3. station 5 clinical instructor's teaching sheet

7/27/2019 3. Station 5 Clinical Instructor's Teaching Sheet

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CLINICAL INSTRUCTORS TEACHING SHEET

STATION 5: CRITICAL CARE MANAGEMENT

Instructors Teaching Sheet

Greet Good (Morning/Afternoon)

Introduce Station At this station, you will be tasked to perform different procedures

related to critical care management. It is required that you have

read your manual prior to this activity. You will be assigned

randomly to one of the following:

1. CODE BLUE TEAM

recorder (nurse 1) physician 1 who gives the order (team leader)

nurse 2

Anesthesiologists (physician 2)

respiratory therapist

Nurse 3

Physician 3 (Surgeon-optional)

OBTAIN ECG

DO CPR APPLY CARDIAC MONITOR

USE MANUAL DEFIBRILLATOR

KNOW THE CONTENTS OF AN EMERGENCY

CART

Station 5 Critical Care Management: Clinical Instructors Teaching Sheet. M. C. Agra, J.

Garcia, F. Mercado. 2010. 2


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Questions Do you have any questions before we proceed to the testing?

Time Limit You each have up to 10 minutes to do a procedure.

Show and Tell Before we proceed to the testing, familiarize yourself with the

following:

Code Blue Team

Room Set-up

ECG Machine

Location of the Chest Leads




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Limb Leads

ECG Paper

Proper Positioning of Client

Know when to call code blue

How to perform CPR


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Application of Cardiac Monitor

Manual Defibrillator

Proper placement of paddle

Emergency/Crash Cart




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Steps This is the basic procedure: (Assuming that you have assessed the

need for performing the required procedure)

1. Knock on the door.

2. Greet the patient.

3. Explain every step of the procedure to the patient.

4. Refer to the manual for every procedure.

5. Document findings and procedure.

Teaching PointsThe procedures are done on a hospital settings wherein the client is

critically ill or assessed as pulseless arrest; thus the CODE BLUE

will be activated.

Code blue activated

A. Medical emergency in which

paramedics are dispatched to aid a person

undergoingcardiac arrest.)

A code blue is the term hospitals and medical

professionals use to describe a situation where a patient

will need to be resuscitated. When a person has stopped

breathing a code will be called.

Assessed a pulseless patient

Call for code blue

Administer oxygen while waiting for the team to

arrive and positions patient in supine ready for

CPR, attachment of cardiac monitor and application

of defibrillation.

Emergency/Crash cart ready at bedside

I. Overview of ECG

A. In the section about the anatomy and physiology we

explained how the cardiac impulse passes through the


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heart, but while doing so electrical current also spreads

from the heart into the adjacent tissues surrounding the

heart.

B. A small portion of the current spreads all the way to thesurface of the body.

C. If electrodes are placed on the skin on opposite sides of the

heart, electrical potentials generated by the current can be

recorded; the recording is known as an electrocardiogram.

D. Placement of electrodes for 12 lead ECG

RA On the right arm, avoiding bony prominences.

LA In the same location that RA was placed, but on the left

arm this time.

RL On the right leg, avoiding bony prominences.

LL In the same location that RL was placed, but on the left

leg this time.

V1 In the fourth intercostal space (between ribs 4 & 5) just

to the right of the sternum (breastbone).

V2 In the fourth intercostal space (between ribs 4 & 5) just

to the left of the sternum.

V3 Between leads V2 and V4.

V4 In the fifth intercostal space (between ribs 5 & 6) in the

mid-clavicular line (the imaginary line that extends down

from the midpoint of the clavicle (collarbone).

V5 Horizontally even with V4, but in the anterior axillary

line.

II. CARDIO PULMONARY RESESCITATION (CPR).

A. The major role of CPR is to provide oxygen to the heart, brain

and other vital organs until medical treatment (Advanced

cardiac life support- ACLS) can restore normal hear action.




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Indicated for respiratory arrest or cardiac arrest.

B. The A B C s of CPR

Determine unresponsiveness ( shake and shout)

A - Open the AIRWAY

Determine breathlessness( Look, listen and feel)

B - Breathing

Determine Pulslessness

C - Circulation

C. The steps of CPR

Assess responsiveness

If no Response: Activate code blue or 108

Open the airway: look, listen, and feel for

breaths

If no breathing; Give 2 rescue breaths

Assess for signs for of circulation

If no signs of circulation: Begin chest

compressions

Continue pump and blow for 1 min

Reassess

III. Cardiac Monitoring

A. The electrocardiography (EKG) is a device used to measure

cardiac electrical current. Electrical currents will provide

important information about heart contractions and can

identify potential problems.

