NURSING DIVISION
Nursing Education, Training and Research
Code BLUE
RESTY P. ANIBIGNO, MSN, RN
Clinical Nurse Educator
Topics Adult Basic Life Support
Pediatric Basic Life Support
Electrical Therapy
Recognition of Rhythms
Adult Cardiac Arrest
Emergency Cart
Nursing Education, Training and Research
Adult Basic Life Support
• Cardiac Arrest is the sudden stop in effective blood
circulation due to failure of the heart to pump blood, leading
to compromised blood flow and oxygen delivery to the entire
body leading to loss of function within minutes.
• It can happen anytime, anywhere and top anyone
• Approximately half of cardiac deaths occur as sudden
cardiac arrest. Pre-existing heart disease is a common
cause, but it may also strike people without any history of
cardiac problems.
Nursing Education, Training and Research
Adult Basic Life Support
• The most common arrythmia in adult out-of-hospital cardiac
arrest victims is Ventricular Fibrilation
• The key person in the early access is the trained healthcare
provider or even a well-informed lay person who is able to
recognize signs or heart attack
Nursing Education, Training and Research
Adult Basic Life Support
Chain of Survival
Nursing Education, Training and Research
Adult Basic Life Support
Nursing Education, Training and Research
Adult Basic Life Support
Nursing Education, Training and Research
Adult Basic Life Support
Nursing Education, Training and Research
Adult Basic Life Support
Nursing Education, Training and Research
Adult Basic Life Support
Nursing Education, Training and Research
Adult Basic Life Support Algorithm
Nursing Education, Training and Research
Adult Basic Life Support
Performing High Quality Chest Compressions
• Push HARD and Push FAST
• Rate: at least 100 to 120/ minute
• Depth
• Adults and Children: 2 inches or 5 cm
• Infants: 1 ½ inches or 4 cm
• Allow CHEST RECOIL
• Minimize interruptions
Nursing Education, Training and Research
Adult Basic Life Support
Performing High Quality Chest Compressions
• Perform 1 cycle of 30 chest
compressions
• After 30 compressions, open the airway
using the head-tilt-chin-lift maneuver,
and provide 2 full one-second breaths.
Check for chest rise in between breaths
• Compression to breath ratio: 30:2
Nursing Education, Training and Research
Adult Basic Life Support
Nursing Education, Training and Research
Topics Adult Basic Life Support
Pediatric Basic Life Support
Electrical Therapy
Recognition of Rhythms
Adult Cardiac Arrest
Emergency Cart
Nursing Education, Training and Research
Pediatric Basic Life Support
AGE GUIDELINES TO FOLLOW
< 28 Days Neonates
28 Days to < 1 year-old Infants
1 year to < 8 years old Children
8 Years old and up Adults
Nursing Education, Training and Research
Pediatric Basic Life Support
Nursing Education, Training and Research
Pediatric Basic Life Support
Nursing Education, Training and Research
Pediatric Basic Life Support
Nursing Education, Training and Research
Pediatric Basic Life Support
Nursing Education, Training and Research
Pediatric Basic Life Support
Notes
• Allow a child with respiratory distress (eg, a child who is bent forward, in
the tripod position, drooling, or appears toxic) to remain in a position that
is most comfortable for him/her.
• Where to check for pulse:
• Infants – Brachial Pulse
• Children – Carotid or Femoral pulse
Nursing Education, Training and Research
Pulse Points
Nursing Education, Training and Research
Topics Adult Basic Life Support
Pediatric Basic Life Support
Electrical Therapy
Recognition of Rhythms
Adult Cardiac Arrest
Emergency Cart
Nursing Education, Training and Research
Electrical Therapy
Defibrillation
• Therapeutic use of large electric currents delivered over verey brief periods of
time
• Temporarily stuns an irregularly beating heart and allows more coordinated
contractile activity to resume
Nursing Education, Training and Research
Electrical Therapy
Manual Defibrillator
•Monophasic
•Biphasic
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Electrical Therapy
Manual Defibrillator
•Monophasic
•Biphasic • Delivers the current
in one direction
• Energy: 360 Joules
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Electrical Therapy
Manual Defibrillator
•Monophasic
•Biphasic
• Delivers the current that flows in a
positive direction over a specified
duration.
• The current reverses and flows in a
negative direction for the remaining
milliseconds of the electrical
discharge
• Energy: Varies
Nursing Education, Training and Research
Electrical Therapy
Cardioversion
• Involves the delivery of a low-energy shock, which is timed or
synchronized with a QRS complex on the ECG.
