and fall
  5. Check for a pulse: Place your fingers on the inside of the patient’s neck, just below the angle of the jaw. You will palpate the carotid pulse for no more than 10 seconds.
 

The person is unresponsive with no pulse or breathing. What are your next actions?

Chest Compressions and Airway (CAB)

Adult Compressions

Perform High-Quality Compressions

  • Hands should be placed on the lower half of the sternum
  • 30 compressions at a rate of 100 to 120 compressions per minute
  • Compresses at least 2 inches (5 cm)
  • Complete chest recoil after each compression

Adult Rescue Breaths

Give 2 breaths with a barrier device

  • Each breath should be given over 1 second
  • Visible chest rise and fall with each breath
  • resume compressions in less than 10 seconds
 

You will need to perform one to two rounds of high-quality CPR.

Automated External Defibrillator (AED)

  1. Turn on the AED and follow the prompts
  2. Correctly attached pads and plug-in connector. Remove any barriers including medication patches, water, or clothing.
  3. Clear for AED analysis. Stop chest compressions. Call out “stand clear.”
  4. Push the analyze button and allow time for analysis.
  5. Deliver shock if recommended by AED.
 

Resume Compressions

Continue compressions immediately after the shock is delivered or if the AED does not recommend the shock.

 

Your scenario has concluded

]]> The Adult BLS 2-Rescuer Megacode: How to Perform CPR and Use an AED https://nursecheung.com/blsmegacode-2rescuer/ Sat, 07 Jan 2023 17:14:41 +0000 https://nursecheung.com/the-adult-bls-2-rescuer-megacode-how-to-perform-cpr-and-use-an-aed/

The BLS 2-Rescuer Megacode is a set of guidelines for how to provide CPR and use an AED. This code was developed by the American Heart Association and provides step-by-step instructions for rescuing someone who is experiencing cardiac arrest.

In this blog post, we will discuss the steps involved in performing CPR and using an AED.

We will also provide a video demonstration of how to perform these procedures.

Adult 2-Rescuer Megacode Scenario

The following is a scenario in which you would use the Adult 2-Rescuer BLS Megacode:

You are two bystanders who witness an adult collapse. The person is unresponsive and not breathing.

Demonstrate what you would do next

  1. Check for scene safety: If the scene is not safe, move the person prior to starting interventions
  2. Check responsiveness: Tap the shoulders and shout, “Are you okay?”
  3. Activate the Emergency Response System: Have the second rescuer call for help and obtain an AED.
  4. Check for breathing: Look for visible chest rising and fall
  5. Check for a pulse: Place your fingers on the inside of the patient’s neck, just below the angle of the jaw. You will palpate the carotid pulse for no more than 10 seconds.
 

The person is unresponsive with no pulse or breathing. What are your next actions?

Chest Compressions and Airway (CAB)

Adult Compressions

Perform High-Quality Compressions

  • Hands should be placed on the lower half of the sternum
  • 30 compressions at a rate of 100 to 120 compressions per minute
  • Compresses at least 2 inches (5 cm)
  • Complete chest recoil after each compression
 

Adult Rescue Breaths

Give 2 breaths with a barrier device

  • Each breath should be given over 1 second
  • Visible chest rise and fall with each breath
  • resume compressions in less than 10 seconds
 

You will need to perform one to two rounds of high-quality CPR.

Automated External Defibrillator (AED)

Have the second rescuer begin compressions as the first rescuer performs the following steps below.

  1. Turn on the AED and follow the prompts
  2. Correctly attached pads and plug-in connector. Remove any barriers including medication patches, water, or clothing.
  3. Clear for AED analysis. Stop chest compressions. Call out “stand clear.”
  4. Push the analyze button and allow time for analysis.
  5. Deliver shock if recommended by AED.
 

Resume Compressions

Continue compressions immediately after the shock is delivered or if the AED does not recommend the shock.

Now that you have both rescuers, the first rescuer will take over for rescue breathing and the second rescuer will continue with chest compressions. You will switch roles every 5 rounds of compressions or every 2 minutes.

 

Your scenario has concluded.

