Emergency Drugs (LEAD)

CARDIOPULMONARY RESUSCITATION and EMERGENCY DRUGS
A Written Report submitted to the

College of Nursing Faculty
Mrs. Soraida B. Basallaje, RN, MN
In Partial Fulfilment for the Requirements in

Nursing Care Management 106N RLE
Acute Biologic Crisis – ICU Rotation
By:
Eli D. Benedetti, St.N
Joash Rey N. Bag-ao, St.N
June Raye C. Prudente, St.N
October 29, 2019

Cardiopulmonary resuscitation
 Cardiopulmonary resuscitation (CPR) is an emergency procedure that combines

chest compressions often with artificial ventilation in an effort to manually preserve
intact brain function until further measures are taken to restore spontaneous blood
circulation and breathing in a person who is in cardiac arrest.
High Quality CPR (2015 guidelines of AHA):

1. Push hard and fast at the rate of 100-120 compression per minute
2. Depth of chest compressions is at least 2-2.5 inches (Adult)
3. Allow complete chest recoil after each compression
4. Minimize interruptions in compressions (10 seconds)
Code Blue
 Blue code is generally used to indicate a patient requiring resuscitation or
otherwise in need of immediate medical attention.
Indication of Code Blue

 Unresponsive
 Pulseless
 Apneic
Early Late Arrest

Airway/Breathing Tachypnea Tachypnea with Gasping
Retractions increased effort Not breathing
Diminished breath
sounds
Circulation Tachycardia Hypotension Bradycardia
Normal BP Cyanosis Weak, thread pulse
Pale and cold Mottled Skin No pulse
extremities
Oliguria
CNS Irritable Stupor Not responsive
Restless
Lethargic
First Responder Duties

- Check the Carotid pulse (less than 5 seconds but not greater than 6)
- Call for code blue
- Position client (Flat)
- Initiate CPR
Code Team
- A specially trained and equipped tem of physician, nurses and technicians that is
available to provide advanced cardiac life support when summoned by an
emergency code set by the institution.
Duties and Responsibilities
- Members of the code should identify themselves and their role upon entering the
room
- Wear appropriate PPE’s
- Tasks are performed simultaneously, rather than sequentially
- The key to running an effective code blue is the quality and timelessness of the
interventions
Members of the Code Blue Team

1. Compressor
 Places the patient flat on bed
 Performs chest compressions immediately
2. Airway manager
 Manages the airway as directed by the code team leader
 Always positioned at the head part of the patient
Guidelines:
a. Prepare the bag-valve mask and hook to O2 source.
b. Set O2 level on the flow meter at 15L/min
c. Open the airway using the head-tilt chin-lift maneuver or jaw thrust
maneuver
d. Hold the bag-valve device using the EC hand position.
e. Bag-mask device ventilation is most effective when performed by two (2)
trained and experienced healthcare professionals.
Frequency Rate
Child 3 – 5 seconds 12 – 20/min
Adult 5 – 6 seconds 10 – 12/min
Reminders:
 Check for chest rise during compression
 Minimize interruptions in compressions when delivering ventilations
 Be prepared to assist with endotracheal intubation
3. Defibrillator manager
 Operates/monitors the defibrillator
4. Crash cart manager

 Distribute contents of the crash cart and administers medications
 Use “close loop” communication
 Should be positioned on the same side of the patient’s venous access.
5. Recorder
 Communicates with the Team Leader throughout the code
 Reminds the code team leader every 2 minutes
 Prints cardiac rhythm strips or the code summary form from the
monitor/defibrillator
 Maintains accurate written record
6. Code team leader

 Directs and orders resuscitation efforts
 Communicates with all team members
 Monitors the patient’s cardiac rate and rhythm
7. Other members of the Code Team:

