Full Course Description

Deciphering Challenging Cardiac Cases to Prevent a Crisis

Are you prepared to rapidly assess and identify a life threatening situation on a deteriorating patient that is reporting chest pain or dyspnea? Can you confidently analyze 12 Lead EKG, CXRs, and lab values to know which data needs immediate intervention? You don’t want to miss this fun, informative, and engaging session. This session uses a case study approach in which participants will analyze patient’s symptoms, history, diagnostics and correctly identify the causes and treatments. A cardiac expert will share practical tips and tools to dramatically increase your confidence in improving outcomes on RRT. You will receive powerful insights on managing cardiac symptoms on RRT and become the cardiac expert on your team!

Program Information

Objectives

Develop critical thinking skills to quickly intervene on a RRT with cardiac patient.
Analyze diagnostics and vitals on a deteriorating cardiac patient.
Recognize the most life-threatening cardiac conditions.
Discuss the management of cardiac patients on a RRT.

Outline

A case study approach will include: Takotsubo Cardiomyopathy, Dissecting Aneurysm, STEMI/NSTEMI, Wellen’s Syndrome, Flash Pulmonary Edema, Pulmonary Embolus, Post Procedure Complications

Cardiac Case Presentation

Symptoms
Patient history
vital signs

Analysis of Data

12 Lead EKG
Chest x-ray
Diagnostic labs

Management Strategies

Identification of life-threatening situations
Pharmacological interventions
Other interventions

Copyright : 11/09/2023

Rapid Response Pharmacotherapy – Update & Pearls

In this two-hour module, participants will review the role of medications in rapid response scenarios, including bradycardia, tachycardia, arrhythmias, cardiac arrest, sepsis, etc. In these scenarios, medications must be given in a time critical manner to provide life-saving intervention while still adhering to safe medication practices. After reviewing current guidelines for medication use as well as late breaking literature, participants will apply knowledge in a series of patient cases.

Program Information

Objectives

Analyze the role of medications in advanced cardiovascular life support (ACLS) algorithms.
Evaluate key supporting literature of ACLS medications.
Identify dosing and administration pearls for medications in rapid response settings.
Apply best practices to patient cases.

Outline

Arrhythmias

Tachycardia: beta-blockers, calcium channel blockers, etc.
Bradycardia: atropine, pressors, etc.
Atrial fibrillation; amiodarone, beta-blockers, etc.

Cardiac arrest

Pulseless electrical activity: epinephrine, Hs & Ts
Ventricular tachycardia/fibrillation: epinephrine, amiodarone, lidocaine

Thromboembolic events

pulmonary embolism: alteplase, heparin
Stroke: tenecteplase
Myocardial infarction: management strategies

Shock & Sepsis

Hemodynamic resuscitation & monitoring: fluids, volume
Sepsis early management: antibiotics, pressors, fluids

Best practices for safe medication use

Administration pearls (syringes, flushes)
Safe practices

Cases

Target Audience

Nurses
Physicians
Physician Assistants

Copyright : 11/09/2023

Sepsis and Septic Shock

Sepsis is a life-threatening condition and continues to have a high morbidity and mortality. Developing an understanding of early sepsis recognition, applying the appropriate treatment in a timely manner can help save lives. Nurses are essential in early recognition and early treatment. The most current 2021 Surviving Sepsis Campaign (SSC) Guidelines are useful in providing recommendations and rationale for treatment. Also new to the 2021 guidelines is a section on long-term outcomes and goals of care. As more and more individuals survive sepsis, resources to aid in their recovery are needed to improve long-term outcomes. This talk is relevant for individuals who care for patients with sepsis and septic shock and is a core measure for the Centers of Medicare and Medicaid. Nurses can make a difference in the lives of patients with sepsis and in the process improve compliance with the performance measure as well.

Program Information

Objectives

Describe the signs and symptoms of septic shock.
Discuss the appropriate treatment for sepsis and septic shock including the 3-hour and 6-hour sepsis bundle elements.
Integrate the 2021 SSC Guidelines to current patients with sepsis or septic shock.
Evaluate sepsis survivors for resources needs during recovery across the continuum of care.

