1ST DECK: 5TH DECK:

1 recorder: INCORPORADO 1 recorder: LAXINA

Compressor 1: GO Compressor 1: YU
Compressor 2: BONTIGAO Compressor 2: CULANAG
Compressor 3: FLOR Compressor 3: LAO
1 code leader: LAXINA 1 code leader: INCORPORADO
1 airway management: YU 1 airway management: GO
1 medicating nurse: CULANAG 1 medicating nurse: BONTIGAO
1 defibrillator: LAO 1 defibrillator: FLOR

2ND DECK: 6TH DECK:

1 recorder: GO 1 recorder: YU
Compressor 1: BONTIGAO Compressor 1: CULANAG
Compressor 2: FLOR Compressor 2: LAO
Compressor 3: LAXINA Compressor 3: INCORPORADO
1 code leader: YU 1 code leader: GO
1 airway management: CULANAG 1 airway management: BONTIGAO
1 medicating nurse: LAO 1 medicating nurse: FLOR
1 defibrillator: INCORPORADO 1 defibrillator: LAXINA

3RD DECK: 7TH DECK:

1 recorder: BONTIGAO 1 recorder: CULANAG
Compressor 1: FLOR Compressor 1: LAO
Compressor 2: LAXINA Compressor 2: INCORPORADO
Compressor 3: YU Compressor 3: GO
1 code leader: CULANAG 1 code leader: BONTIGAO
1 airway management: LAO 1 airway management: FLOR
1 medicating nurse: INCORPORADO 1 medicating nurse: LAXINA
1 defibrillator: GO 1 defibrillator: YU

4TH DECK: 8TH DECK:

1 recorder: FLOR 1 recorder: LAO
Compressor 1: LAXINA Compressor 1: INCORPORADO
Compressor 2: YU Compressor 2: GO
Compressor 3: CULANAG Compressor 3: BONTIGAO
1 code leader: LAO 1 code leader: FLOR
1 airway management: INCORPORADO 1 airway management: LAXINA
1 medicating nurse: GO 1 medicating nurse: YU
1 defibrillator: BONTIGAO 1 defibrillator: CULANAG
REMINDERS:
● Epinephrine is only given 3-5 minutes. If the patient has non shockable rhythm, give immediately
● Amiodarone is only given after the 3RD SHOCK
○ When giving amiodarone after synchronized cardioversion, number of shock does not matter and only 1
DOSE (150mg) is given
● Lidocaine can be given twice only
● You can’t give 2 meds at a time
● You can ask for BP regardless of rhythm, but only VTACH and SVT have stable and unstable rhythms
● If the px is pulseless, ACTIVATE CODE BLUE IMMEDIATELY and initiate HQCPR

MANAGEMENT

AV BLOCK VFib VTach

1. Atropine IVTT 1mg (3 doses q ● No need to check pulse WITH PULSE

3-5 mins) (always pulseless)
2. Transcutaneous pacing (if pt. ● Defibrillate 200 J STABLE:
is stable - Amiodarone 150 mg slow
3. Dopamine drip IVTT over 10-15 mins
4. Epinephrine drip - O2 Therapy

UNSTABLE:
- Synchronized cardioversion
(120J)

WITHOUT PULSE
- Initiate HQCPR first (5 cycles)
- Defibrillation one shock only
(200J)

SVT ASYSTOLE PEA

STABLE SVT: 1. HQCPR 1. HQCPR

- Adenosine 6mg IV + PNSS 20 2. Epinephrine 1mg IVTT + flush 2. Epinephrine 1,g IVTT q 3-5
ml (1st dose) 10 ml PNSS mins
- Adenosine 12 mg IV + PNSS
20 ml (2nd and 3rd dose)
- Carotid massage
- Blow from syringe until plunger
is pushed

UNSTABLE SVT
- Synchronized cardioversion
(120J); sedate pt.

SINUS BRADY SINUS TACHY A-FIB, A-FLUTTER

● Atropine 1mg IVTT ● Regulate PNSS and Digoxin 0.125mg IVTT

● Transcutaneous pacing (if intubate px now
pt is stable)

PVC
 ACLS: MEGACODE
Before saying this, make sure the rhythm presented to you is pulseless
1. CODE LEADER: active code blue
● “Activating code blue”
● Initiating HQCPR

2. Code blue team arrives

● “We are here to help”

3. CODE LEADER: “prepare to switch compressor in 3: 1, 2, 3”

● This is only said when CL will be switched to the CC 1

CODE LEADER: “prepare ambu bag and start bagging now”

AIRWAY MANAGEMENT: “bagging patient now”

CODE LEADER: “attach cardiac monitor”

DEFIBRILLATOR NURSE: Defibrillator nurse attaching the cardiac monitor (3 electrodes)

● “cardiac monitor attached”
Hi
4. CODE LEADER: establish IV/IO access
5. MEDICATION NURSE: establish IV/IO access
● “Establishing IV access”
● “IV access started”
OR

● CODE LEADER: “are you able to have IV access?”