IV. DEFIBRILLATION

A. Defibrillation consists of delivering a therapeutic dose of

electrical energy to the affected heart with a device called adefibrillator.

V. PERFORMING BASIC CODE MANAGEMENT




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A. Purpose

To establish an airway

To initiate breathing

To maintain circulation and advance life support guidance

B. Activate code blue "Code Red" "Code Blue", "Code Black"...people

sometimes wonder what these terms mean if they

happen to hear them used in a hospital. Technically, there's no formal definition for a

"Code", but doctors often use the term as slang fora cardiopulmonary arrest happening to a patient in a

hospital or clinic, requiring a team of providers

(sometimes called a "code team") to rush to thespecific location and begin immediate resuscitative

efforts.

C. Prepare emergency/crash cart A crash cart is a wheeled cart with drawers stocked

with medical supplies used for emergencies outsideof an emergency room.

They are most commonly used to help medical

personnel quickly respond to people who have goneinto cardiac arrest, which is often referred to as the

patient having "crashed," or cardiac/pulmonary

arrest

A cart carrying emergency equipment and supplies,

such as medications, suction devices, sutures,

scalpels, surgical needles, sponges, swabs,

retractors, hemostats, forceps, airways, O2 supplies,IV supplies, tracheal tubes, and often a cardiac

monitor with a defibrillator.

Contents:

TOP: Defibrillator Gloves 6-1/2 3Electrodes Gloves 7-1/2 3

Suction Machine Tape

Adult & Pedi Ambu Bags Introcan 22ga 2Stethoscope Introcan 20ga 2

CPR Board Tourniquet 1

CPR Book Alcohol SwabsOxygen Tanks w/one Regulator Syringes 60ml 2

Syringes 20ml 2

FIRST DRAWER: Syringes 10ml 5Atropine 1/mg/10ml 1 Syringes 5ml 5

Adenosine 6mg/2cc -- 2 Syringes 3ml 5


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Calcium 1gm/10ml 1 Needles 18ga 10

Epinephrine 1:1000/1ml 4 Conductivity GelDexamethasone 4mg/1ml 1 KY Gel

Neo-Synephrine 10mg/1 ml 1 Injectable Saline 30ml 2

Epinephrine 1:10,000/10ml 10

Lanoxin 0.5mg/2ml 1Diltiazem 3 (refrigerated)

Benadryl 50mg/1ml 1 LRomazion 1mg/10ml (anesthesia cart)

Narcan 0.4mg/1ml (anesthesia cart)

Tongue Blades 5

Oxygen WrenchThermal Paper

SECOND DRAWER: Airways 6 1

Glucagon Emergency Kit 1 Airways 8 1Vasopressin 20 units/cc 2 Batteries C 2

Dextrose 50gm/50ml 1Amiodarone 150mg/3ml 2Nitroglycerine 50mg/10ml 1

Sodium Bicarb 8.4%/50ml 1

Dopamine 400mg/10ml 1Microshield 2

Yankeur Tip 2

Suction Tubing 2

THIRD DRAWER:

Lasix 40mg/10ml 2

Mag Sulfate 5gm/10ml 1

FOURTH DRAWER:Gloves 6-1/2 3

Gloves 7-1/2 3

TapeIntrocan G22/G20 2 each

Torniquet 1

Alcohol swabs

Syringes 60ml 2Syringes 20ml - 2

Syringes 10ml - 5

Syringes 5ml - 5Syringes 3ml - 10

Needles G18 10

Conductivity GelKY Gel

Injectable Saline 30ml - 2

FIFTH DRAWER:

Dantrium 20mg 36




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Laryngoscope Handle

Miller Blade #2 1Miller Blade #3 1

Macintosh Blade #2 1

Macintosh Blade #3 1

ET Tubes 4 1ET Tubes 7 1

ET Tubes 8 1Airways 6 1

Airways 8 1

Batteries C 2

SIXTH DRAWER:

Cric Kit w/Trach Tube (adult) 1

D5 NS 250cc 1

Lactated Ringers 500cc 2NACL 0.9% 500cc 2

IV tubing - 5D. Starts procedures



3. station 5 clinical instructor's teaching sheet

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