Outline

Sepsis Background Physiology

Why Sepsis, Why Now?
Sepsis Facts
Stakeholders

Sepsis Definitions

Systemic Inflammatory Response Syndrome (SIRS)
Sepsis
Severe Sepsis
Septic Shock

Assessment Criteria

Sequential [Sepsis-related] Organ Failure Assessment Score (Sofa)
Most recent SSC guidelines -Sepsis Bundle Project (SEP)
National Hospital Inpatient Quality Measures
SEP-1 Early Management Bundle, Severe Sepsis/Septic Shock

Implications for nursing practice

Mortality based on organ failures
Sepsis Bundles
Early Patient Identification
Screening Tools
Early Treatment in ICU

Long-term outcomes for survivors of sepsis

Educate and Empower Patients & Family
Goals of Care
SCC Recommendations
Shared Decision- Making Sepsis Survivors
Return to Normal
- Psychological Support
- Physical Support
- Family Support
- Cognitive Impairment
- Self-Perception

Target Audience

Nurses
Nurse Practitioners
Physicians Assistants

Copyright : 10/07/2022

Neurocritical Care Medication Update

Neurocritical care patient management is highly complicated, especially when trying to optimize therapy during the acute injury. Pharmacologic management must be carefully considered in order to minimize cognitive dysfunction and avoid confounding patient neurologic evaluations. During the care of a neuro critical care patient, pharmacotherapy must be individualized for each patient, considering their age, comorbidities, and chronic medications. Pharmacokinetic and pharmacodynamic characteristics must be considered as they may change in acute illness and with neurocritical care interventions. Pharmacokinetic changes may include alterations in medication absorption, distribution, metabolism, and elimination, while pharmacodynamic changes could result in loss of drug effect or an increase in toxicity. This talk will focus on pharmacotherapy and clinical pearls that will help the care of a neurocritical care patient.

Program Information

Objectives

Evaluate common medications used in the critical care setting, involved in the care of neuro patients.
Assess appropriate use of medications for neuro diagnosis in the critical care setting.
Choose the appropriate neuro agent, with consideration to patient’s organ function, medication allergies, potential adverse drug effects, drug interactions, critical illness, and age-related pathophysiologic changes.
Appraise the key pharmacokinetic and pharmacodynamic characteristics, advantages and disadvantages, and clinical pearls of the medication therapies.

Outline

Hyperosmolar therapy
Antiseizure medications
Antithrombotic agents
Anticoagulant reversal and hemostatic agents
Antishivering agents
Neuromuscular blocking agents
Antihypertensive agents
Sedation and Analgesia
Vasopressors and inotropes
Antimicrobials

Target Audience

Nurses
Nurse Practitioners
Physician Assistants

Copyright : 09/28/2022

Life Threatening Diabetic Emergencies

With the high prevalence of 38 million Americans in the US with diabetes and almost ¼ of the US population with prediabetes, healthcare professionals need to know how to respond to diabetic emergencies. Emergency nurses need to be aware of the pathophysiology and treatment standards, as the acceleration of available diabetic medications can be confusing. There has also been confusion for the term HNS, also known as “HANKS” or HHNKS, or HNC,” which will be clarified.

Program Information

Objectives

Identify the three diabetic emergencies as hypoglycemia, DKA and HNKS.
Discuss the presenting signs and symptoms, pathophysiology, risk factors, and diagnostic tests for the three diabetic emergencies.
Explain the medical treatment and management protocol for each diabetic emergency.

Outline

Overview of pathophysiology and classifications of Diabetes Mellitus.

Hypoglycemia:

Clinical presentation
Causes and risk factors
Diagnostic tests and criteria
Emergency treatment
Pharmacological management
ADA standards
Case study

Diabetic Ketoacidosis:

Clinical presentation
Causes and risk factors
Diagnostic tests and criteria
Emergency treatment
Pharmacological management
ADA standards
Case study

Hyperosmolar Hyperglycemic Nonketotic Syndrome:

Clinical presentation
Causes and risk factors
Diagnostic tests and criteria
Emergency treatment
Pharmacological management
ADA standards
Case study

Target Audience

Nurses
Nurse Practitioners
Clinical Nurse Specialists
Physician Assistants

Copyright : 09/12/2023

Limit Legal Liability: Protect Yourself & Your License During a Rapid Response

How exciting! As a member of the rapid response team, you step into serious medical complications as they happen and work hard to “Save the Day!” Hemodynamically unstable patients, arrhythmia’s, seizures, chest pain, altered mental status, respiratory failure … Each patient is a puzzle for us to try to decipher and treat. Though the role of rapid response is exciting, it’s also laden with risk. Join Cyndi Zarbano as we explore potential pitfalls and how to avoid them.