● MEDICATION NURSE: “i have tried several times but it has failed”
● CODE LEADER: “ok, let’s move on to IO access”
● MEDICATION NURSE: “Establishing IO access”
○ “IO access started”

6. CHEST COMPRESSOR 1: HQCPR for 2 minutes

RECORDER: “2 minutes”

7. CODE LEADER: “stop chest compression, analyzing rhythm and switch compressor” – when this is said,
CCs will immediately switch to the next CC
● CODE LEADER: While analyzing the rhythm “at 0600H patient is in vfib”
● CODE LEADER: “Continue HQCPR, charge defibrillator to 200J”
● DEFIBRILLATOR NURSE: “charging defibrillator to 200J, ready to shock”
● CODE LEADER: “shock patient now”
● DEFIBRILLATOR NURSE: “shocking patient now, shocking on 3; *look to self, look across, look
around* 1, 2, 3 … shock delivered”
● CODE LEADER: resume HQCPR

TIME RHYTHM MGMT

0600H Vfib HQCPR, 200J

RECORDER: “2 minutes”
 8. CODE LEADER: “stop chest compression, analyzing rhythm and switch compressor” – when this is said,
CCs will immediately switch to the next CC

9. CHEST COMPRESSOR 2: HQCPR for 2 minutes

10. CODE LEADER: While analyzing the rhythm “at 0602H patient is in vfib”
● CODE LEADER: “Continue HQCPR, charge defibrillator to 200J”
● DEFIBRILLATOR NURSE: “charging defibrillator to 200J, ready to shock”
● CODE LEADER: “shock patient now”
● DEFIBRILLATOR NURSE: “shocking patient now, shocking on 3; *look to self, look across, look
around* 1, 2, 3 … shock delivered”
● CODE LEADER: resume HQCPR
● CODE LEADER: “Prepare epinephrine 1mg and flush 10ml of PNSS”
● MEDICATION NURSE: “Epinephrine 1mg and flush 10ml of PNSS ready”
● CODE LEADER: “give epinephrine 1mg IVTT now and flush 10ml of PNSS” → (verbalize)
● MEDICATION NURSE: “administering epinephrine 1mg IVTT and flushing 10ml of PNSS”

TIME RHYTHM MGMT

0600H Vfib HQCPR, 200J

0602H vfib HQCPR, 200J, epi 1mg

RECORDER: “2 minutes”

11. CODE LEADER: “stop chest compression, analyzing rhythm and switch compressor” – when this is said,
CCs will immediately switch to the next CC

12. CHEST COMPRESSOR 3: HQCPR for 2 minutes

13. CODE LEADER: While analyzing the rhythm “at 0604H patient is in vfib”
● CODE LEADER: “Continue HQCPR, charge defibrillator to 200J”
● DEFIBRILLATOR NURSE: “charging defibrillator to 200J, ready to shock”
● CODE LEADER: “shock patient now”
● DEFIBRILLATOR NURSE: “shocking patient now, shocking on 3; *look to self, look across, look
around* 1, 2, 3 … shock delivered”
● CODE LEADER: resume HQCPR
● CODE LEADER: “Prepare amiodarone 300mg and flush 10ml of PNSS”
● MEDICATION NURSE: “Amiodarone 300mg and flush 10ml of PNSS ready”
● CODE LEADER: “give amiodarone 300mg IV bolus now and flush 10ml of PNSS” → (verbalize)
● MEDICATION NURSE: “administering amiodarone 300mg IV bolus and flushing 10ml of PNSS”

TIME RHYTHM MGMT

0600H Vfib HQCPR, 200J

0602H vfib HQCPR, 200J, epi 1mg

0604H vfib HQCPR, 200J, amiodarone 300mg

AT 0605H: CODE LEADER: “Prepare epinephrine 1mg and flush 10ml of PNSS”
MEDICATION NURSE: “Epinephrine 1mg and flush 10ml of PNSS ready”
CODE LEADER: “Administer Epinephrine 1mg and flush 10ml of PNSS”
MEDICATION NURSE: “administering Epinephrine 1mg and flush 10ml of PNSS”
 0605H vfib HQCPR, epi 1mg

