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Emergency & Rapid Response Team Tools
What is my role on the Rapid Response Team (RRT)?
Whether in a small rural clinic or at a large county hospital, your expertise as a
pharmacist is invaluable during a code. Your contribution can be a crucial part of saving
an individual's life and you will be depended on (by the rest of the team) in the following
ways:
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To identify appropriate drug therapies and make recommendations
To provide correct medication dosages and limits
To prepare the necessary medications/solutions
Attending a Code
1.
2.
3.
4.
Identify yourself and offer to handle medications
Remove the medication tray from the crash cart
Prepare all medications/solutions for the appropriate route of administration
Provide drug information and recommendations as needed– Check patient’s
allergies, age, height,
5. Ensure that the correct medication is being dispensed
6. Help code recorder keep track of medications used
Click ➲ to open the original resource and explore more.
ACLS Basics ➲
Normal Sinus Rhythm
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Heart rate: 60-100 beats per minute
ECG Waves: P wave preceding QRS triplet. QRS narrow with positive P wave.
Systole blood pressure: 90-120
Diastole blood pressure: 60-80
Respiratory rate: 12-18 breaths/min
Normal O2 saturation: 90% or more
Bradycardia
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Symptoms: heart rate less than 50 beats/min, chest discomfort/pain, SOB,
decreased consciousness, weakness, light-headedness, presyncope or syncope
Treatment: Atropine. 0.5 mg rapid IV bolus every 3 to 5 minutes. Max dose of 3
mg.
Tachycardia
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Symptoms: heart rate greater than 100 beats/min, pain, decreased
parasympathetic activity, sympathetic activation, hypotention, fever, hypoxia.
Treatment: Correct underlying causes. If stable and no correctable cause,
use vagal maneuvers and consider adenosine. (Initial dose = 6 mg rapid IV bolus
+ 20 mL normal saline flush. Try adenosine 12 mg twice if no improvement, with
saline after each dose as described.)
Cardiac Arrest: Ventricular Fibrillation (VF) OR Pulseless Ventricular Tachycardia
(VTach)
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5.
6.
Management
High Energy Shock
CPR
High Energy Shock (if indicated)
CPR + Epinephrine (1 mg IV every 3 to 5 mins)
High Energy Shock (in indicated)
CPR + Amiodarone (Initial dose = 300 mg IV bolus; Second dose = 150 mg IV)
Cardiac Arrest: Asystole OR Pulseless Electrical Activity (PEA)
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Management
1. CPR
2. Epinephrine* (1 mg IV every 3 to 5 minutes)
3. Rhythm check (if not shockable rhythm then continue CPR)
4. CPR
5. Epinephrine*
6. Rhythm check
*Vasopressin may replace the first or second Epinephrine dose. Use 40 unites IV.
Other Code Actions ➲
Compromised Airway
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All sizes of airways (may need in case of seizure)
McGill forceps large and small to retrieve foreign object obstructing airway
Respiratory Distress
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Nasal Canula for Infant, Pedi, Adult
100% non-rebreather masks for Infant, Pedi, Adult
O2 ‘E’ cylinder with key, flow adapter, and Christmas tree (to connect to tubing)
Respiratory Arrest
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Pocket Mask
Ambu Bag for Infant, Pedi, Adult
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O2 ‘E’ cylinder with key, flow adapter, and Christmas tree (to connect to tubing)
(Consider: Laryngoscope handles and blades, all sizes of ET tubes)
“ACS” Acute Cardiac Syndrome
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Aspirin: chew one 325mg tab
Nitroglycerin tab (gr. 0.4) sublingual every 5 minutes till relief achieved (max
3 tabs)
100% non-rebreather face mask at minimum 10-15 liters/min
Establish IV access (Normal Saline at kvo rate)
Cardiac Arrest
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A – B – Cs
AED application (Turn on unit – Place pads – Allow to analyze – If
advised, deliver shock)
CPR
Establish IV access (Normal Saline at kvo rate)
Epinephrine 1 mg IVPush (1:10,000 conc)
Continue with ACLS protocols to extent possible until EMS arrives
Drug Overdose or Unresponsive Patient (becomes unresponsive for unknown
reason)
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A – B – Cs
Establish IV access (Normal Saline at kvo rate)
Administer Narcan 1 mg IVP (max: 2 mg)
Hypoglycemia
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Establish IV access (Normal Saline at kvo rate)
Administer 25 mls D50, may repeat another 25 mls
Anaphylactic Reaction (acute allergic response)
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Establish IV access (Normal Saline at kvo rate)
EpiPen or EpiPen Jr. for children less than 30 kilograms
Benadryl 50 mg IVPush for adult
Pepcid 20 mg IV piggyback (mixed in 50 ml normal saline, D5WOLR)
SoluMedrol 125 mg IVPush for adult
A – B – Cs
Standard Crash Cart Medications
1. Aspirin 325 mg tabs
2. Nitroglycerin 0.4 mg sublingual tabs
3. Dextrose 50% 50 ml.
4. Narcan 1 mg Amp
5. Epinephrine 1 mg, (1:10:000 conc)
6. Atropine Sulfate 0.1 mg/ml
7. Lidocaine 100mg
8. EpiPen
9. EpiPen Jr. (for child less that 30 kilograms)
10. SoluMedrol 125 mg Vial
11. Benadryl 50 mg Vial
12. Pepcid 20 mg Vial
(per 2010 ACLS guidelines)
Need extra practice?
Take practice quizes to test your knowledge of ACLS
 https://www.acls.net/quiz.htm
Watch ACLS review and tutorial videos

http://acls-algorithms.com/acls-video-review
Resources/Credit
1. http://www.ucdmc.ucdavis.edu/cppn/resources/clinical_skills_refresher/crash_car
t/top_drawer.html
2. http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=7&ved=0CD
YQFjAG&url=http%3A%2F%2Fwww.ttuhsc.edu%2Fprovost%2Fclinic%2Fforms
%2FACForm2.03.A.pdf&ei=lPMXU_DRJYisyAHInYDgAQ&usg=AFQjCNG1nEv8
kxpAJAzxU6ERHrLZmqaucA&sig2=Z3LSiqpExa3Lj_RJzebvA&bvm=bv.62577051,d.aWc