RLE – ADVANCE CARDIAC LIFE SUPPORT (ACLS)

WHAT IS ACLS PROCEDU RE?  The choice depends on the patient’s condition (e.g.,
 Also known as: MEGACODE hypotension, dehydration).
 Basic life support skills, including effective chest compressions, 2. What cannula would you use for a geriatric, pediatric, or
use of a bag-mask device, and use of an Automated External general client?
Defibrillator (AED)  Geriatric: Smaller gauge, like 22-24 gauge, to avoid vein
 Recognition & early management of respiratory & cardiac damage.
arrest.  Pediatric: 22–24-gauge catheter, depending on the size of
 Recognition and early management of peri-arrest conditions the vein.
such as symptomatic bradycardia (slow) – HOSPITAL SETTING  General: Typically, 18-20 gauge for quick fluid
 Airway management administration.
Can be: 3. What infusion set do you use in cases with particular conditions?
o Nasal cannula  Use a standard IV infusion set for general conditions.
o Face mask  For blood products, use a blood administration set.
o Bag-mask device – 2 rescue breaths  For rapid fluid administration, use a set with a larger bore.
o Intubation (considered as advanced airway, negative 4. During the implementation of oxygen therapy, what are your
breath sounds) responsibilities as a nurse for a face mask and nasal cannula?
 Related pharmacology  Face Mask: Ensure a proper fit, monitor oxygen flow rate
 Advanced Cardiac Life Support (ACLS) is primarily required for and assess the patient for signs of respiratory distress.
RNs who work in a hospital setting and care for critically ill adults.  Nasal Cannula: Ensure correct placement in nostrils, check
 ACLS care includes CPR, but also "higher level" interventions, for skin breakdown, and monitor oxygen flow
such as intubation, medications, and IVs. 5. How do you properly apply a face mask or nasal cannula to a
 The goal of Advanced Cardiovascular Life Support (ACLS) is to patient?
achieve the best possible outcome for individuals who are  Face Mask: Place the mask over the nose and mouth,
experiencing a life-threatening event. securing it behind the ears or head, ensuring it’s snug but
 Basic Life Support (BLS) = anyone can do it not tight to avoid discomfort.
 Advanced Cardiovascular Life Support (ACLS) = only medical  Nasal Cannula: Place the prongs in the nostrils, adjust the
team/ medical health worker tubing over the ears, and secure it comfortably under the
chin.
Restriction: 6. What considerations are there when implementing intubation?
 DNR (Do-Not-Resuscitate Order)  Ensure patient is unconscious (via sedation),
 DNI (Do-Not-Intubate Order)  Have necessary equipment ready (laryngoscope, ET tube,
suction),
 Confirm the patient’s airway is clear, and
 Check for contraindications (e.g., facial trauma, airway
obstruction).
7. How do you perform intubation?
 Pre-oxygenate the patient.
 Position the head to align the airway (sniffing position).
 Insert the laryngoscope to visualize the vocal cords, then
gently insert the endotracheal tube (ETT) between the
cords.
 Inflate the cuff and confirm placement via auscultation and
capnography.

TREAM POSITIONING, R OLES & RESPONSIBILITY

CONTINUOUS WAVEFORM CAPNOGRAPHY

 Capnography is an effective method to diagnose early
respiratory depression and airway disorders, especially during
sedation, leading to a reduction in serious complications
 The primary goal is to prevent hypoxia (decrease level of
oxygen in the tissue/blood) and capnography helps to identify
situations that can lead to hypoxia if uncorrected.
 PETCO2 which stands for Patient End-Tidal Carbon Dioxide.
 Normal PETCO2 Values: 35-40 mm Hg
 PETCO2 less than 10 = ineffective chest compressions
o Qualitative - Yellow
o Quantitative - 35 to 40 mmHg

RETURN DEMONSTRATION
Materials:

Roles will be random depends on the ID that you will picked.

Possible Questions:
1. What kind of IV fluid do you use?
 Typically, isotonic fluids like Normal Saline or Lactated
Ringers are used during ACLS to restore fluid volume and
maintain blood pressure.