 Event Manager – manages crowd control; ensures management of the
rest of the unit; communicates with the family; notify the social worker,
hospital chaplain, and the interpreter; coordinates patient transfer; and is
usually the role of a charge nurse or a nursing supervisor.
 Bedside nurse – provides the situation, background, assessment, and
recommendation (SBAR); initiates high quality of CPR; and usually stays
at the bedside
 Runner – person who does the errands
 Security – assists with crowd control
EMERGENCY DRUGS
Generic Name: LIDOCAINE
Brand Name(s): Xylocaine, Xylocard
Classification: Amide Local Anesthetic, Anti-

arrhythmic
Mechanism of Action:
 IV, IM: Suppresses automaticity and
spontaneous depolarization of the
ventricles during diastole by altering the
flux of sodium ions across cell
membranes with little or no effect on
heart rate.
 Therapeutic Effects: Control of
ventricular arrhythmias. Local
anesthesia.
Indication:
 IV: Ventricular arrhythmias.
 IM: Self-injected or when IV unavailable (during transport to hospital facilities).
 Local: Infiltration/mucosal/topical anesthetic.
 Transdermal: Pain due to post-herpetic neuralgia.
Side effects:
 CNS: seizures, confusion, drowsiness, blurred vision, dizziness, nervousness,
slurred speech, tremor.
 EENT: mucosal use — for absent gag reflex.
 CV: cardiac arrest, arrhythmias, bradycardia, heart block, hypotension.
 GI: nausea, vomiting. Resp: bronchospasm.
 Hemat: methemoglobinemia. Local: stinging, burning, contact dermatitis,
erythema.
 MS: chondrolysis.
 Misc: allergic reactions, including anaphylaxis.
Nursing interventions:
1. Monitor ECG, BP, pulse, rhythm continuously.
2. Monitor serum lidocaine levels throughout therapy
3. Monitor intake and output.
4. Prepare dopamine at bedside.
Generic Name: EPINEPHRINE
Brand Name(s): Adrenalin, Adrenalick,

Allerject, Anapen, EpiPen
Classification: Antiasthmatics,
bronchodilators, vasopressors, alpha- and
beta-adrenergic agonist
Mechanism of Action: Results in the

accumulation of cyclic adenosine
monophosphate (cAMP) at beta-adrenergic
receptors. Affects both beta1 (cardiac)-
adrenergic receptors and beta2 (pulmonary)-
adrenergic receptor sites. Produces
bronchodilation. Also has alpha-adrenergic
agonist properties, which result in
vasoconstriction. Inhibits the release of mediators of immediate hypersensitivity reactions
from mast cells.
Therapeutic Effects: Bronchodilation. Maintenance of heart rate and BP. Localization/
prolongation of local/spinal anesthetic.
Indication:
 Subcutaneous, IV, Inhalation: Management of reversible airway disease due to
asthma or COPD.
 Subcutaneous, IM, IV: Management of severe allergic reactions.
 IV, Intracardiac, Intratracheal, Intraosseous (part of advanced cardiac life
support [ACLS] and pediatric advanced life support [PALS] guidelines):
Management of cardiac arrest (unlabeled).
 Inhalation: Management of upper airway obstruction and croup (racemic
epinephrine).
 Local/Spinal: Adjunct in the localization/ prolongation of anesthesia.
Side Effects:
 CNS: nervousness, restlessness, tremor, headache, insomnia.
 Resp: Paradoxical Bronchospasm (excessive use of inhalers).
 CV: angina, arrhythmias, hypertension, tachycardia.
 GI: nausea, vomiting.
 Endo: hyperglycemia.
Nursing Interventions:
1. Monitor VS and check for cardiac dysrhythmias.
2. Avoid IM use of parenteral suspension into the buttocks. Gas gangrene may occur.
3. Massage site after IM injection to counteract possible vasoconstriction.
4. If blood pressure increases sharply, rapid acting vasodilators such as nitrates or
alpha blockers can be given to counteract its effect.
Generic Name: ATROPINE
Brand Name(s): Atro-Pen
Classifications: anti-arrhythmic, anti-