]]> The Infant BLS Megacode: A Comprehensive Guide to Saving Lives https://nursecheung.com/blsmegacode-infant/ Sat, 07 Jan 2023 17:14:39 +0000 https://nursecheung.com/the-infant-bls-megacode-a-comprehensive-guide-to-saving-lives/

In this comprehensive guide, we will teach you everything you need to know about the Infant BLS Megacode. This lifesaving procedure is used to resuscitate infants who are not breathing or have a heartbeat.

We will discuss the steps involved in performing the Megacode. We will also provide a video demonstration of how to perform these procedures.

We highly recommend that all healthcare providers become familiar with this procedure, as it could one day save a life!

Infant 1 and 2-Rescuer Megacode Scenario

The following is a scenario in which you would use the Infant 1 and 2-Rescuer BLS Megacode:

You arrive on a scene for an infant who is not breathing and no bystander CPR has been performed.

Demonstrate what you would do next

  1. Check for scene safety: If the scene is not safe, move the infant prior to starting interventions
  2. Check responsiveness: Tap the infant’s heel for a response
  3. Activate the Emergency Response System: Call for help. If you are with someone, have them find an AED and call 911. If you are by yourself, perform a round of CPR then call for help and obtain an AED.
  4. Check for breathing: Look for visible chest rising and fall
  5. Check for a pulse: Palpate the brachial pulse for no more than 10 seconds.
 

The infant is unresponsive with no pulse or breathing. What are your next actions?

Chest Compressions and Airway (CAB)

Infant Compressions

Single Rescuer Compressions (30 chest compressions to 2 breaths)

  • Option #1: 2 fingers in the center of the infant’s chest, the lower half of the breast bone
  • Option #2: 2 thumbs with hands wrapped around the infant’s chest, the lower half of the breast bone
  • Option #3: 1 hand in the center of the infant’s chest, the lower half of the breast bone
 

Two-Rescuer Infant Compressions (15 chest compressions to 2 breaths)

  • 2 thumbs with hands wrapped around the infant’s chest, the lower half of the breast bone
 

Perform High-Quality Compressions

  • Compressions are provided at a rate of 100 to 120 compressions per minute
  • Compresses at least 1 1/2 inches (4 cm)
  • Complete chest recoil after each compression

Infant Rescue Breaths

Give 2 breaths with a barrier device after each 30 chest compressions

  • Utilize the sniffing position which requires flexion of the cervical spine and extension of the atlantooccipital joint
  • Each breath should be given over 1 second
  • Visible chest rise and fall with each breath
  • Resume compressions in less than 10 seconds
 

You will need to perform one to two rounds of high-quality CPR.

Automated External Defibrillator (AED)

Have the second rescuer begin compressions (if available) as the first rescuer performs the following steps below.

  1. Turn on the AED and follow the prompts
  2. Correctly attached pads and plug-in connector. Remove any barriers including medication patches, water, or clothing. Use the child pads if available. If child pads are not available, you may use adult pads. Place pads so they do not touch each other. One pad is placed on the chest and the other pad is placed on the back. Pads should sandwich the heart when placed appropriately.
  3. Clear for AED analysis. Stop chest compressions. Call out “stand clear.”
  4. Push the analyze button and allow time for analysis.
  5. Deliver shock if recommended by AED.
 

Resume Compressions

Continue compressions immediately after the shock is delivered or if the AED does not recommend the shock.

If you have both rescuers, the first rescuer will take over for rescue breathing and the second rescuer will continue with chest compressions. You will switch roles every 5 rounds of compressions or every 2 minutes.

 

Your scenario has concluded.

]]> The Child BLS Megacode: A Comprehensive Guide to Saving Lives https://nursecheung.com/blsmegacode-child/ Sat, 07 Jan 2023 17:14:37 +0000 https://nursecheung.com/the-child-bls-megacode-a-comprehensive-guide-to-saving-lives/

In this comprehensive guide, we will teach you everything you need to know about the Child BLS Megacode. This lifesaving procedure is used to resuscitate infants who are not breathing or have a heartbeat.

We will discuss the steps involved in performing the Megacode. We will also provide a video demonstration of how to perform these procedures.

We highly recommend that all healthcare providers become familiar with this procedure, as it could one day save a life!

Child Megacode Scenario

The following is a scenario in which you would use the Child BLS Megacode:

You arrive on a scene for a child (ages 13 months to the age of puberty) who is not breathing and no bystander CPR has been performed.