Program Information

Objectives

Determine how practice acts give direction to help avoid legal risks.
Analyze ethical concepts as they relate to the rapid response role.
Evaluate common documentation errors that increase liability risk during an emergency.

Outline

Limit Legal Liability

The rapid response role
Exciting, yet fraught with potential risks
Liability and potential penalties
Quick review of some legal concepts

Understanding Your Limits

Important statutes to guide your nursing practice
Facility policies
Staying within your scope of practice
The importance of communication skills

Ethical Concepts & How They Relate to the Rapid Response Role

ANA’s Code of Ethics for Nurses
Beneficence
Nonmalefiscence
Respect
Veracity
Autonomy
Accountability

Documentation

One of the most important tools to keep you safe!
Common errors
How much is enough?
Documentation tips

Target Audience

Nurses
Physicians
Physician Assistants

Copyright : 11/10/2023

High Flow Nasal Cannula Use in Rapid Response Respiratory Distress Calls

High-flow nasal cannula gained popularity in acute care settings during the pandemic. High-flow nasal cannula oxygen therapy has been used in different patient care populations revealing strengths and weaknesses. Each strength and weakness will be discussed in this presentation. Find out if the research findings could lead you to consider this therapy, a new standard for rapid response calls on patients in respiratory distress.

Program Information

Objectives

Distinguish the difference between non-invasive ventilation and high-flow nasal cannula.
Determine patient populations that benefit from high-flow nasal cannula oxygen therapy.
Develop initiation and titration strategies for a patient on high-flow nasal cannula.
Apply the ROX index when assessing a patient for high-flow nasal cannula therapy.

Outline

Media influence on respiratory support during COVID

Message that ventilators were killing covid patients
Praise for the “discovery” of high flow nasal cannulas (HFNC)

What is high flow nasal cannula

Settings
Comfort
Easy to use
Humidification

Does HFNC provide PEEP?

Therapeutic PEEP
Off set intrinsic PEEP

What patient populations benefit form HFNC

Hypoxic respiratory failure
Post extubation patients
CHF
AE COPD: Oxygen hemoglobin dissociation curve

Monitor a patient on HFNC

ROX index
Initiation
Provide medicated aerosol treatments with HFNC

Titrate and Discontinue HFNC

Clinical Outcomes

FLORALIS
HOT-ER
Smaller trials/studies

Does the data support HFNC to be a routine for RRTs treating respiratory distressed patients?

Target Audience

Nurses
Physicians
Physician Assistants

Copyright : 11/10/2023

Subtle Clues of Impending Doom: Prioritizing Action

You’ve been there before, caring for a patient…when you get that pit in your stomach feeling that something is going to take a turn for the worse.

It all happens so quickly! Soon you are calling for the rapid response team to provide some backup. Those minutes feel long until others arrive to lend a clinical hand. You’ve worked hard to accumulate experience and important patient insights. However, in these critical moments when a patient begins to deteriorate, are you confident in your next steps?

Join Sean G. Smith MSc, FP-C, C-NPT, CEN, CFRN, CPEN, CCRN-CMC (Adult), CCRN-K (Neonatal), CCRN-K (Pediatric), for this practice changing session. Sean is a flight nurse-paramedic who has practiced in Rapid Response teams, Emergency Medicine, Critical Care, and Aero-Medical Transport (military and civilian) for over 25 years. His extensive and on-going clinical expertise will be evident!

Fear of the unknown is often the biggest problem we face in our professional work, and few patients are more terrifying or difficult than the patient facing impending doom. This session will provide new clinical problem-solving skills, so you won’t need to feel uncertain, scared or at risk anymore. The ability to assess, intervene and advocate will be reinforced through exciting – and real! - cases.

Program Information

Objectives

Develop a proactive high performance rapid response team approach to respond to deteriorating patients.
Identify determinants of cerebral and end organ perfusion.
Understand how reversible causes impact cardiac output and can exacerbate patient deterioration.
Apply best practice assessment and interventional approaches for a variety of emergent cardiac and respiratory scenarios.
Incorporate pharmacological interventions into your current clinical practice with respect to the pre, peri, and post arrest management of the medically fragile patient.

