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Pulse Checks and Epi

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brookalyn is a BSN, RN and specializes in MICU/SICU.

596 Profile Views; 54 Posts

Hello! Sorry this may be lengthy, trying to give context. I'm looking to learn or further my understanding of how other people manage pulse checks and epinephrine. My main question is, what do you prioritize in cardiac arrest, the timing of epinephrine administration or the pulse checks? 

I've always thought ACLS 2 minute pulse checks were a hard and fast rule, unless a physician is present and says otherwise. I've been told recently by experienced RNs on my new unit that it is not, and that concept is new for me. They have said that they believe it is more important to circulate the epinephrine for a couple minutes than to do the 2 minute pulse checks. Please help me understand where we as nurses can be flexible with these concepts without practicing outside of our scope?


Example at my place of work: If compressions start at 0900, epi given at 0901, a pulse check will not occur until 0903 to allow for the circulation of the epi. They essentially time their pulse checks for 2 minutes after the epi administration.

To me, this will draw out compression time and may miss opportunity for shockable rhythms? What are your thoughts? How do your peers or doctors execute ACLS concerning epi timing and pulse checks? I'm willing to learn and go outside of my box of "this is how I've always done it" or get clarification. Thanks in advance!

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MountaineerFan57 is a BSN and specializes in Critical Care/CVICU.

31 Posts; 814 Profile Views

We follow protocol at my facility; pulse checks every 2 minutes, epi every 3. (ACLS says 3-5 min). 

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nuttynurse2b is a ADN and specializes in ER, ICU, MS, SNF, OTC.

20 Posts; 658 Profile Views

9 hours ago, MountaineerFan57 said:

We follow protocol at my facility; pulse checks every 2 minutes, epi every 3. (ACLS says 3-5 min). 

Same here

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839 Posts; 14,193 Profile Views

On 12/16/2019 at 9:56 PM, MountaineerFan57 said:

We follow protocol at my facility; pulse checks every 2 minutes, epi every 3. (ACLS says 3-5 min). 

Same here. 

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419 Posts; 5,353 Profile Views

Mostly we follow protocol. 

 

I have on occasion seen the code team hold off on a pulse check for an additional 30 seconds or so if the epi was just administered and the compressor is not looking fatigued in the least (big, strong, fit compressor, small frail patient, etc). I don't believe there is any evidence to back this practice, but I've seen it done and it makes a kind of sense.

Also seen early pulse checks performed mainly for the few seconds it takes to swap a compressor who is obviously worn out before pulse checks are due. This is more clearly backed - anyone giving poor quality compressions should swap out immediately. 

Epi timing is never intentionally varied, really. 

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brookalyn is a BSN, RN and specializes in MICU/SICU.

54 Posts; 596 Profile Views

Thank you all kindly for your replies!! Definitely helps me get a better sense of what is normal. 

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CCU BSN RN has 7 years experience and specializes in CICU, Telemetry.

258 Posts; 4,416 Profile Views

If you have enough people (and ive never been to a code that didnt have at least 10 unnecessary staff) there's no reason not to follow the algorithm. If you had to stop doing compressions to give Epi that would be one thing. That's why you give multiple rounds of epi in the algorithm. To allow enough to circulate.

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