How long you push emergency drugs during codes

[Kaitef0716]

Was just wondering how long you push emergency drugs for during codes. Etomidate, sux, ketamine, amiodarone, bicarbonate, calcium, Epi,vasopressin? Any other main ones I'm missing. Thanks

[~Mi Vida Loca~RN, ASN, RN]

Why are you pushing Etomidate, and sux and ketamine for a code??? Are we talking about an RSI or an actual code? As far as the Epi and the BiCarb and Vasopressin (although I have never actually seen that used during the 100+ codes I have been involved in) the person isn't going to get anymore dead. So we have always slammed them.

[Double-Helix, BSN, RN]

You might benefit from taking an ACLS course, or at the very least reviewing some of the algorithms available through the American Heart Association. There's a fair bit more to running a code than pushing drugs.

Typically the code continues until the team feels they have exhausted all their options or they get ROSC (return of spontaneous circulation).

[TheCommuter, BSN, RN]

Moved to the Emergency Nursing forum for more replies.

[DayDreamin ER CRNP]

You push 'em as quickly as your can.....they ain't getting any deader.

But I'm also wondering why you would give etomidate or sux during a code. In my world a code is epi, bicarb, atropine, more epi.

[AnnieOaklyRN, BSN, RN, EMT-P]

Please clarify what you mean by "code", as someone else said some of those meds would not be given during a cardiac arrest.

Annie

[Lunah, MSN, RN]

Please clarify what you mean by "code", as someone else said some of those meds would not be given during a cardiac arrest.

Annie

Yep. Very little need for RSI drugs like succinylcholine, etomidate, or ketamine in a code because coding patients typically have zero gag and don't need to be paralyzed or sedated prior to intubation. The other "code drugs" (primary epi with a few others thrown in) are typically pushed quickly. Like KeeperMom said, coding patients don't get deader.

[nurse2033, MSN, RN]

What an awesome cocktail!! Don't forget lifesaving tetorifice!!!

[nurseburst, ASN, BSN]

Although I know there is a text book of "push for" but I don't remember them at this time. We don't have emergency drugs on our crash cart at our LTC facility.

[CCU BSN RN]

I'm going to assume the background here is that you work on a floor that is not an ICU, and are a relatively newer nurse, and maybe have taken ACLS but don't have people coding on you weekly or anything. I would guess that you basically want to know what other meds might need to be made available so you can help procure them, or so that you can give meds in a code under someone's direction. That's fine. Here goes.

Also, we'll clarify code blue. In most hospitals, a code blue is classified as a cardiopulmonary arrest. If someone is breathing agonally on the floor and needs to be intubated, they have to call a code to get the appropriate resources assembled in one place to intubate their patient, otherwise their patient would be dead before someone competent showed up. So the OP has probably seen rapid sequence intubations for respiratory distress or agonal, etc. that have been classified as codes.

Respiratory arrest:

Intubation meds. In the drawer on the code cart for us, but check with your institution. Basically a sedative of some kind (Etomidate, propofol, versed) and a neuromuscular blocking agent of some kind (Rocuronium, Vercuronium, Succ). Typically Versed is out on the floors because controlled substance, more difficult to get. You should not be pushing these drugs unless you are trained in moderate sedation and do it on your floor. an ICU nurse should respond to codes, either she or anesthesia should typically push these, but again, we're kind of on the clock here, so you're basically allowed to push everything pretty quickly. Very important to have IV access. While someone starts compressions, flush their IVs, by the time the code team arrives you'll at least know what's functional and if you need new lines.

In the case of a cardiac arrest

Amiodarone 150/300mg IVP, Epinephrine- slam, Magnesium Sulfate- you can push in Torsades but that's possibly the med I'd be least likely to slam of all my code options, Bicarb, as fast as your little fingers can push it out of the bristajet, D50 occasionally, calcium acetate, atropine, lidocaine bolus, I think vasopressin is going out of style with ACLS so expect it less during an actual code blue. We give a lot of NEO either immediately post RSI for the resultant hypotension or the hypotension when/if we get ROSC

[Lunah, MSN, RN]

I'm going to assume the background here is that you work on a floor that is not an ICU, and are a relatively newer nurse, and maybe have taken ACLS but don't have people coding on you weekly or anything.

We're in the ER forum, so ... probably ER. But newer, if I had to guess. ER is typically fertile ground for codes!

[Nalon1 RN/EMT-P, BSN, RN]

We're in the ER forum, so ... probably ER. But newer, if I had to guess. ER is typically fertile ground for codes!

Was moved to the ER forum from somewhere else ---

Moved to the Emergency Nursing forum for more replies.

Not sure if the OP is asking how fast to give the meds or how long do we keep given them?

Both have been answered already though.