Outline

High Performance Resuscitation Teams During a Rapid Response

Physical and psychological components
Skills maintenance strategies
2023 AHA Guidelines for CPR and Emergency Cardiovascular Care

Worst Case Scenarios & Proactive Planning  

Proactive risk assessments 
Lab test clues that a crisis is looming

Crucial Patient Assessments & Interventions

Anticipate needs of high-risk populations (neuro, cardiac, respiratory, oncologic)
Incorporate rapid assessment techniques and ask the critical questions

Pharmacological Guidelines for Emergent Patient Scenarios

Pharmacokinetic and pharmacodynamic considerations in the rapid response patient
Pharmacologic pearls and pitfalls in medically fragile patients

Rapid Cardiac Assessment and Stabilization During Cardiac Emergencies

Identify determinants of cardiac output and end organ perfusion
Current interventions for reversible causes of cardiac emergencies
Rapidly assess and treat concomitant reversible causes contributing to decreased cardiac output

Optimize Response in Respiratory Distress and Cardio-Pulmonary Resuscitation

Apply best practice methods to assess oxygenation and ventilation (Sao2, ETCO2, ABGs…)
Critical thinking strategies for ABG analysis
Must have components of high-quality CPR

Target Audience

Nurses
Nurse Practitioners
Clinical Nurse Specialists
Physician Assistants

Copyright : 08/15/2023

Triage for Rapid Response Teams: Evidence-based Pearls and Pitfalls

Rapid Response Teams (RRT) identify deteriorating hospitalized patients prospectively and seek to alter their clinical trajectory through increasing the clinical resources directed to them. As hospitalized patients may exhibit warning signs prior to deterioration, RRT have the potential to prevent adverse clinical outcomes, including cardiac arrest and death.

Brought to widespread attention by the 2005 Institute for Healthcare Improvement’s 100,000 Lives Campaign, the development of the Rapid Response Team (RRT) was in reaction to a growing body of evidence that revealed deficiencies in the response to rapid clinical decline in the inpatient setting. A key principle underlying RRT is that early intervention can prevent avoidable morbidity and mortality in the non-intensive care hospital setting.

Members of the RRT must possess skills in rapid and thorough patient assessment, positive team dynamics and correct triaging of all patients. Inadequacies in any of these areas could result in rapid patient deterioration and patient demise.

In this presentation, you will learn about the following: (1) the most effective physical assessment techniques to assess a patient; (2) proper planning and interventions for your patient’s condition; (3) treatment modalities for the most common causes of activating an RRT call; and (4) pitfalls to avoid when responding to an RRT call.

Program Information

Objectives

Evaluate the role of the rapid response team (RRT).
Identify three physical assessment methods used to effectively triage an RRT patient.
Determine pitfalls that can occur during the triage process which adversely affect the patient's outcome.

Outline

Rapid Response vs. Code Blue: What is the difference?

Team members
Team training

Personal equipment you must take to every rapid response call

Beyond the stethoscope and penlight

The five-minute focused physical assessment

Setting priorities and identifying patients at risk for decompensation

Communication

SBAR and CUS words (concern, uncomfortable and safety)

Triage methods based on levels of care

Is the patient stable or rapidly deteriorating?

Evidence based criteria to transfer to higher level of care

Team communication and feedback mechanisms

Performance, attitude and knowledge sharing during the debriefing

Case Studies

Target Audience

Nurses
Nurse Practitioners
Clinical Nurse Specialists
Physician Assistants

Copyright : 10/19/2023

Failure to Rescue: Replace Fear with Courage and Action

“Failure to Rescue: Replacing Fear with Courage and Action” is designed for healthcare Rapid Response Teams. Focusing on empowered teams in emergency situations, the presentation unpacks primal responses, the crucial role of in-patient responders, patient acuity, and early warning systems. Attendees will learn about the Visual Acuity Scale application, self-efficacy rescue drills, tricks to teaching proper use of emergency equipment, and the significance of teamwork in high-performance resuscitation. You will cultivate a readiness mindset and gain the transformative power of courage and action to enhance patient outcomes.