RECORDER: “2 minutes”

14. CODE LEADER: “stop chest compression, analyzing rhythm and switch compressor” – when this is said,
CCs will immediately switch to the next CC

15. CHEST COMPRESSOR 3: HQCPR for 2 minutes

16. CODE LEADER: While analyzing the rhythm “at 0606H patient is in vfib”
● CODE LEADER: “Continue HQCPR, charge defibrillator to 200J”
● DEFIBRILLATOR NURSE: “charging defibrillator to 200J, ready to shock”
● CODE LEADER: “shock patient now”
● DEFIBRILLATOR NURSE: “shocking patient now, shocking on 3; *look to self, look across, look
around* 1, 2, 3 … shock delivered”
● CODE LEADER: resume HQCPR
● CODE LEADER: “Prepare amiodarone 150mg and flush 10ml of PNSS”
● MEDICATION NURSE: “Amiodarone 150mg ang flush 10ml of PNSS ready”
● CODE LEADER: “administer amiodarone 150mg IVTT now and flush 10ml of PNSS” →
(verbalize)
● MEDICATION NURSE: “administering amiodarone 150mg IV bolus and flushing 10ml of PNSS”

TIME RHYTHM MGMT

0600H Vfib HQCPR, 200J

0602H vfib HQCPR, 200J, epi 1mg

0604H vfib HQCPR, 200J, amiodarone 300mg

0605H vfib HQCPR, epi 1mg

0606H vfib HQCPR, 200J, amiodarone 150mg

AT 0608H: CODE LEADER: “Prepare epinephrine 1mg and flush 10ml of PNSS”
MEDICATION NURSE: “Epinephrine 1mg and flush 10ml of PNSS ready”
CODE LEADER: “Administer Epinephrine 1mg and flush 10ml of PNSS”
MEDICATION NURSE: “administering Epinephrine 1mg and flush 10ml of PNSS”

0608H vfib HQCPR, 200J, epi 1mg

RECORDER: “2 minutes”

17. CODE LEADER: “stop chest compression, analyzing rhythm and switch compressor” – when this is said,
CCs will immediately switch to the next CC

18. CHEST COMPRESSOR 3: HQCPR for 2 minutes

19. CODE LEADER: While analyzing the rhythm “at 0610H patient is in vfib”
● CODE LEADER: “Continue HQCPR, charge defibrillator to 200J”
● DEFIBRILLATOR NURSE: “charging defibrillator to 200J, ready to shock”
● CODE LEADER: “shock patient now”
 ● DEFIBRILLATOR NURSE: “shocking patient now, shocking on 3; *look to self, look across, look
around* 1, 2, 3 … shock delivered”
● CODE LEADER: resume HQCPR
● CODE LEADER: “Prepare amiodarone drip 600mg plus 250ml of D5W”
● MEDICATION NURSE: “Amiodarone drip 600mg plus 250ml of D5W ready”
● CODE LEADER: “start amiodarone drip 600mg in 250ml of D5W to run for 24hrs”
● MEDICATION NURSE: “starting amiodarone drip 600mg in 250ml of D5W”

TIME RHYTHM MGMT

0600H Vfib HQCPR, 200J

0602H vfib HQCPR, 200J, epi 1mg

0604H vfib HQCPR, 200J, amiodarone 300mg

0605H vfib HQCPR, epi 1mg

0606H vfib HQCPR, 200J, amiodarone 150mg

0608H vfib HQCPR, epi 1mg

0610H vfib HQCPR, 200J, amio drip

AT 0611H: CODE LEADER: “Epi 1mg IVTT due now”

MEDICATION NURSE: “administering 1mg epi IVTT now”

0611H vfib HQCPR, epi 1mg

RECORDER: “2 minutes”

20. CODE LEADER: “stop chest compression, analyzing rhythm and switch compressor” – when this is said,
CCs will immediately switch to the next CC

21. CHEST COMPRESSOR 3: HQCPR for 2 minutes

22. CODE LEADER: While analyzing the rhythm “at 0612H patient is in vfib”
● CODE LEADER: “Continue HQCPR, charge defibrillator to 200J”
● DEFIBRILLATOR NURSE: “charging defibrillator to 200J, ready to shock”
● CODE LEADER: “shock patient now”
● DEFIBRILLATOR NURSE: “shocking patient now, shocking on 3; *look to self, look across, look
around* 1, 2, 3 … shock delivered”
● CODE LEADER: resume HQCPR
● CODE LEADER: “administer lidocaine 1mg/kg now”
● MEDICATION NURSE: “administering lidocaine 1mg/kg now”