Demonstrate what you would do next

  1. Check for scene safety: If the scene is not safe, move the child prior to starting interventions
  2. Check responsiveness: Tap the shoulders of a child and shout “Are you okay?” Check for any kind of response.
  3. Activate the Emergency Response System: Call for help. If you are with someone, have them find an AED and call 911. If you are by yourself, perform a round of CPR then call for help and obtain an AED.
  4. Check for breathing: Look for visible chest rising and fall
  5. Check for a pulse: Palpate the carotid or femoral pulse for no more than 10 seconds.
 

The child is unresponsive with no pulse or breathing. What are your next actions?

Chest Compressions and Airway (CAB)

Child Compressions

Perform High-Quality Compressions

  • Hands should be placed on the lower half of the sternum
  • 30 compressions at a rate of 100 to 120 compressions per minute
  • Compresses at least 2 inches (5 cm)
  • Complete chest recoil after each compression
 

Child Rescue Breaths

Give 2 breaths with a barrier device after each 30 chest compressions

  • Each breath should be given over 1 second
  • Visible chest rise and fall with each breath
  • Resume compressions in less than 10 seconds
 

You will need to perform one to two rounds of high-quality CPR.

Automated External Defibrillator (AED)

Have the second rescuer begin compressions (if available) as the first rescuer performs the following steps below.

  1. Turn on the AED and follow the prompts
  2. Correctly attached pads and plug-in connector. Remove any barriers including medication patches, water, or clothing. If the person is under 8 years old, use the child pads if available. If child pads are not available, you may use adult pads. Place pads so they do not touch each other. One pad is placed on the chest and the other pad is placed on the back. Pads should sandwich the heart when placed appropriately. If the child is 8 years old or older, use the adult pads. Do not use child pads as the shock will be too low of a dose.
  3. Clear for AED analysis. Stop chest compressions. Call out “stand clear.”
  4. Push the analyze button and allow time for analysis.
  5. Deliver shock if recommended by AED.
 

Resume Compressions

Continue compressions immediately after the shock is delivered or if the AED does not recommend the shock.

If you have both rescuers, the first rescuer will take over for rescue breathing and the second rescuer will continue with chest compressions. You will switch roles every 5 rounds of compressions or every 2 minutes.

 

Your scenario has concluded.

]]> AHA BLS Choking Megacode: How to Save a Life in an Emergency https://nursecheung.com/blsmegacode-choking/ Sat, 07 Jan 2023 17:14:35 +0000 https://nursecheung.com/aha-bls-choking-megacode-how-to-save-a-life-in-an-emergency/

When someone is choking, time is of the essence. In just a few short minutes, they could lose consciousness and die.

That’s why it’s important to know how to perform the AHA BLS Choking Megacode. This emergency procedure can help save a life in an instant.

In this blog post, we will teach you how to do the megacode, as well as provide some tips on how to avoid choking in the first place!

Difference between Mild and Severe Airway Block

Mild Airway Block: Person can talk, make sounds, and cough loudly

Severe Airway Block: Person cannot breathe, talk, make sounds, has a cough that has no sound, makes the choking sign

Universal Sign of Choking: holding the neck with one or both hands

Choking Adult Megacode Scenario

The following is a scenario in which you would use the Chocking Adult BLS Megacode:

You are out to eat with your family when a person at the table next to you begins exhibiting signs of choking. This person is coughing with no sounds and is making the choking sign.

Demonstrate what you would do next

  1. Ask the person “Are you choking?” If the person nods “yes” and cannot talk, severe airway obstruction is present.
  2. Ask the person if they would like help. If they nod “yes,” help the person with the AHA protocol. If they nod “no,” then you must respect their wishes.
  3. Stand behind the person, wrap your arms around their waist slightly above the belly button and make a fist, place your knee between their legs, and provide five abdominal thrusts. If the person is large, pregnant, or in a wheelchair, place your fist on the lower half of the breastbone for chest thrusts.
  4. Call 911 if the object does not dislodge after five abdominal thrusts or chest thrusts.
 

The person becomes unresponsive. What are your next actions?

  1. Activate the emergency response system through your mobile phone or send someone for help.
  2. Begin CPR starting with compressions. Important Note: If the person originally said no to help when they were conscious when the person falls unconscious consent is implied at this point and you should begin CPR.
  3. Turn the person towards yourself. If you see the object, remove it if possible. If you cannot see the object, do not attempt to remove the object. Never perform a blind finger sweep as you can further lodge the object in the airway.
  4. If unsuccessful, continue with CPR until there is a return of breathing and pulse.
 