Program Information

Objectives

Recognize primal fear responses in emergent situations to mitigate them for improved patient care.
Analyze the perception gap between in-patient and critical care teams.
Plan for early recognition of patient deterioration, using Early Warning Systems and the Visual Acuity Scale.
Evaluate the importance of teamwork, effective use of emergency equipment, and coordination in forming a high-performance BLS Rapid Response Team.

Outline

The Primal Fear Response

Define the fight, flight, or freeze response
Discuss its impact on healthcare professionals in emergencies
Importance of training to mitigate these responses

Vital Contribution of In-Patient Responders

Explore the in-patient responders’ role in ‘critical’ situations
The role of the Basic Life Support (BLS) RRT
Case studies to illustrate the real-world application

Patient Acuity: Bridging the Perception Gap between In-Patient and Critical Care Teams

Patient acuity concept: Identifying sick vs. not sick
Differing perceptions and the need for harmonization

Lead the Change: The Role of Rapid Response Teams

Mindset differences between in-patient and critical care teams
Strategies to bridge the gap: Empower non-critical care teams
Leadership of rapid response teams in this transformation

Develop High-Performance Readiness through Recognition

Timely recognition and response in patient survival
Function of early warning systems in rapid response situations
Use the Visual Acuity Scale to detect early deterioration

Master Emergency Equipment: Defibrillators and More

Importance of equipment familiarity in emergencies
Explore defibrillator functions and features through a non-critical care lens
Tips and tricks for quick and effective ways to create a defibrillator comfort zone

Create a Highly Effective Basic Life Support (BLS) Rapid Response Team

Role definition and responsibilities within a BLS rapid response team
Coordinated teamwork in successful patient outcomes
Case study: Implement the ‘red carpet’ approach

Empower Teams through Unit-Based Rescue Drills

The significance of hands-on practice for confidence building
Foster a culture of ownership and excellence
Demonstrate real-world impact – Cardiac arrest case study

Assemble a High-Performance Resuscitation Approach

The ‘pit crew’ approach: Emphasizing teamwork and coordination
Assign roles and expectations for each team member
The collective impact of an entire community/culture/system in life-saving

Encourage Confidence and Action for Effective Emergency Response

Role of confidence and self-efficacy in survival rates
The goal: High-performance rapid response teams trained in BLS/ACLS
The critical connection between confidence, ACTION, and survival rates

Target Audience

Nurses
Physicians
Physician Assistants

Copyright : 11/09/2023

When the Rapid Response is a Trauma Patient

This will be a presentation that focuses on the unique aspects of trauma care in an emergency response system. Topics will include assessment considerations that are unique for the trauma patient. We will focus on recognition and management of hemorrhage to include a balanced resuscitation approach which is guided by thromboelstagraphy. Medication used in the management of bleeding will be reviewed. We will cover treating the trauma patient who is on anticoagulants and medication adjuncts used in the management. We will review what criteria should be considered when determining the level of care a patient needs when a rapid response is called. We will conclude with a case study that will allow an opportunity to review the concepts presented in a patient scenario.

Program Information

Objectives

Determine the initial assessment of the trauma patient.
Evaluate treatment strategies for the trauma patient with ongoing hemorrhage.
Assess and manage the trauma patient who is on anticoagulants.
Analyze considerations that guide what level of care a patient needs after a rapid response has been initiated.

Outline

Assessment Overview

Primary Survey
Secondary Survey
Tertiary Survey
Ultrasound Utility

Airway Emergencies in Trauma

Airway Trauma
Special Considerations

Resuscitation of the Bleeding Trauma Patient

Physical Assessment
Laboratory Findings
Overview of Massive Transfusion Protocol
Medication Adjuncts

Anticoagulation Considerations in Trauma

Medication Adjuncts
Thromboelastagraphy Guided Therapy

Considerations when Determining Level of Care for the Patient

Case Study Review

Target Audience

Nurses
Physicians
Physician Assistants

When Resuscitation Will Not Change the Outcomes: The Difficult Conversations

Health-related quality of life (QOL) has a unique meaning to every patient and caregiver. Bridging the gap between QOL and goals of care (GOC) can be seamless when the expectations are clearly communicated and consistently honored. A patient crisis is not the time to discuss advanced care planning (ACP) and GOC.

Engaging in difficult conversations with patients and families may seem taboo. Discussing goals of care prior to a crisis promotes dignity and respect to our loved ones. Fostering compassionate and open dialogue promotes dying with dignity.

