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Emergency & Rapid Response Team ToolsWhat is my role on the Rapid Response Team (RRT)?Whether in a small rural clinic or at a large county hospital, your expertise as a pharmacist is invaluable during a code. Your contribution can be a crucial part of saving an individual's life and you will be depended on (by the rest of the team) in the following ways:To identify appropriate drug therapies and make recommendationsTo provide correct medication dosages and limitsTo prepare?the necessary medications/solutionsAttending a CodeIdentify yourself and offer to handle medications?Remove the medication tray from the crash cartPrepare all medications/solutions for the appropriate route of administrationProvide drug information and recommendations as needed– Check patient’s allergies, age, height,Ensure that the correct medication is being dispensedHelp code recorder keep track of medications used?Click???to open the original resource and explore more.?ACLS Basics???Normal Sinus RhythmHeart rate:?60-100 beats per minuteECG Waves:?P wave preceding QRS triplet. QRS narrow with positive P wave.Systole blood pressure:?90-120Diastole blood pressure:?60-80Respiratory rate:?12-18 breaths/minNormal O2 saturation:?90% or moreBradycardiaSymptoms:?heart rate less than 50 beats/min, chest discomfort/pain, SOB, decreased consciousness, weakness, light-headedness, presyncope or syncopeTreatment:?Atropine. 0.5 mg rapid IV bolus every 3 to 5 minutes. Max dose of 3 mg.TachycardiaSymptoms:?heart rate greater than 100 beats/min, pain, decreased parasympathetic activity, sympathetic activation, hypotention, fever, hypoxia.Treatment:?Correct underlying causes.?If stable and no correctable cause, use?vagal maneuvers?and consider?adenosine.?(Initial dose = 6 mg rapid IV bolus + 20 mL normal saline flush. Try adenosine 12 mg twice if no improvement, with saline after each dose as described.)?Cardiac Arrest: Ventricular Fibrillation (VF) OR Pulseless Ventricular Tachycardia (VTach)ManagementHigh Energy ShockCPRHigh Energy Shock (if indicated)CPR +?Epinephrine?(1 mg IV every 3 to 5 mins)High Energy Shock (in indicated)CPR +?Amiodarone?(Initial dose = 300 mg IV bolus; Second dose = 150 mg IV)Cardiac Arrest: Asystole OR Pulseless Electrical Activity (PEA)ManagementCPREpinephrine* (1 mg IV every 3 to 5 minutes)Rhythm check (if not shockable rhythm then continue CPR)CPREpinephrine*Rhythm check*Vasopressin?may replace the first or second Epinephrine dose. Use 40 unites IV.Other?Code Actions??Compromised AirwayAll sizes of airways (may need in case of seizure)McGill forceps large and small to retrieve foreign object obstructing airwayRespiratory DistressNasal Canula for Infant, Pedi, Adult100% non-rebreather masks for Infant, Pedi, AdultO2 ‘E’ cylinder with key, flow adapter, and Christmas tree (to connect to tubing)Respiratory ArrestPocket MaskAmbu Bag for Infant, Pedi, AdultO2 ‘E’ cylinder with key, flow adapter, and Christmas tree (to connect to tubing)(Consider: Laryngoscope handles and blades, all sizes of ET tubes)“ACS” Acute Cardiac SyndromeAspirin: chew one 325mg tabNitroglycerin tab (gr. 0.4) sublingual every 5 minutes till relief achieved (max 3?tabs)100% non-rebreather face mask at minimum 10-15 liters/minEstablish IV access (Normal Saline at kvo rate)Cardiac ArrestA – B – CsAED application (Turn on unit – Place pads – Allow to analyze – If advised,?deliver shock)CPREstablish IV access (Normal Saline at kvo rate)Epinephrine 1 mg IVPush (1:10,000 conc)Continue with ACLS protocols to extent possible until EMS arrivesDrug Overdose or Unresponsive Patient (becomes unresponsive for unknown reason)A – B – CsEstablish IV access (Normal Saline at kvo rate)Administer Narcan 1 mg IVP (max: 2 mg)HypoglycemiaEstablish IV access (Normal Saline at kvo rate)Administer 25 mls D50, may repeat another 25 mlsAnaphylactic Reaction (acute allergic response)Establish IV access (Normal Saline at kvo rate)EpiPen or EpiPen Jr. for children less than 30 kilogramsBenadryl 50 mg IVPush for adultPepcid 20 mg IV piggyback (mixed in 50 ml normal saline, D5WOLR)SoluMedrol 125 mg IVPush for adultA – B – CsStandard Crash Cart Medications?Aspirin 325 mg tabsNitroglycerin 0.4 mg sublingual tabsDextrose 50% 50 ml.?Narcan 1 mg Amp?Epinephrine 1 mg, (1:10:000 conc)?Atropine Sulfate 0.1 mg/ml?Lidocaine 100mg?EpiPen?EpiPen Jr. (for child less that 30 kilograms)?SoluMedrol 125 mg VialBenadryl 50 mg VialPepcid 20 mg Vial(per 2010 ACLS guidelines)Need?extra practice?Take practice quizes to test your knowledge of ACLS ACLS review and tutorial videos ................
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