It’s important to note that when the object becomes dislodged and breathing returns, the person may vomit which is why it’s important to have the person on their side.

Choking Infant Megacode Scenario

The following is a scenario in which you would use the Chocking Infant BLS Megacode:

You are feeding your infant when they stop accepting food and begin exhibiting signs of choking. The infant is making no sound and becomes anxious.

Demonstrate what you would do next

  1. Kneel or sit with the infant on your lap
  2. Remove clothing from the infant’s chest if possible
  3. Hold the infant facedown with the head slightly lower than the chest, resting the infant on your forearm. It is important to support the infant’s head and jaw with your hand. Avoid compressing the soft tissue in the infant’s throat.
  4. Deliver up to 5 back slaps forcefully between the infant’s shoulder blades. Deliver each slap with enough force to dislodge the object.
  5. Next, place your free hand on the infant’s back supporting the back of the infant’s head with the palm of your hand. Turn the infant over while carefully supporting the head and neck keeping the head lower than the body.
  6. Provide 5 downward chest thrusts in the middle of the chest over the lower half of the breastbone. Each thrust should be delivered over about 1 second.
  7. Repeat the sequence until the object is removed or the infant becomes unresponsive.
 

The infant becomes unresponsive. What are your next actions?

  1. Activate the emergency response system through your mobile phone or send someone for help.
  2. Begin CPR starting with compressions.
  3. Turn the infant towards yourself. If you see the object, remove it if possible. If you cannot see the object, do not attempt to remove the object. Never perform a blind finger sweep as you can further lodge the object in the airway.
  4. If unsuccessful, continue with CPR until there is a return of breathing and pulse.
 

It’s important to note that when the object becomes dislodged and breathing returns, the infant may vomit which is why it’s important to have the person on their side.

 

Your scenario has concluded.

]]> Out-Of-Hospital ACLS Airway Management Megacode: The Best Strategies for Saving Lives https://nursecheung.com/aclsmegacode-ooh-airwaymanagement/ Sat, 07 Jan 2023 17:14:33 +0000 https://nursecheung.com/out-of-hospital-acls-airway-management-megacode-the-best-strategies-for-saving-lives/

Table of Contents

Adult Out-Of-Hospital Respiratory Arrest Megacode Scenario

The following is a scenario in which you would use the out-of-hospital adult respiratory arrest Megacode:

You are a paramedic and arrive on the scene for a woman having an asthma attack at home.

Demonstrate what you would do next

Initial Impression

The woman is conscious and reports difficulty breathing during her evening meal. The woman begins to have respiratory distress and a decrease in mental status.

Primary Assessment Survey (A, B, C, D, E)

Airway: The airway is starting to swell. The flow through the trachea is impaired.

Breathing: Oxygenation is showing less than 50% on room air. Agonal gasps are noted.

Circulation: Blood pressure is 60/38, heart rate is 120/min, and the pulse is present but weak.

Disability: Decrease in mental status. Responsive to verbal stimulation.

Exposure: No obvious signs of trauma, bleeding, burns, markings, or medical alert bracelet.

Change in Condition

After assessment of the initial impression and primary assessment, the woman becomes unresponsive.

What are your next actions?

  1. Check responsiveness: Tap the shoulders and shout, “Are you okay?” There is no response.
  2. Activate the emergency response system. You direct the second rescuer to activate the emergency response system and get an AED.
  3. Check for breathing: Look for visible chest rising and falling. No breathing present.
  4. Check for a pulse: Place your fingers on the inside of the patient’s neck, just below the angle of the jaw. You will palpate the carotid pulse for no more than 10 seconds. Pulse is present but weak.
 

What are your next actions?

  1. Pulse is present so we will not begin CPR starting with compressions.
  2. The decision between oropharyngeal or nasopharyngeal airway can be difficult, but there are a few things to consider when making the decision.
  3. Oropharyngeal airways are inserted into the mouth, and nasopharyngeal airways are inserted into the nose. Oropharyngeal airways are more likely to be successful the first time, but nasopharyngeal airways are less likely to cause vomiting.
  4. Administer oxygen. Oxygen saturation is less than 50%. 
  5. Perform bag-mask ventilation for 1 minute effectively at the proper rate (1 breath every 6 seconds), speed (over 1 second), and volume (about half a bag).
 