Program Information

Objectives

Recognize the meaning of health-related quality of life and what it means to each patient.
Determine how to make certain the advanced care planning follows the patient through their hospitalization.
Evaluate new communication techniques to approach difficult conversations.
Implement learning strategies to ensure health-related quality of life and goals of care are patient focused and protected.

Outline

Discuss the differences between quality of life compared to health-related quality of life

Holistic care

Physiological
Psychological
Spiritual
Emotional

Multi-disciplinary conversations

Cornerstone to QOL
Who’s who on the “Team Patient”

Crisis management during a rapid response

Patients get scared and change their minds

Families and caregivers get scared and have a realization of crisis

Preparedness and readiness are the keys to storm management

Target Audience

Nurses
Physicians
Physician Assistants

Legal Risk Aversion Tools for Critical Care Nurses

It’s unbelievable how often “things’ happen in healthcare.

Alarms, pumps, drains, changing vent settings, tubes, equipment, technology, orders, consults, intake, output, donning, doffing, and stressed loved ones.... There are countless things to keep up with during your non-stop busy shifts.

You love the pace and intensity of the ICU. But what happens when you thought everything was done correctly, only to later find out that something important was missed? Can reportable events like pressure injuries, central line infections, and urinary infections lead to litigation? What about unanticipated events with immediate bad patient outcomes?

Join Rosale Lobo, PhD, RN, MSN, LNC, to learn what you can do today to decrease your legal risks tomorrow. Discover the secrets to keep your license and profession safe from scrutiny and litigation.

Program Information

Objectives

Analyze legal risks specific to high stress, high intensity situations in the critical care setting.
Manage your clinical actions that could trigger a legal risk.
Integrate common potential missteps into strategic resolutions for confident practice habits.
Appraise your own practice to incorporate new knowledge, power, and resources.

Outline

Legal Risks in Critical Care Nursing

Straight talk on medical malpractice
Personal injury and equipment failures
Information technology: Path of an unfortunate outcome
The trail of information – Evidence speaks for itself
The dark cloud on your license

Conflicting Practice Habits

Actions and inactions – Both are important
Communication – Multiple minds to consider
Short cuts – Do they benefit the critically ill?
Simulating – Honesty is the best policy
Trusting – Yourself and others

What Really Happened?

The critical dissection of a story
What could we have done differently?
Multiple players, multiple steps

License Defense Tactics

Resources – Specificity is key in critical care
Innovation – The iteration of critical care nursing
Reporting – Share experiences for education
Time management – Caring for a few, at one time

Target Audience

Nurses
Nurse Practitioners
Physicians Assistants

Wake Up the Surgeon! Acute Abdominal Pain Can't Miss Diagnoses

In this comprehensive overview of evaluating abdominal pain, using an approach that relies on the likelihood of disease, patient history, physical examination, laboratory tests, and imaging studies, you will hear the latest evidence. In this recorded session, Patrick will discuss situations that are emergent, may be life threatening, and may require surgical intervention, including acute appendicitis, ectopic pregnancy, abdominal aortic aneurysm and more. The unique needs in geriatric patients with abdominal pain will also be covered.

Program Information

Objectives

Conduct a history of pertinent historical details related to a chief complaint of abdominal pain leading to the diagnosis of an acute surgical abdomen.
Determine pertinent physical exam findings related to an acute surgical abdomen.
Formulate a plan for emergent and surgical management of several common potential life threatening surgical abdominal emergencies.
Debate potential pitfalls in the management of acute abdominal pain in the geriatric population.

Outline

Patient History
- Pertinent historical details related to a chief complaint of abdominal pain
- Risk factors
- Benign vs urgent
- Visceral vs pareietal vs referred
Physical Exam
- Findings leading to the diagnosis of an acute surgical abdomen
- Benign vs urgent
Emergent and surgical management of several common potential life threatening surgical abdominal emergencies
- Differential dx
- Acute appendicitis
- GI Perforation
- Ectopic pregnancy
- Small bowel obstructions
- Mesenteric Ischemia
- Volvulus
- Abdominal Aortic Aneurysm
Potential pitfalls in the management of acute abdominal pain in the geriatric population

Target Audience

Nurses
Nurse Practitioners
Clinical Nurse Specialists
Physicians
Physician Assistants

Code Blue Training: Life Support Challenges

Cardiac arrest affects over 600,000 people per year in North America alone. Depending on the circumstances of arrest, 20 to 40 percent of adults who survive to hospital care after resuscitation from cardiac arrest are discharged alive, the majority of whom enjoy favorable functional recovery. Advances in cardiopulmonary resuscitation (CPR) and post-cardiac arrest care delivery have improved outcomes over time.