GRACE 1
 RLE – ADVANCE CARDIAC LIFE SUPPORT (ACLS)
Verbalize (Subjective of patient)
 Ask the patient what they feel.
 TEAM LEADER: “Good day __, I am nurse ___, may I ask how are
you today? Can you rate your pain level from 1 to 10? Can you
describe the location and kind of pain you are experiencing? Is
it stabbing or cutting? or does it feel like burning or aching? How
often do you feel pain? Is it short or long in duration? How do
you relieve your pain? Does it radiate to any other part of your
body?”

Vital Signs:
 The CI will be the one who will state what the Vital signs of the
patient are. The TEAM LEADER should observe what the
abnormal Vital signs of the patient is and what should be the
management.
Example (related on the case)
CI: “For your vital signs, the BP is 100/70. Temperature of 36.8.
oxygen saturation of 92%. RR of 28”
OBSERVANT/RECORDER should list the initial Vital Signs stated by
the CI even if he/she is not yet on the scene.
O – Oxygen Therapy
TEAM LEADER will be the first one to start the VOMIT column. Team TEAM LEADER: “Since the oxygen saturation of the patient is below
Leader will be the one who will order everything while his team 95%, I am going to begin oxygen therapy via:”
member will be the one who will do the order. Any questions
regarding VOMIT will only be answered by the Team Leader.

FIRST COLUMN
 Pre-arrest ACLS Survey (VOMIT) for the TEAM LEADER only but
everyone in the group should still listen especially the
OBSERVANT/RECORDER, he/she should write everything
important about the patient.
 The CI will give a scenario. Nasal Cannula: Face Mask: Non rebreather mask
Example: 2-4 liters per minute 6-10 liters per minute 11-15 liters per minute
"Everyone, this is a case of a 65-year-old white client presenting (Independent Nursing)
with severe chest pain and difficulty breathing. The patient has
been admitted to ____ with a preliminary diagnosis of
__________. Now, the SCENARIO BEGINS”
 When the CI said SCENARIO BEGINS, that’s the cue that the
TEAM LEADER should start.

PRE-ARREST/ACLS SURVE Y
(VOMIT )
V – Visualize, Verbalize, Vital Signs
Visualize(Objective of Nurse)
 Team Leader should visualize what he/she see in the patient
based on the scenario given by the CI.
 “The patient is diaphoretic.”
 “The patient appears pale.”
 “The patient is having difficulty breathing.”
 “The patient shows signs of cyanosis.”  How do you properly apply a face mask or nasal cannula to a
 “The patient is agitated and appears anxious.” patient?
 Signs & Symptoms:  Face Mask: Place the mask over the nose and mouth,
 Diaphoresis: The patient appears excessively sweaty securing it behind the ears or head, ensuring it’s snug but
 Pallor: The patient looks pale. not tight to avoid discomfort.
 Dyspnea: The patient is visibly struggling to breathe.  Nasal Cannula: Place the prongs in the nostrils, adjust the
 Cyanosis: The patient exhibits bluish discoloration of the skin, tubing over the ears, and secure it comfortably under the
indicating insufficient oxygen in the blood. chin.
 Agonal Breathing: The patient is gasping for air, often seen  During the implementation of oxygen therapy, what are your
in severe cases. responsibilities as a nurse for a face mask and nasal cannula?
 Agitation: The patient appears fearful or anxious. /  Face Mask: Ensure a proper fit, monitor oxygen flow rate
Restlessness and assess the patient for signs of respiratory distress.
 Cold, Clammy Skin: The patient’s skin feels wet and cold,  Nasal Cannula: Ensure correct placement in nostrils, check
often a sign of severe stress or shock. for skin breakdown, and monitor oxygen flow
 Facial Grimace: The patient shows facial expressions  Precautionary Measure When Providing Oxygen Therapy:
indicating pain.  Verify flow rate
 Tachypnea: Increased respiratory rate (>20 breaths per  Ensure safe placement of the oxygen equipment
minute).  Make sure the room is well ventilated
 Use of Accessory Muscles: Visible effort in breathing,  Note: humidifier w/ DISTILLED WATER – prevent dryness and
including neck or shoulder muscles. irritation of the respiratory tract
 Lethargy or unresponsiveness: The patient appears  Goals of O2 Therapy
extremely tired, weak, and less responsive than usual.  Reverses hypoxemia
 Altered Mental State: Confusion or disorientation  Decreases the work of the respiratory system
 Unequal Chest Expansion: May indicate pneumothorax or  Decreases the heart’s work in pumping blood
respiratory distress.  Hazards of O2 Therapy
 TEAM LEADER: (Upon Visualizing the patient, the team leader  Oxygen toxicity
should say what he/she saw in the patient)  Vision difficulties in newborns (premature)
"The patient has cool, clammy skin, likely due to stress or  Hypoventilation (oxygen-induced)
discomfort. Additionally, the patient is exhibiting agonal  Atelectasis
breathing and cyanosis, which indicate severe oxygen  Safety Precautions
deprivation and respiratory distress." OR "The patient is  Place “No Smoking: Oxygen in Use” sign.
diaphoretic, pale, and struggling to breathe, with cyanosis  Avoid use of oils, greases, alcohol and acetone near the
indicating poor oxygenation. They appear agitated and client.
anxious, likely due to pain or distress."  Avoid materials that generate static electricity.
 Make sure that the electric devices are in good working
condition.