• Administered to victims with unstable and refractory tachyarrythmias, such
as unstable SVT, A-Fib, A-Flutter, or monomorphic VT
Nursing Education, Training and Research
Electrical Therapy
Cardioversion
• Procedure:
• Sedate the patient
• Remove transdermal medications, shave chest
• Apply gel on the paddles
• Turn Machine “on”
• Press “sync” button
• Select energy level
• Press charge button
• Ensure proper placement of paddles
• Ensure no one is in direct contact with the victim before delivering shock
• Press discharge or shock button on the paddles
Nursing Education, Training and Research
Topics Adult Basic Life Support
Pediatric Basic Life Support
Electrical Therapy
Recognition of Rhythms
Adult Cardiac Arrest
Emergency Cart
Nursing Education, Training and Research
Recognition of Rhythm
Electrocardiogram
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Recognition of Rhythm
Anatomy and Physiology
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Recognition of Rhythm
Electrocardiogram
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Recognition of Rhythm
Normal Heart Rate: 60 to 100 beats per minute
<60 : BRADYCARDIA
>100 : TACHYCARDIA
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Recognition of Rhythm
Normal Sinus Rhythm
0.6 to 1.2 sec
0.12 to
0.20 sec
0.08 to 0.12 sec
Nursing Education, Training and Research
Recognition of Rhythm
Normal Sinus Rhythm
• There must always be a “P” wave
• The “P” wave should be rounded shape, same shape, followed by
QRS complex
• P-R interval must be 3-5 small squares and constant
• Regular rhythm
Nursing Education, Training and Research
Recognition of Rhythm
Slow Rhythms
Nursing Education, Training and Research
Recognition of Rhythm
Slow Rhythms
Nursing Education, Training and Research
Recognition of Rhythm
Fast Rhythms
Nursing Education, Training and Research
Recognition of Rhythm
Fast Rhythms
Nursing Education, Training and Research
Topics Adult Basic Life Support
Pediatric Basic Life Support
Electrical Therapy
Recognition of Rhythms
Adult Cardiac Arrest
Emergency Cart
Nursing Education, Training and Research
The Resuscitation Team
Nursing Education, Training and Research
Adult Basic Life Support
Adult Cardiac Arrest Algorithm
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Adult Basic Life Support
Adult Bradycardia Algorithm
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Adult Basic Life Support
Adult Tachycardia Algorithm
Nursing Education, Training and Research
Adult Basic Life Support
Things to Remember:
1. Always check for the patient’s level of consciousness (GCS)
2. Do a quick rhythm check
3. If with pulse and NSR, check the CBG
4. Establish a good IV line
Nursing Education, Training and Research
Adult Basic Life Support
Nursing Education, Training and Research
Topics Adult Basic Life Support
Pediatric Basic Life Support
Electrical Therapy
Recognition of Rhythms
Adult Cardiac Arrest
Emergency Cart
Nursing Education, Training and Research
Emergency Cart
Equipment needed
• Intubation Kit
• Cardiac Monitor/ Defibrillator
• Glucometer
• Endotracheal Tubes
• Bag-Valve-Mask
• Sterile Gloves
• Clean Gloves
• Syringes
• Goggles/Face Shield
• Laryngoscope with blades
Nursing Education, Training and Research
Pharmacologic Therapy
Drug Epinephrine
Stock • 1 mg/mL/ Amp
• 1 mg/IV bolus or 2.0 to 2.5 mg/ET every 3 to 5
mins
• 0.3 mg TIM
Dosage • Drip: D5Water 250 + Epinephrine 1mg at 15 to 50
ugtts.min
• For pulseless/ arrested patients (Asystole)
Indication • Anaphylaxis