The most immediate threat to survival during the first minutes to hours is cardiovascular collapse. Interventions to optimize blood pressure and maintain brain and other end-organ perfusion (e.g., boluses of intravenous [IV] fluid, vasopressors, and inotropes) can help prevent secondary injury from hypotension. Additional short-term goals during the first hours of care include optimizing oxygenation and ventilation and correcting electrolyte abnormalities. 

If the person survives the cardiac arrest, management of the post-cardiac arrest patient is also complex and must address multiple major problems simultaneously:

Initial cardiopulmonary stabilization and prevention of rearrest
Identification and treatment of reversible causes of cardiac arrest
Ongoing stabilization and prevention of brain injury
Early risk stratification

Immediately following resuscitation from cardiac arrest, the patient can develop severe problems due to medical comorbidities, the underlying cause of arrest, and sequelae of global ischemia-reperfusion injury.

In this presentation, you will hear about real-world code blue events. You will learn about the management of both adult- and pediatric-code blue scenarios. Highlights will include pharmacology, advanced interventions (extracorporeal membrane oxygenation, ECMO; intra-arterial fibrinolytics) and case studies.

Program Information

Objectives

Describe three priorities initially in a code blue.
Discriminate medications used in code blue.
Identify medication dosing and frequency in code blue.
State the return of spontaneous circulation outcomes for a patient surviving a code blue.

Outline

Code Blue vs. Rapid Response

Baseline Equipment for Code Blue

Crash Cart with defibrillator, portable oxygen source, suction equipment
Bedside ultrasound
End-tidal CO2 detector

Pharmacology – Adult doses and sequences

Oxygen
Epinephrine
Amiodarone
Lidocaine
Atropine
Adenosine
Diltiazem
Sotalol
Procainamide infusion
Dopamine infusion
Norepinephrine infusion
Thrombolytics

Pharmacology – Pediatric doses and sequences

Oxygen
Epinephine
Amiodarone
Lidocaine
Atropine

Post-arrest stabilization

Cardiac Catheterization
Targeted Temperature Management
EEG monitoring
Extracorporeal Membrane Oxygenation
Intra-arterial thrombolytics

Case Studies

Target Audience

Nurses
Nurse Practitioners
Clinical Nurse Specialists
Physician Assistants

Rapid Response for Imminent Clinical Deterioration

Rapid response systems are an invaluable tool for healthcare professionals. They provide a way to quickly and efficiently respond to emergencies in hospitals, allowing medical personnel to quickly assess the situation and take action. The rapid response system is designed to minimize the time it takes for medical staff to respond, often saving precious minutes that could make all the difference. Healthcare providers can also use this system to contact appropriate healthcare personnel for further assistance. By taking a proactive approach to emergency care, healthcare providers can give patients the best possible chance at recovery. Rapid response systems have become essential for hospitals and medical centers worldwide.

In addition to helping reduce response times and improve patient outcomes, rapid response systems benefit healthcare providers. By promptly accessing the appropriate personnel and resources, healthcare providers can provide better care with fewer delays. With so many positive benefits to rapid response systems, it is no wonder that they have become an integral part of modern healthcare.

Program Information

Objectives

Differentiate between the roles and benefits of different rapid response models of care.
Determine the criteria to activate a rapid response system.
Recognize the early warning signs of acutely deteriorating patients.
Initiate Goals of Care Discussions, as part of the rapid response.

Outline

Rapid Response Models – Roles, Prose & Cons

Medical Emergency Team
Critical Outreach Service
Rapid Response Team
Patient/Family Initiated Rapid Response
Track and Trigger warning System

The Criteria for Activating Rapid Response

Vital sign changes
Physical exam assessment change
Acute neurological changes
Healthcare staff significant concern

The Early Warning Score

The "Afferent" and "Efferent" of Rapid Response

Incorporation of Goals of Care

Target Audience

Nurses
Nurse Practitioners
Clinical Nurse Specialists
Physician Assistants