ACLS MEGA CODE

UNIVERSITY OF THE CORDILLERAS

College of Nursing
NCM 118A RLE
A.Y. 2023-2024
 What are ACLS MEGACODES
and why are they important?

It is why the physicians and nurses at ACLS Medical Training

have developed MEGACODES. We have designed the
MEGACODES to simulate real-life scenarios as part of our
ACLS curriculum. They are series of questions that test your
knowledge of patient assessment, diagnosis, and management.
 Why megacode simulations?

We strongly feel these megacode simulations will help

you gauge your personal preparation for responding to a
code in real life. Our megacodes develops critical part of
your life support education.
 Benefits are:

-Synergy between participants.

-Delineation of task and assignments
and coordination of responsibilities.
-Minimizes variability in treatment approach.
-Builds on individual core competences.
 What do all these events
have in common

• Respiratory or cardiac arrest. • Near drowning

• Mass casualty (ex: War , • Cave-in (mines, land slides)
Earthquakes) • Electrocution
• Motor Vehicular • Drug overdose
Accidents/V.A. (Trauma)
• Poisoning
• Fire accidents
• Gun shot
• Fall from height
 What is Code Blue at hospital mean?

A “Code Blue” is defined as any patient with an

unexpected cardiac or respiratory arrest requiring
resuscitation and activation of a hospital-wide alert.
 What are the roles and responsibilities
of the code blue team
The term "code blue" is a hospital emergency code used to describe
the critical status of a patient. Hospital staff may call a code blue if a
patient goes into cardiac arrest, has respiratory issues, or experiences
any other medical emergency. The Adult Code Blue team assumes
care of victim and determines need to transfer care to another facility
as required. The PRIORITIES of ACLS responders, if the victim is in
cardiac arrest, are: High quality chest compressions with minimal
interruptions <10 sec with pulseless arrest. Early defibrillation, if
indicated.
 Code Blue roles during the code and explain
their tasks.

The essential Roles are that of the Team Leader, Recorder,

Compressors, Respiratory, Vascular Access/Medication RN
and the Code Cart RN. You can see how clear and effective
communication is imperative when there are this many people
involved.
 .

1.Team leader - (orchestrator/physician)

Team dynamics in CPR that 2.IV/IO medication -
each team member roles and 3.Compressor -
each are critical to the success 4.Airway - (suctioning, oxygenation,
of the entire team should BVM, V/S)
focus on their individual tasks, 5.AED/Monitor/Defibrillator -
the team leader must focus on
6.Time recorder -Time, Meds started
comprehensive patient care and given, Intubation.
and must take to reach a
desired outcome. -Time of
compressions and defibrillation.
-Date, Time revives,
ECG strips., any X-ray & lab works
done, which ward, etc.
How can we get this done:
1.Learn it
2. Practice it
3. Believe in it
4. We all want to make a difference
 .,

CRITICAL POSITIONS
Compressors
-Need at least 2or more available
-One to start immediately your recognition of cardiac arrest
-Must switch every 2 minutes for effective CPR delivery (regardless
of physical condition
of rescuer
-Can also deliver electrical therapy (AED)
-Cannot wild cat - must stay on task - stand to help if necessary
ex: First timers/new.
NURSE 1 - COMPRESSOR - At patient Right side
-Assess patient
-Initiate compressions rate100-120/min/ 30:2
alternate position 2 every 2min.
-Assist when not compressing
a)Airway and ventilation (BVM)
b)Advanced airway preparation
-Start IV fluid NSS and administer medicines
as order (2-3person)
 .

NURSE 2 - COMPRESSOR/ AED -At patients Left side

-Operates AED’s Activate Life Support monitor
-Alternate compressions with NURSE 1
-Monitor ECG for rhythm changes
-Responsible for delivering of Electrical therapy
a)Defibrillation
b) Cardioversion
c)Pacing
 .

CRITICAL POSITIONS
Airway
-One person needed, ideally person with most airway experience
-BVM first, if chest rise, then everything else can wait… remember
ETT may require hands --
off time.
-External- glottic airway may be preferred to insertion during
resuscitation phase due to ease of insertion and minimization of hands
-off time.
-Airway provider should not run the code. If the airway on chest rise
is not adequate… Team leader make the decisions.
 .

NURSE 3 AIRWAY - Behind patient head

-Initial assessment of airway potency
-Opening of airway with adjuncts (OPA, NPA)
-Ventilation of patient
-Advance airway placement (ETT)
-Capnography set-up
-Continuous monitoring of ET position O2 Sat
 .

CRITERIA POSITION
IV Access- Medications (Crash Cart/E- Cart)
-Health provider should have experience in accessing multiple IV
sites insertion and I/O.
-Should be familiar with resuscitation drugs, dosage,
and I/O.
-Should be able to stay one -step ahead.
-Can serve as recorder in between drug orders.
 ...

NURSE 4 IV/I/O MEDICATION -Patient Right leg

-Prepare access during first round of compressions.
-Gain access after First shock or confirmation on non-shockable
rhythm.
-IV (Right arm) or I/O (Right tibia or humerous)
-Prepare at least 3-5 rounds of drugs.
-Can serve as recorder.
 .