The woman is stable and oxygen saturation is rising. What are your next steps?

Secondary Survey (SAMPLE)

Signs and Symptoms: Signs and symptoms are improving; however, swelling is still present.

Allergies: The woman’s friend states she has an allergy to peanuts.

Medications: Albuterol inhaler and an epinephrine pen

Past Medical History: Asthma

Last Meal, Liquid Consumed: Last meal and liquid consumed during the asthma attack. This ordered Chinese takeout Pai Thai.

Events: No events lead up to the asthma attack.

What are your text interventions?

  • Epinephrine
  • Diphenhydramine
  • Albuterol
  • Vital signs monitoring
  • Monitor for any changes
 
 

You will begin the transfer to the nearest hospital. Your scenario has concluded.

]]> Emergency Department ACLS Airway Management Megacode: The Best Strategies for Saving Lives https://nursecheung.com/aclsmegacode-ed-airwaymanagement/ Sat, 07 Jan 2023 17:14:31 +0000 https://nursecheung.com/emergency-department-acls-airway-management-megacode-the-best-strategies-for-saving-lives/

The Airway Management section of the AHA Emergency Department (ED) ACLS algorithm is one of the most important, and it can be difficult to know what to do when someone is choking or has another airway emergency.

We will provide you with a step-by-step guide on how to manage an airway emergency, as well as some tips for avoiding common mistakes.

In this blog post, we will discuss the best strategies for saving lives in the Emergency Department setting.

Adult ED Respiratory Arrest Megacode Scenario

The following is a scenario in which you would use the ED adult respiratory arrest Megacode:

You are working the day shift in an emergency department. You are asked to see a new patient in your bay. A bystander called 911 after finding a man unconscious in a ditch.

Demonstrate what you would do next

Initial Impression

The man is unconscious with mildly cyanotic lips. The paramedics placed a nasopharyngeal airway and have been trying to ventilate but have had difficulty. The paramedics also noted that there were drug paraphernalia on the scene and an empty syringe.

Primary Assessment Survey (A, B, C, D, E)

Airway: There is a nasopharyngeal airway present. It is being ventilated by paramedics on arrival and taken over by respiratory. The flow through the trachea is impaired by the tongue.

Breathing: Oxygenation is showing 75% with bag valve mask ventilation. The man has no spontaneous breaths.

Circulation: Blood pressure is 100/60, heart rate is 140/min, the rhythm is narrow-complex rapid tachycardia, and the pulse is present but weak.

Disability: Unresponsive to any stimuli. Pupils are dilated bilaterally at 7 mm (commonly misused drugs that dilate pupils are amphetamines, bath salts, benzodiazepines, cocaine, crystal meth, ecstasy, LSD)

Exposure: Numerous track marks are located on the man’s arms.

Change in Condition

After assessment of the initial impression and primary assessment, the man’s oxygen continues to decline and his heart rate increases.

What are your next actions?

  1. Check responsiveness: Tap the shoulders and shout, “Are you okay?” Found unresponsive during the primary survey, move on to the next step.
  2. Activate the emergency response system. Shout for backup and announce what room you are in.
  3. Check for breathing: Look for visible chest rising and falling. No spontaneous breathing was present.
  4. Check for a pulse: Place your fingers on the inside of the patient’s neck, just below the angle of the jaw. You will palpate the carotid pulse for no more than 10 seconds. Pulse is present but weak.
 

What are your next actions?

  1. Pulse is present so we will not begin CPR starting with compressions.
  2. The nasopharyngeal airway is not working effectively. It may be time to switch to endotracheal intubation.
  3. Administer oxygen. After endotracheal intubation, the oxygen saturation is 99% with positive color changes on the CO2 Detector. Waveform capnography is the gold standard.
  4. Perform bag-mask ventilation for 1 minute effectively at the proper rate (1 breath every 6 seconds), speed (over 1 second), and volume (about half a bag) until the ventilator arrives.
 

The man is stable and oxygen saturation is normal. What are your next steps?