Nursing Education, Training and Research
Pharmacologic Therapy
Drug Adenosine
Stock ▪ 6 mg/2 mL/Amp
• 1st dose: 6 mg IV bolus
• 2nd dose: 12 mg IV bolus
Dosage • 3rd dose: 12 mg IV bolus
(followed by 10 to 20 cc NSS)
Indication/ ▪ Drug of choice for stable Supraventricular
Notes Tachycardia; very short half-life (<5 secs)
Nursing Education, Training and Research
Pharmacologic Therapy
Drug Esmolol
Stock ▪ 100 mg/ 10mL vial
▪ Esmolol: 0.5 mg/kg loading dose over 2 minutes then 0.056
Dosage to 0.20 mg/kg/min infusion
▪ Beta Blocker
Indication/
▪ Widely used to treat supraventricular and ventricular
Notes arrhythmias
Nursing Education, Training and Research
Pharmacologic Therapy
Drug Lidocaine
Stock ▪ 10mg/mL
▪ 1st dose: 1.0 to 1.5 mg/kg/IV bolus after
3rd defibrillation
Dose
▪ Drip: D5W 250 + 1g Lidocaine at 1mg to
4mg/Hr
▪ Anti-arrhythmic
Indication/ Notes ▪ Adjunct therapy for V-Fib and V-Tach
Nursing Education, Training and Research
Pharmacologic Therapy
Drug Magnesium Sulfate
Stock ▪ 250 mg/mL, 20 mL/vial
• 1 to 2 g in 100 mL D5W SIVP over 1-2
Mins. (Torsades)
Dosage • 4 g SIVP over 1-2 mins (Eclampsia)
• Drip: D5W 250 + MgSO4 2g X 12 hours OR
4g X 24 hours
▪ DOC for termination of Torsades de Point
Indication
▪ DOC for eclampsia
Nursing Education, Training and Research
Pharmacologic Therapy
Drug Amiodarone
Stock ▪ 150mg/3mL
• 1st dose: 300 mg IV after 3rd defibrillation
• 2nd dose: 150 mg IV after the 4th defibrillation
• 150 mg + 100 cc D5W X 10 mins if stable
Dosage
Vtach and SVT
• Drip: D5W 250 + 1mg/min X 6 Hours = 360
mg, THEN 0.5 mg/min X 18 hours = 540 mg
• Indicated in Ventricular arrhythmias: V-Fib
Indication
and pulseless V-Tach
Nursing Education, Training and Research
Pharmacologic Therapy
Drug Verapamil
Stock • 5mg/2mL/Amp
• 2.5 to 5 mg/IV over 2 minutes, repeated every 15 to 30 mins
Dose to a max dose of 20 mg
• 0.75 to 1.15 mg/kg
• Ca Channel Blocker
Indication/ Notes • Alternative to Adenosine in stable SVT
• rate controller for stable atrial fibrillation and atrial flutter
Nursing Education, Training and Research
Pharmacologic Therapy
Drug Calcium Gluconate
Stock ▪ 10%, 10mL/ampule
Dosage ▪ 1.5 to 3 g IV over 2 to 5 mins
▪ Management of cardiac arrest only in
Indication/
presence of hyperkalemia, hypocalcemia or
Notes
hypermagnesemia
Nursing Education, Training and Research
Pharmacologic Therapy
Drug Sodium Bicarbonate
Stock ▪ 1mEq/mL, 20mL/amp, 50mL/amp
▪ Use ”16” for CKD and “18” for Normal
▪ Formula: 18 or 16 – Pt Result X wt X 0.4
Dosage
- give ½ HCO3 as IVP, then 1/2 HCO3 + D5W 250 x
24 hours
Indication/No
▪ Correction of Acid-Base imbalances
tes
Nursing Education, Training and Research
Pharmacologic Therapy
Drug Atropine
Stock ▪ 1mg/mL/Amp
▪ 1mg IV bolus, may be repeated to a max of 3
Dosage
mg
Indication/ ▪ For unstable bradycardia and bradycardia
Notes with symptoms
Nursing Education, Training and Research
Pharmacologic Therapy
Drug Dopamine
Stock • 200 mg/5mL Ampule
Dosage • 2.5 to 20 mcg/kg/min IV infusion
Nursing Education, Training and Research
Pharmacologic Therapy
Drug Dobutamine
▪ 250 mg/5mL
Stock
Ampule
▪ 2.5 to 20
Dosage
mcg/kg/min
Nursing Education, Training and Research
Pharmacologic Therapy
Drug Noradrenaline/
Norepinephrine
Stock ▪ 4mg/4mL ampule
Dosage ▪ 0.2 to 0.4 mcg/kg/min
Indication ▪ DOC for septic and cardiogenic shock
Nursing Education, Training and Research
Pharmacologic Therapy
Drug Phenytoin
Stock • 100mg/2mL
• 10 to 15 mg/kg or 15 to 20 mg/kg loading
Dosage dose (Adult) then 100 mg TIV every 6 to 8
hours.