OTHERS:
-Obtain IV access
-Monitor V/S O2Sat
-Obtain ECG leads and identify heart rhythm shock or non shock
able
-Give Epinephrine IV push every 3-5 min.
-Give Amiodarone 300mg for refractory (VT,VF)
-If rhythm is shock able continue CPR for 2min. And give another
Epinephrine to treat reversible causes a)Pulseless/VT b)PEA
c)Asystole
 .

Doses Dose of Adenosine IV

• Synchronized cardioversion: • Initial dose of 6mg bulos IV
• Narrow regular: 50-100J push: Then flush with NSS.
• Narrow irregular Biphasic 120J • Follow of second dose is 12mg
0 200J Monophasic 200J if required.
• Wide irregular: 100J
• Wide regular: 100J
 .

Antiarrhytmic infusions for stable wide QRS tachycardia:

Procainnamide IV dose:
• 20-50 mg per minute until arrhythmia suppressed, hypotension ,or QRS
duration increases >50%, maximum dose 17mg/kg is given.
• Maintenance infusion: 1-4mg per minute. Avoid if prolonged QT or CHF.
Amiodarone IV dose:
• Initial dose: 150mg over 10minutes: Repeat as needed if VT reoccurs
• Maintenance infusion: 1mg per minute for first 6hrs.
Sotalol IV dose:
• 100mg (1.5mg/kg)over 5minutes, avoid if prolonged QT.
 .

 Supraventricular Tachy Treatment

-Rapid at 150-250 bpm  consider vagal manuever
-P wave cannot be positively -carotid sinus massage
identified -valsalva
-QRS narrow  Adenosine
-6mg , 12mg
 .

Treatment of Stable SVT Treatment of Unstable SVT

 Consider vagal maneuver  Electrical conversion
-Carotid sinus massage  Cardioversion is not
-valsalva defibrillation
 Use defibrillation in “sync”
mode
 Adenosine
-Prevent delivering energy in
-6mg , 12mg the wrong part of cardiac cycle.
 .

Electric Cardioversion Electric Cardioversion

Energy level Be prepared
-100J - 200J - 300J -360J -Monitor O2, IVF
-Atrial flutter -may give lower -Suction ready
energy of 50J -Airway supply ready
-Polymorphic VT -start 200J Pre-medicate when possible
can be increase. -Conscious sedation
-Electricshock are painful
 STABLE TACHYCARDIA

 Narrow complex  Wide complex

-Regular rhythm -Uncertain rhythm - assume VT
Sinus tachycardia -Narrow complex tachycardia
SVT with aberrancy
AV nodal reentry -Vent. tachycardia
-Irregular rhythm Monomorphic or polymorphic
Atrial fibrillation
Atrial flutter
 .

ATRIAL FIBRI/FLUTTER Treatment

-May be rapid -Unstable = Immediate electrical
-Irregular (Fib) or more regular cardioversion
(Flutter) -Stable-
-No P waves, narrow QRS. Control the rate
-Diltiazem
. -Esmolol
-Digoxin
Provide anticoagulant
 .

ASYSTOLE SINUS BRADYCARDIA

-Check leads and cable -Slow and regular
connections -Normal P waves and QRS
-Is everything turn on complex.
-Verify asystole in another lead
-May be it is really fine Vent.
fibrillation
 .

BRADYCARDIAS  Treat only symptomatic

 Many possible causes bradycardias
-Enhanced parasympathetic -Ask if bradycardia causing the
tone symptoms
-Increased ICP  Recognize the red flag
bradycardia
-Hypothermia
-Second degree type IIblock
-Hyperkalemia
-Third degree block
-Drug theraphy
Other treatment
-Atropine, Epin. Dopamine
 .

FIRST DEGREE AV SECOND AV BLOCK

BLOCK -Regular rate & rhythm
-Regular rate & rhythm -Normal P waves, QRS complex
-Normal P wave, long PR -Increasing PR intervals until
intervals QRS dropped.
_Normal QRS
 .

 If patient experiencing tachy arrithmia, unstable your intervention

is to do synchronized cardioversion.
 tachy not usually serious, heart rate is 150 bpm.
 In case cardioversion is unsuccessful & unconscious w/ pulseless
Vent.Tachy your intervention is to give one unsynchronized shock
120J.
 If patient feels lightheadedness, as if feels to pass out start
transcutaneous pacing. Therefore if not available give atropine &
dopamine.
 Atropine are drugs,Epi &Dopamine first line agent to treat
symptomatic brady/algorythm.
 .

 Vagal manuever not do if presenting primary tachy.

 Synchronized cardioversion is timed to deliver shock during
QRcomplex.
 Correct first dose of Adenosine is rapid IV6mg over 1-3 sec.
followed by 20ml NSS.
.

“ Thecapacity to learn is a gift;

The ability to learn is a skill;
The willingness to learn is a
CHOICE!”
Brian Herbert