TIME RHYTHM MGMT

0600H Vfib HQCPR, 200J

0602H vfib HQCPR, 200J, epi 1mg

0604H vfib HQCPR, 200J, amiodarone 300mg

0605H vfib HQCPR, epi 1mg

0606H vfib HQCPR, 200J, amiodarone 150mg

 0608H vfib HQCPR, epi 1mg

0610H vfib HQCPR, 200J, amio drip

0611H vfib HQCPR, epi 1mg

0612H vfib HQCPR, 200J, lidocaine 1mg

AT 0614H: CODE LEADER: “Epi 1mg IVTT due now”

MEDICATION NURSE: “administering 1mg epi IVTT now”

0614H vfib HQCPR, epi 1mg

RECORDER: “2 minutes”

23. CODE LEADER: “stop chest compression, analyzing rhythm and switch compressor” – when this is said,
CCs will immediately switch to the next CC

24. CHEST COMPRESSOR 3: HQCPR for 2 minutes

25. CODE LEADER: While analyzing the rhythm “at 0616H patient is in vfib”
● CODE LEADER: “Continue HQCPR, charge defibrillator to 200J”
● DEFIBRILLATOR NURSE: “charging defibrillator to 200J, ready to shock”
● CODE LEADER: “shock patient now”
● DEFIBRILLATOR NURSE: “shocking patient now, shocking on 3; *look to self, look across, look
around* 1, 2, 3 … shock delivered”
● CODE LEADER: resume HQCPR
● CODE LEADER: “administer lidocaine 0.5mg/kg now”
● MEDICATION NURSE: “administering lidocaine 0.5mg/kg now”

TIME RHYTHM MGMT

0600H Vfib HQCPR, 200J

0602H vfib HQCPR, 200J, epi 1mg

0604H vfib HQCPR, 200J, amiodarone 300mg

0605H vfib HQCPR, epi 1mg

0606H vfib HQCPR, 200J, amiodarone 150mg

0608H vfib HQCPR, epi 1mg

0610H vfib HQCPR, 200J, amio drip

0611H vfib HQCPR, epi 1mg

0612H vfib HQCPR, 200J, lidocaine 1mg/kg

0614H vfib HQCPR, epi 1mg

0616H vfib HQCPR, 200J, lidocaine 0.5mg/kg

RECORDER: “2 minutes”
26. CODE LEADER: “stop chest compression, analyzing rhythm and switch compressor” – when this is said,
CCs will immediately switch to the next CC

27. CHEST COMPRESSOR 3: HQCPR for 2 minutes

28. CODE LEADER: While analyzing the rhythm “at 0618H, the patient is in sinus bradycardia”
● CODE LEADER: “is there a pulse?”
● SIR: “yes, we have pulse”
● CODE LEADER: “patient revived with return of spontaneous circulation, begin post cardiac arrest
care”
● CODE LEADER: “give atropine 1mg IVTT now and flush 10ml of PNSS”
● MEDICATION NURSE: “administering atropine 1mg IVTT now and flushing 10ml of PNSS”
● CODE LEADER:
○ “Check vital signs, check bp”
○ “Maintain O2 sat > or equal to 95%”. Intubate if low O2
○ “regulate PNSS, call labs- CBC, ABG, crea, Na, K, SGPT, CBG”

TIME RHYTHM MGMT

0600H Vfib HQCPR, 200J

0602H vfib HQCPR, 200J, epi 1mg

0604H vfib HQCPR, 200J, amiodarone 300mg

0605H vfib HQCPR, epi 1mg

0606H vfib HQCPR, 200J, amiodarone 150mg

0608H vfib HQCPR, epi 1mg

0610H vfib HQCPR, 200J, amio drip

0611H vfib HQCPR, epi 1mg

0612H vfib HQCPR, 200J, lidocaine 1mg/kg

0614H vfib HQCPR, epi 1mg

0616H vfib HQCPR, 200J, lidocaine 0.5mg/kg

0618H Sinus bradycardia Atropine 1mg, check vs, bp,

regulate PNSS, call labs- CBC,
ABG, crea, Na, K, SGPT, CBG
 ANOTHER SCENARIO

1. CODE LEADER: active code blue

● “Activating code blue”
● Continue HQCPR

2. Code blue team arrives

● “We are here to help”

3. CODE LEADER: “prepare to switch compressor in 1, 2, 3”

● This is only said when CL will be switched to the CC 1

CODE LEADER: “prepare ambu bag and start bagging now”

AIRWAY MANAGEMENT: “bagging patient now”

CODE LEADER: “attach cardiac monitor”

DEFIBRILLATOR NURSE: Defibrillator nurse attaching the cardiac monitor (3 electrodes)

● “cardiac monitor attached”

4. CODE LEADER: establish IV/IO access

5. MEDICATION NURSE: establish IV/IO access
● “Establishing IV access”
● “IV access started”
OR

● CODE LEADER: “are you able to have IV access?”