GRACE 2
 RLE – ADVANCE CARDIAC LIFE SUPPORT (ACLS)
M – MONITORING  0.9% NS, 5% dextrose in water D5W, D5 ¼ NS, Lactated
TEAM LEADER: “I will now put the pads on the chest to monitor Ringer’s Solution
cardiac rhythm and heart rate. I will put the White pads on the right
then smoke (black pads) over fire (red pads). Then I will hook it on TYPES OF IV CANNULA:
cables and monitor”  G14-19 – for rapid fluid administration (blood products or
anesthetics)
 G20-21 – Used for fat infusions, typically for patients needing
nutritional support.
 G22-24 – Common for standard IV fluids and clear liquid
medications (used in most adult patients).
 G24-25 – Very small veins (like in infants) or delicate veins need
these smaller cannulas.

After putting the pads on the patient, the CI will turn on the Cardiac
Monitor and ask about the rhythm.

TYPES OF INFUSION SETS:

 MACRO DRIP INFUSION SET
 Drops per mL: 15-20 drops.
 Purpose: For faster delivery of larger volumes of fluids.
 Use: Common in adult patients or for rapid hydration, blood
Sinus Bradycardia transfusions, or fluid resuscitation.
 MICRODRIP INFUSION SET
 Drops per mL: 60 drops.
 Purpose: For slow and precise infusion of smaller volumes.
 Use: Ideal for children, infants, or critical patients requiring
careful fluid control, like medications or nutritional infusions.
 SOLUSET
 Purpose: Used for slow and accurate fluid or medication
Ventricular Aystole (No Rhyhtm) administration.
 Use: Typically used for pediatric patients or neonates
needing small, controlled volumes of fluids or medications.
 BT SET (BLOOD TRANSFUSION SET)
 Purpose: Designed for administering blood products to a
patient.
 Key Features: Includes a filter to remove clots, a flow
regulator, and longer tubing for easy blood transfusion.
Ventricular Fibrillation  Use: Specifically used when a patient needs a blood
transfusion or blood products for surgery, trauma, or
anemia.
INTRAOSSEOUS
(If IV is ineffective)
 Direct to the bone
 It’s for short-term use only, less than 24 hrs.
 Can pass first through peripheral circulation
Ventricular Tachycardia  After insertion, always check the site for swelling and needle
displacement
 IO medications are followed with a flush of 5 to 10 mL of normal
saline.

Sites for IO:

 Proximal Tibia
 Humeral Head
 Medial Malleolus
Supraventricular Tachycardia  Sternum

I – Establishing INTRAVENOUS/INTRAOSSEOUS
 INTRAVENOUS – on the vein (Cubital Vein)
 INTRAOSSEOUS – on the bone
Use INTRAOSSEOUS after 3 failed attempts of INTRAVENOUS.

TEAM LEADER: “I will establish IV for three times. If failed, I will proceed T - TREATMENT
to IO (Intraosseous)”  Treatment will depend on what is flashed on the cardiac
INTRAVENOUS monitor (Slow/Fast Cardiac Rate).
Intravenous Fluid: SLOW RHYTHM:
 Atropine - 1mg every 3-5min Sinus Bradycardia
 Dopamine - 1mg TEAM LEADER: “For the Sinus Bradycardia, I will treat the patient by
 Epinephrine - 2-10 mcg every 3-5mins using A.T.D.E.”