• Status Epilepticus
Indication/ Notes • Loading dose of more than 1g should be
diluted
Nursing Education, Training and Research
Pharmacologic Therapy
Drug HydroxyEthyl Starch
Stock ▪ 500 mL
Dosage ▪ 500 mL as Fast Drip for adults
▪ Hypovolemic Shock
Indication/ Notes
▪ Excessive Fluid Loss
Nursing Education, Training and Research
Pharmacologic Therapy
Drug Dextrose 50%
Stock ▪ 50%/50mL vial
Dosage ▪ 1 Vial
Indication ▪ Hypoglycemia
Nursing Education, Training and Research
Pharmacologic Therapy
Drug Furosemide
Stock • 40 mg/2mL/amp
• 20 to 80 mg Loading Dose. Dose may be
raised by 20 or 40 mg not sooner than 6 to 8
Dosage hours after
• Drip: D5W 80 cc + 200 mg Furosemide X 6 cc/Hr
• Drip: D5W 100 cc + 100 mg X 10 ugtts/min
• Edema
Indication
• Pulmonary Congestion
Nursing Education, Training and Research
Pharmacologic Therapy
Drug Nitroglycerin
Stock ▪ 10mg/ 10 mL Amp
▪ 10 mg Nitroglycerine + 90 mL PNSS to
Dosage
start at 10 cc/Hr
▪ Short-acting Nitrate
Indication/ Notes ▪ Chest Pain
▪ Myocardial Infarction
Nursing Education, Training and Research
Pharmacologic Therapy
Drug Isosorbide Dinitrate
▪ 10mg/10mL Amp
Stock
▪ 5mg tab sL
• 5mg SL
• 1 to 5 mg/Hr:
Dosage
a. 10 mg + 90 cc PNSS or D5W at 10 to 50 cc/Hr
b. 20 mg + 80 cc PNSS or D5W at 5 to 25 cc/Hr
▪ Long-acting Nitrate
Indication ▪ Chest Pain (MI) or Elevated BP for patients with
pulmonary Congestion
Nursing Education, Training and Research
Pharmacologic Therapy
Drug Hydrocortisone
Stock • 100mg powder/vial
Dosage • 100 to 200 mg TIV as initial dose
• Bronchodilator for Respiratory Distress and
Indication
Anaphylaxis
Nursing Education, Training and Research
Pharmacologic Therapy
Drug Terbutaline
Stock ▪ 1mg/mL Amp
▪ 0.3 mg SQ
Dosage ▪ Drip: D5W 250 mL + 5 mg Terbutaline at
10 to 30 ugtts/min
▪ Respiratory distress such as BAIAE
Indication/ Notes
(Bronchodilator)
Nursing Education, Training and Research
Pharmacologic Therapy
Drug Phytomenadione (Vit. K)
Stock ▪ 10 mg/mL
Dosage ▪ 10 mg every 8 hours
Indication ▪ Severe bleeding
Nursing Education, Training and Research
Pharmacologic Therapy
Drug Aminophylline
Stock • 250 mg/10mL Amp
• 250 mg to d5W 250
• Loading Dose: 5mg/kg + D5W 30cc
• Maintenance Dose:
Dosage a. 0.4 to 0.8 mg/kg – ugtts
b. 0.2 to 0.3 mg/kg/hr (Pregnant, Elderly,
CHF, Liver disease, Cor Pulmunale
• Respiratory Distress due to BAIAE
Indication/
(Bronchodilator)
Notes
Nursing Education, Training and Research
Pharmacologic Therapy
Drug Nicardipine
Stock ▪ 10mg/10 mL/ Amp
▪ 10 mg Nicardipine + 90 cc PNSS at 10 to 50
ugtts/min (+/- 5 cc/Hr) – 1 to 5 mg/Hr
Dosage
▪ 20 mg Nicardipine + 80 cc PNSS at 5 to 25 ugtts/min (+/-
3 cc/Hr)
Indication ▪ Uncontrolled BP
Nursing Education, Training and Research
Pharmacologic Therapy
Drug Diphenhydramine
Stock ▪ 50 mg/mL/ Amp
Dosage ▪ 50 mg IV/IM
Indication ▪ Hypersensitivity/ Anaphylaxis
Nursing Education, Training and Research
Pharmacologic Therapy
Drug Digoxin
Stock ▪ 2.5 mg/mL, 2mL Amp
• Loading Dose 0.5 to 1mg IV
- Then 0.004 to 0.006 mg/kg initially over 5 mins
Dosage
- Then 0.002 to 0.003 mg/kg at 8-8 hours interval
• Total of 0.008 to 0.012 mg/kg divided to 8 to 16 hours
• Indicated in the treatment of supraventricular arrythmias (A-Fib/
Indication/ Notes A-Flutter)
• Alternative to calcium channel blockers for heart rate control
Nursing Education, Training and Research
Pharmacologic Therapy
Drug Hydralazine
Stock ▪ 20 mg/mL
▪ 5 mg to 10 mg SIVP, may repeat after 20 to 30 mins (max
Dosage
40 mg/day)
• Pre-Eclampsia and toxemia of pregnancy
Indication/ Notes
• Incompatible with dextrose
Nursing Education, Training and Research
IV Fluids
• Normal Saline Solution
• Lactated Ringer’s Solution
• 5% Dextrose in LRS
• 5% Dextrose in Water
• 10% Dextrose in Water
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Thank
You!
Nursing Education, Training and Research