Secondary Survey (SAMPLE)

Signs and Symptoms: Signs and symptoms are improving, heart rate has decreased to 90 bpm normal sinus rhythm; however, no spontaneous breathing is noted.

Allergies: Unknown if there are any allergies.

Medications: Unknown if there are any medications.

Past Medical History: Unknown if there is any past medical history.

Last Meal, Liquid Consumed: Unknown when the last meal and liquid were consumed.

Events: No events were noted outside of what was discussed with the paramedic team.

What are your text interventions?

  • Drug urinalysis
  • Labs
  • Fluids
  • Naloxone trial with escalating doses
  • Transfer to a higher level of care – Intensive Care Unit
 
 

You will begin the transfer to the unit. Your scenario has concluded.

]]> Inpatient ACLS Airway Management Megacode: The Best Strategies for Saving Lives https://nursecheung.com/aclsmegacode-ip-airwaymanagement/ Sat, 07 Jan 2023 17:14:29 +0000 https://nursecheung.com/inpatient-acls-airway-management-megacode-the-best-strategies-for-saving-lives/

The Airway Management section of the AHA Inpatient ACLS algorithm is one of the most important, and it can be difficult to know what to do when someone is choking or has another airway emergency.

We will provide you with a step-by-step guide on how to manage an airway emergency, as well as some tips for avoiding common mistakes.

In this blog post, we will discuss the best strategies for saving lives in the inpatient setting.

Adult Inpatient Respiratory Arrest Megacode Scenario

The following is a scenario in which you would use the inpatient adult respiratory arrest Megacode:

You are the healthcare provider taking care of a female patient with a history of diabetes in the intermediate care unit. The patient is noncompliant with medications for her asthma and heart failure and is well known by the cardiologist and pulmonologist. She has been intubated and sedated prior to coming to you.

Demonstrate what you would do next

Initial Impression

The woman is currently on CPAP at 10 as part of her heart failure treatment. She is becoming restless, short of breath, and trying to take the mask off.

Primary Assessment Survey (A, B, C, D, E)

Airway: There is a CPAP mask present. It is hard to determine if the woman’s airway is patent due to her restlessness and combativeness.

Breathing: Oxygen saturation is showing 80% with CPAP 100% oxygen. Respiratory rate is 28/min. The patient states “I can’t keep this up much longer.” Breath sounds are diminished bilaterally. Wheezing and crackles are noted upon auscultation.

Circulation: Blood pressure is 128/90, heart rate is 82/min, and the pulse is present but weak. Capillary refill is 3 seconds.

Disability: The woman is alert, oriented, and restless. She is attempting to remove the CPAP mask and eventually takes it off.

Exposure: Skin is cool to the touch.

Change in Condition

After assessment of the initial impression and primary assessment, the woman becomes unresponsive while attempting to place the mask back on and waiting for respiratory therapy/rapid response.

What are your next actions?

  1. Check responsiveness: Tap the shoulders and shout, “Are you okay?” The woman is unresponsive and doesn’t answer any stimuli.
  2. Activate the emergency response system. Shout for backup and announce what room you are in. It is perfectly acceptable to hit the code button for faster backup.
  3. Check for breathing: Look for visible chest rising and falling. No spontaneous breathing was present.
  4. Check for a pulse: Place your fingers on the inside of the patient’s neck, just below the angle of the jaw. You will palpate the carotid pulse for no more than 10 seconds. Pulse is present but weak.
 

What are your next actions?

  1. Pulse is present so we will not begin CPR starting with compressions.
  2. Start providing oxygenation via bag valve mask with oxygen while waiting for help to arrive. Perform bag-mask ventilation for 1 minute effectively at the proper rate (1 breath every 6 seconds), speed (over 1 second), and volume (about half a bag) until the ventilator arrives.
  3. Consider endotracheal re-intubation due to condition deterioration. After endotracheal intubation, the oxygen saturation is 99% with positive color changes on the CO2 Detector. Waveform capnography is the gold standard.
 

The woman is stable, restless, and oxygen saturation is within normal but falling slowly due to her biting on the tube. What are your next steps?

Secondary Survey (SAMPLE)

Signs and Symptoms: Signs and symptoms are improving; however, no spontaneous breathing is noted.