TYPES OF SOLUTIONS
 Hypotonic - Water moves into cells, making them swell; used to
rehydrate cells when they're dehydrated.
 0.45% SALINE (1/2 NS)
 Hypertonic - Water moves out of cells, making them shrink; used
to reduce swelling or provide extra nutrients.  A: Atropine Sulfate (Anticholinergic Parasymphatolytic)
 D5LR, D5 ½ NS, D5 NSS, D10W  0.5 mg IV every 5 minutes
 Isotonic - No movement of water; keeps the body's fluid levels  Max dose of 3 mg
balanced, like normal saline.

GRACE 3
 RLE – ADVANCE CARDIAC LIFE SUPPORT (ACLS)
 T: Transcutaneous Pacing delivers small electrical current to SECOND COLUMN
temporarily restore the electrical activity of the heart
ARREST: BLS SURVEY
 Electrical stimulus  Depolarization  Cardiac contraction
TEAM LEADER: “Hey! Hey! Hey! Are You Okay? Hey Hey Hey Are You
 D: Dopamine Infusion (1 mg max) Alpha-adrenergic agonist |
Okay? No Response! Activate Code Blue. I Will Now Check The
Sympathomimetic
Carotid Pulse And Breathing 1001, 1002, 1003, 1004, 1005, 1006 No
 Renal Perfussion (2 mcg/kg/min) – can lead to renal
Pulse, No Breathing. Start High Quality CPR” (30:2 HQCPR – hard, fast,
vasodilation and increased renal blood flow.
complete chest recoil, no less than 10s interruption, avoid excessive
 Cardiac Contractility (5 mcg/kg/min) - can increase heart
ventilation) GIVE 2 RESCUE BREATHS USING BAG-MASK (USE E-C
rate, contractility and cardiac output.
TECHNIQUE)
 Vasopressor (10 mcg/kg/min) – causes vasoconstriction
that increases blood pressure.
CI: “Team Arrives”
 E: Epinephrine Infusion (2-10mcg/min) titrate to patient
response. Mixed in 1 liter of isotonic solution (1 ampule: 1L)
 Alpha/Beta-adrenergic agonist
 Sympathomimetic
 Cardiac Stimulant
 Vasopressor
FAST RHYTHM:
Supraventricular tachycardia & Ventricular Tachycardia
Supraventricular Tachycardia (Narrow Complex Tachycardia)

TEAM LEADER: “The patient is manifesting a fast heart rate, with a

The team should immediately go to their designated places.
heart rate of ___. The rhythm in the cardiac monitor is Narrow
Complex Tachycardia which is Supraventricular Tachycardia. Let’s
TEAM LEADER: Good day ma’am, now I will introduce my team
also check the BP of the patient, which is _____ and it is stable and so
members and their specific roles.
we can manage the patient using Physiologic & Pharmacologic.”
 My name is __, and I am the team leader of this group and my
role is to lead my team members.
Physiologic:
 For the role of airway, we have Ms. __,
 Vagal maneuver – Massage the carotid pulse of the patient for
 For the compressor, we have Ms. __,
10 seconds or ask the client to cough (to check gag reflex)
 For monitor/ defibrillation, we have Ms. ___,
Pharmacologic:
 For IV/ IO, we have Ms. __,
 Adenosine – 1st dose (6 mg) rapid IV push followed by PNSS
 Lastly for the Observer/ recorder, we have Ms. ___,
flush; 2nd dose (12 mg) if 1st dose is ineffective. Antiarrhythmic
drug that can restore normal heart rhythm by slowing down
If PETCO (patient end-tidal carbon dioxide) is more than 10 mmHg, it
electrical conduction.
is shockable Ventricular Fibrillation/pulseless VTACH. PETCO (35-45
mmHg) but the normal is 35-40 mmHg.
Ventricular Tachycardia (Wide Complex Tachycardia)
Team leader: “Stop, Analyze, Switch”
Monitor/Defibrillator: “The patient still in Ventricular Fibrillation”
Team leader: “Switching in 3, 123”
Compressor: (Nag switch na sila ni team leader)
Team leader: “Continue high quality CPR” (order to Compressor)
“Shock 360 joules.” (order to Deribrillator)
Monitor/Defibrillator: “Charging 360 joules. Is everybody clear?”
TEAM LEADER: “The patient is manifesting a fast heart rate, with a
(Stop CPR & raise hands)
heart rate of ____. The rhythm in the cardiac monitor is Wide Complex
All: Clear! (raise hands)
Tachycardia which is Ventricular Tachycardia. Let’s also check the
Monitor/Defibrillator: “Initiating shock in 3, 123.” (Compressor: Pindot
BP of the patient, which is ____ and it is unstable and so we can treat
ng shock)
the patient using Sedation & Synchronize Cardioversion”
Monitor/Defibrillator: “Shock delivered.”
Team leader: “Continue high quality CPR” (order to Compressor)
Sedate/Sedation: choose only one
Airway: (give 2 rescue breaths after 30 compressions)
 Diazepam: 5mg – VALIUM (most common)
 Midazolam: 5mg
 Demerol: 50mg CI: 2 Minutes (1st)
Synchronized Cardioversion: Team leader: “Stop, Analyze, Switch”
 Supraventricular Tachycardia – 50-100 Joules Airway: “Still no breathing”
 Ventricular Tachycardia – 100 -120 Joules Monitor/Defibrillator: “Still in ventricular fibrillation” (mag switch na
sila ni Compressor)
Team leader: “Continue high quality CPR” (Defibrillator compress)
“Shock 360 joules.”
“Prepare 1 mg of epinephrine.”
Compressor: “Charging 360 joules”
IV-IO MEDICATION: “Preparing 1 mg of epinephrine”
Compressor: “Is everybody clear?”
All: “Clear!”
Compressor: “Initiating shock in 3, 123.” (Defibrillator: Pindot ng
shock) “Shock delivered.”
Team leader: “Continue high quality CPR” (Defibrillator compress)
“Administer 1 mg of epinephrine. “
Airway: Give 2 rescue breaths after the 30 compressions.
IV-IO Medication: Administering 1 mg of epinephrine with 20 cc of
PNSS for flushing. Elevating the hand of the patient.

