Code Question?!?!

[jk2185, BSN, RN]

I feel pretty dumb asking this, but here goes....in a code situation do you always push the entire vial of Epi?? I'm always on the chest...every single time, which I like, but I've never pushed drugs. I know this theoretically and I've seen it done. Guess I just need to here it from a bunch of you. I've seen some instances where just a bump was given to boost the BP, but I just want to make sure for those pulseless and fib'n rhythms, you do give the whole thing?!?! Right??? I've got some weird thing about giving a large-ish amount of any med. Thanks!

[irishicugal]

You can't get any deader than dead... Push it all in, stat!!

[Wile E Coyote, ASN, RN]

99% of the time, I push the standard 1mg adult dose. In working with CV anesthesia providers/intensivists who are particularly comfortable with choreographing the dance of a not-quite-dead but crazy-sick pt...yes, we've been known to give little squirts of Neo and Epi. We're usually trying to buy time (30 seconds) while a more appropriate drip is getting set up or recovering from an acute event. The orders are coming from these few docs, and in no way should be considered a routine use of the med.

[TiffyRN, BSN, PhD]

If they are adults, the whole thing. Neonates get their doses carefully measured. Not sure on children, I don't do kids, so don't know about them.

My memories of adult codes is being amazed by how many doses of Epi are given. In fact, we upped the number of boxes we stocked in the crash cart due to this (maybe ACLS had changed then? Early 90s). Anyway, give the whole dose, as fast as you like, and get the next box out, cause you are probably giving that one too.

[Corey Narry, MSN, RN, NP]

ACLS have very specific guidelines that call for the whole stick of epinephrine 1 mg every 3-5 minutes in adult cardiac arrest. That's the norm that's followed in majority of codes.

However, as another poster already alluded to, some instances require a different approach (smaller doses of epinephrine) that takes into account risks associated with sudden peaks in BP from giving the whole amp of epinephrine (such as in fresh cardiac surgery patients who have fragile vascular grafts that can rupture in the setting of an elevated BP). Even the chest compression recommendations in some of these cardiac surgery cases can be controversial. There is a growing literature aimed at establishing new set of guidelines for these particular subset of patients though I'm not sure there is an actual consensus.

For your benefit stick to your unit's or institution's protocol and seek guidance from your senior nurses.

Further reading: http://www.aacn.org/wd/Cetests/media/C152.pdf