cholinergic, anti-muscarinic
Mechanism of Action: Inhibits the action

of acetylcholine at postganglionic sites
located in: Smooth muscle, secretory
glands, CNS (antimuscarinic activity). Low
doses decrease: Sweating, salivation,
respiratory secretions. Intermediate doses
result in: Mydriasis (pupillary dilation),
cycloplegia (loss of visual accommodation),
Increased heart rate. GI and GU tract
motility are decreased at larger doses.
Therapeutic Effects: Increased heart rate.
Decreased GI and respiratory secretions.
Reversal of muscarinic effects. May have a spasmolytic action on the biliary and
genitourinary tracts.
Indications:
 IM: Given preoperatively to decrease oral and respiratory secretions.
 IV: Treatment of sinus bradycardia and heart block.
 IV: Reversal of adverse muscarinic effects of anticholinesterase agents
(neostigmine, physostigmine, or pyridostigmine).
 IM, IV: Treatment of anticholinesterase (organophosphate pesticide) poisoning.
 Inhalation: Treatment of exercise-induced bronchospasm.
Side Effects:
 CNS: drowsiness, confusion, hyperpyrexia.
 EENT: blurred vision, cycloplegia, photophobia, dry eyes, mydriasis.
 CV: tachycardia, palpitations, arrhythmias.
 GI: dry mouth, constipation, impaired GI motility.
 GU: urinary hesitancy, retention, impotency.
 Respiratory: tachypnea, pulmonary edema.
 Misc: flushing, decreased sweating.
1. Monitor VS. Report in rapid increase of heart rate.
2. Monitor for constipation.
3. Instruct to take 30 minutes before meals.
4. Advice to use hard candy, ice chips, for dry mouth.
Generic Name: DOPAMINE
Brand Name(s): Intropin, Revimine
Classifications: inotropic, vasopressors, adrenergic,

catecholamines
Mechanism of Action: Small doses (0.5–3 mcg/kg/min)

stimulate dopaminergic receptors, producing renal vasodilation.
Larger doses (2–10 mcg/kg/min) stimulate dopaminergic and
beta1-adrenergic receptors, producing cardiac stimulation and
renal vasodilation. Doses greater than 10 mcg/kg/min stimulate
alpha-adrenergic receptors and may
cause renal vasoconstriction.
Therapeutic Effects: Increased cardiac output, increased BP, and
improved renal blood flow.
Indications:
 Adjunct to standard measures to improve: BP, Cardiac output, Urine output in
treatment of shock unresponsive to fluid replacement. Increase renal perfusion
(low doses).
Side Effects:
CNS: headache.
EENT: mydriasis (high dose).
Respiratory: dyspnea.
CV: arrhythmias, hypotension, angina, ECG change, palpitations,
vasoconstriction.
GI: nausea, vomiting.
Derm: piloerection.
Local: irritation at IV site.
1. During infusion, frequently monitor ECG, BP, cardiac output, pulse rate.
2. Check for urine output. If urine flow decreases without hypotension, notify
physician.
3. Do not infuse sodium bicarbonate in the same line with dopamine.

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What are the guidelines for high quality CPR?

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CARDIOPULMONARY RESUSCITATION and EMERGENCY DRUGS

A Written Report submitted to the

In Partial Fulfilment for the Requirements in

October 29, 2019

 Cardiopulmonary resuscitation (CPR) is an emergency procedure that combines

High Quality CPR (2015 guidelines of AHA):

Indication of Code Blue

Early Late Arrest

First Responder Duties

Members of the Code Blue Team

4. Crash cart manager

6. Code team leader

7. Other members of the Code Team:

Generic Name: LIDOCAINE

Brand Name(s): Xylocaine, Xylocard

Classification: Amide Local Anesthetic, Anti-

Generic Name: EPINEPHRINE

Brand Name(s): Adrenalin, Adrenalick,

Mechanism of Action: Results in the

Generic Name: ATROPINE

Brand Name(s): Atro-Pen

Classifications: anti-arrhythmic, anti-

Mechanism of Action: Inhibits the action

Generic Name: DOPAMINE

Brand Name(s): Intropin, Revimine

Classifications: inotropic, vasopressors, adrenergic,

Mechanism of Action: Small doses (0.5–3 mcg/kg/min)

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