● MEDICATION NURSE: “i have tried several times but it has failed”
● CODE LEADER: “ok, let’s move on to IO access”
● MEDICATION NURSE: “Establishing IO access”
○ “IO access started”

6. CHEST COMPRESSOR 1: HQCPR for 2 minutes

RECORDER: “2 minutes”

7. CODE LEADER: “stop chest compression, analyzing rhythm and switch compressor” – when this is said,
CCs will immediately switch to the next CC
● CODE LEADER: While analyzing the rhythm “at 0608H patient is in ventricular tachycardia”
● CODE LEADER: “is there a pulse?”
● SIR: “no pulse”
● CODE LEADER: “Continue HQCPR, charge defibrillator to 200J”
● DEFIBRILLATOR NURSE: “charging defibrillator to 200J, ready to shock”
● CODE LEADER: “shock patient now”
● DEFIBRILLATOR NURSE: “shocking patient now, shocking on 3; *look to self, look across, look
around* 1, 2, 3 … shock delivered”

TIME RHYTHM MGMT

0608H Vtach HQCPR, 200J

RECORDER: “2 minutes”
 8. CODE LEADER: “stop chest compression, analyzing rhythm and switch compressor” – when this is said,
CCs will immediately switch to the next CC
● CODE LEADER: While analyzing the rhythm “at 0610H patient is in ventricular tachycardia”
● CODE LEADER: “is there a pulse?”
● SIR: “yes, we have a pulse”
● CODE LEADER: “What's the BP sir?”
● SIR: “<90”
● CODE LEADER: “prepare synchronized cardioversion to 120J”
● DEFIBRILLATOR NURSE: “charging defibrillator to 120J, ready to shock”
● CODE LEADER: “shock patient now”
● DEFIBRILLATOR NURSE: “shocking patient now, shocking on 3; *look to self, look across, look
around* 1, 2, 3 …. 1, 1002, 1003, 1004, 1005, 1006 then remove; shock delivered”
● CODE LEADER: resume HQCPR

TIME RHYTHM MGMT

0608H Vtach HQCPR, 200J

0610H Unstable vtach 120J

RECORDER: “2 minutes”

9. CODE LEADER: “stop chest compression, analyzing rhythm and switch compressor” – when this is said,
CCs will immediately switch to the next CC
● CODE LEADER: While analyzing the rhythm “at 0612H patient is in supraventricular
tachycardia”
● CODE LEADER: “is there a pulse?”
● SIR: “yes, we have a pulse”
● CODE LEADER: “What's the BP sir?”
● SIR: “>90”
● CODE LEADER: “administer adenosine 6mg, rapid IV bolus flushed with 20ml PNSS”
● MEDICATION NURSE: “administering adenosine 6mg, rapid IV bolus and flushing with 20ml
of PNSS”
● CODE LEADER: resume HQCPR

TIME RHYTHM MGMT

0608H Vtach HQCPR, 200J

0610H Unstable vtach 120J

0612H Stable SVT Adenosine 6mg

RECORDER: “2 minutes”

10. CODE LEADER: “stop chest compression, analyzing rhythm and switch compressor” – when this is said,
CCs will immediately switch to the next CC
● CODE LEADER: While analyzing the rhythm “at 0614H patient is still in supraventricular
tachycardia”
● CODE LEADER: “is there a pulse?”
● SIR: “no pulse”
● CODE LEADER: “Continue HQCPR and administer 1mg of epinephrine IVTT and flush with
10ml of PNSS”
● MEDICATION NURSE: “administering epinephrine 1mg IVTT and flushing 10ml of PNSS”
● CODE LEADER: resume HQCPR

TIME RHYTHM MGMT

0608H Vtach HQCPR, 200J

0610H Unstable vtach 120J

0612H Stable SVT Adenosine 6mg

0614H Pulseless SVT HQCPR, 1mg of epi