Allergies: Allergic to morphine and acetaminophen

Medications: Albuterol, Metformin, and digoxin

Past Medical History: Diabetes, asthma, and congestive heart failure

Last Meal, Liquid Consumed: Unknown when the last meal and liquid were consumed as she was transferred to your unit without a full report.

Events: No events were noted outside of what was discussed.

What are your text interventions?

  • Albuterol
  • Sedation for restlessness
  • Arterial Blood Gases
  • Maybe Fluid – Depends on the Heart Failure
  • Waveform Capnography
  • Critical Care Consult
  • Transfer back to a higher level of care – Intensive Care Unit
 
 

You will begin the transfer to the unit. Your scenario has concluded.

]]> Out-Of-Hospital ACLS Unstable Bradycardia Megacode: How to Respond in an Emergency Situation https://nursecheung.com/alcsmegacode-ooh-unstablebradycardia/ Sat, 07 Jan 2023 17:14:28 +0000 https://nursecheung.com/out-of-hospital-acls-unstable-bradycardia-megacode-how-to-respond-in-an-emergency-situation/

In this blog post, we will discuss how to respond to an out-of-hospital ACLS unstable bradycardia megacode. This is a serious emergency situation that requires quick action.

If you are not familiar with the megacode, don’t worry! We will go over the steps that you need to take in order to provide lifesaving care for the patient.

Adult Out-Of-Hospital Unstable Bradycardia Megacode Scenario

The following is a scenario in which you would use the out-of-hospital adult unstable bradycardia Megacode:

You are a paramedic responding to a call of a person with altered mental status.

Demonstrate what you would do next upon arrival

Initial Impression

The 60-year-old male person is sitting upright on a couch. He is disoriented, pale, and diaphoretic.

Primary Assessment Survey (A, B, C, D, E)

Airway: The airway is patent. The flow through the trachea is not impaired.

Breathing: Oxygenation is showing 86% on room air. You provide oxygen 4LNC.

Circulation: Blood pressure is 80/68, heart rate is 40/min, a rhythm check shows third-degree heart block, and the pulse is present but weak.

Disability: Decrease in mental status. Responsive to painful stimulation.

Exposure: No obvious signs of trauma, bleeding, burns, markings, or medical alert bracelet.

Change in Condition

After assessment of the initial impression and primary assessment, the man becomes unresponsive.

What are your next actions?

  1. Check responsiveness: Tap the shoulders and shout, “Are you okay?” There is no response.
  2. Activate the emergency response system. You direct the second rescuer to activate the emergency response system and get an AED.
  3. Check for breathing: Look for visible chest rising and falling. Breathing is present but weak.
  4. Check for a pulse: Place your fingers on the inside of the patient’s neck, just below the angle of the jaw. You will palpate the carotid pulse for no more than 10 seconds. Pulse is present but weak.
 

What are your next actions?

  1. Pulse and breathing is present so we will not begin CPR starting with compressions.
 

Unstable Bradycardia Algorithm

Identify and Treat the Underlying Cause

  1. Maintain patent airway, assist with breathing if necessary – Airway is patent and breathing is spontaneous
  2. Oxygen (if hypoxemic) – person is on 4LNC upon Primary Assessment
  3. Cardiac monitor, blood pressure, oximetry – Third Degree Heart Block, BP 80/68, 98% on 4LNC
  4. IV Access – 20 gauge in the right antecubital
  5. 12-Lead ECG if available and doesn’t delay therapy – Not readily available
  6. Consider hypoxic and toxicologic causes – Myocardial Ischemia/infarction, calcium-channel blockers, beta-blockers, digoxin, hypoxia, hyperkalemia
 

Persistent Bradyarrhthmia Causing

  • Hypotension? – YES
  • Acutely altered mental status? – YES
  • Signs of shock (low blood pressure, altered mental status, cold moist skin, weak or rapid pulse, rapid breathing, decreased urine output) – YES
  • Ischemic chest discomfort? – Wife states the man experienced chest pain prior to becoming unresponsive – YES
  • Acute heart failure (heavy breathing, suffocating sensation, struggle to breathe while lying down, tight chest, arrhythmia, cough, fluid retention, loss of consciousness)? – YES
 

Interventions

What interventions could you perform next?

  • Atropine 1mg bolus – relatively contraindicated in high-degree blocks

If atropine is not effective or contraindicated:

  • Transcutaneous pacing – YES
  • Dopamine
  • Epinephrine
 
 

You will begin the transfer to the nearest hospital. Your scenario has concluded.

]]> Emergency Department ACLS Unstable Bradycardia Megacode: How to Respond in an Emergency Situation https://nursecheung.com/aclsmegacode-ed-unstablebradycardia/ Sat, 07 Jan 2023 17:14:26 +0000 https://nursecheung.com/emergency-department-acls-unstable-bradycardia-megacode-how-to-respond-in-an-emergency-situation/

In this blog post, we will discuss how to respond to an emergency department ACLS unstable bradycardia megacode. This is a serious emergency situation that requires quick action.

If you are not familiar with the megacode, don’t worry! We will go over the steps that you need to take in order to provide lifesaving care for the patient.

Adult Emergency Department Unstable Bradycardia Megacode Scenario

The following is a scenario in which you would use the ED adult unstable bradycardia Megacode:

You are a healthcare provider working in the emergency department. You are assessing a woman with a history of syncopal episodes. She is present in the ED as she feels she is going to have another syncopal episode.

Demonstrate what you would do next

Initial Impression

The 75-year-old female is sitting upright on a stretcher. She is feeling dizzy, light-headed, weak, and faint. There are no complaints of chest pain, dyspnea, or palpitations. Overall she has been healthy with no recent changes to her medications.

Primary Assessment Survey (A, B, C, D, E)

Airway: The airway is patent. The flow through the trachea is not impaired.

Breathing: Oxygenation is showing 98% on room air.

Circulation: Blood pressure is 76/50, heart rate is 30/min, a rhythm check shows second-degree heart block Type II, and the pulse is present but weak.

Disability: The patient is oriented but drowsy. Overall alert, but responsive to verbal stimuli at times.

Exposure: No obvious signs of trauma, bleeding, burns, markings, or medical alert bracelet.

Change in Condition

After assessment of the initial impression and primary assessment, the patient’s mental status starts to deteriorate and the monitor shows a third-degree AV block.

What are your next actions?

  1. Check responsiveness: Tap the shoulders and shout, “Are you okay?” There is a slight response.
  2. Activate the emergency response system. Shout for backup and announce what room you are in.
  3. Check for breathing: Look for visible chest rising and falling. Breathing is present but weak.
  4. Check for a pulse: Place your fingers on the inside of the patient’s neck, just below the angle of the jaw. You will palpate the carotid pulse for no more than 10 seconds. Pulse is present but weak.
 

What are your next actions?

Pulse and breathing is present so we will not begin CPR starting with compressions.

Unstable Bradycardia Algorithm

Identify and Treat the Underlying Cause

  1. Maintain patent airway, assist with breathing if necessary – Airway is patent and breathing is spontaneous
  2. Oxygen (if hypoxemic) – The patient is not hypoxemic at this time and does not require oxygen.
  3. Cardiac monitor, blood pressure, oximetry – Third Degree Heart Block, BP 76/50, 98% on room air
  4. IV Access – 20 gauge in the left and right antecubital
  5. 12-Lead ECG if available and doesn’t delay therapy – Not readily available
  6. Consider hypoxic and toxicologic causes – Myocardial Ischemia/infarction, calcium-channel blockers, beta-blockers, digoxin, hypoxia, hyperkalemia
 

Persistent Bradyarrhthmia Causing

  • Hypotension? – YES
  • Acutely altered mental status? – YES
  • Signs of shock (low blood pressure, altered mental status, cold moist skin, weak or rapid pulse, rapid breathing, decreased urine output) – YES
  • Ischemic chest discomfort? – Unknown at this time but declined on previous assessment
  • Acute heart failure (heavy breathing, suffocating sensation, struggle to breathe while lying down, tight chest, arrhythmia, cough, fluid retention, loss of consciousness)? – YES
 

Interventions

What interventions could you perform next?

  • Atropine 1mg bolus – relatively contraindicated in high-degree blocks

If atropine is not effective or contraindicated:

  • Transcutaneous pacing – YES
  • Dopamine
  • Epinephrine
  • Labs – electrolytes and cardiac biomarkers
  • Urinalysis
  • Fluids
  • Chest x-ray
  • Cardiac Consultation
  • Transfer to a higher level of care
 
 

You will begin the transfer to a higher level of care. Your scenario has concluded.

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