Patient then will be in ARREST. CI: 2 Minutes (2nd)

Team leader: “Stop, Analyze, Switch”
Airway: “Still no breathing”
Compressor: “Still in ventricular fibrillation” (mag switch na sila ni
Defibrillator)
Team leader: “Continue high quality CPR” (Compressor compress)
“Shock 360 joules.”

GRACE 4
 RLE – ADVANCE CARDIAC LIFE SUPPORT (ACLS)
“Prepare 300 mg of amiodarone.” Treat Reversible Causes of H’s & T’s
Defibrillator: “Charging 360 joules” H’s
IV-IO MEDICATION: “Preparing 300 mg of amiodarone” 1. Hypoxia – low oxygen levels in the body tissues.
Defibrillator: “Is everybody clear?” Treatment: Administer 100% oxygen, check for airway
All: “Clear!” obstruction, and if necessary, provide ventilation or intubation.
Defibrillator: “Initiating shock in 3, 123.” (Compressor Pindot ng shock) 2. Hypovolemia – low blood volume in the body due to an injury
“Shock delivered.” Treatment: If hemorrhagic shock is suspected, administer IV
Team leader: “Continue high quality CPR” (Compressor compress) fluids or blood products, such as normal saline or lactated
“Administer 300 mg of amiodarone. “ Ringer's.
Airway: Give 2 rescue breaths after the 30 compressions. 3. Hydrogen ions (acidosis) – there is too much acid and
IV-IO Medication: Administering 300 mg of amiodarone with 20 cc of hydrogen ions in the blood and body tissues.
PNSS for flushing. Elevating the hand of the patient. Treatment: Administer sodium bicarbonate to correct
metabolic acidosis, especially in cases of hyperkalemia or
CI: 2 Minutes (3rd) prolonged arrest, if necessary.
Team leader: “Stop, Analyze, Switch” 4. Hypo/hyperkalemia – low/high levels of potassium ions in the
Airway: “Still no breathing” blood.
Monitor/Defibrillator: “Still in ventricular fibrillation” (mag switch na Treatment: For hypokalemia: Administer potassium supplements
sila ni Compressor) after confirming levels. For hyperkalemia: Administer calcium
Team leader: “Continue high quality CPR” (Defibrillator compress) chloride, sodium bicarbonate, or insulin with glucose to lower
“Shock 360 joules.” potassium levels
“Prepare 1 mg of epinephrine.” 5. Hypothermia – abnormally low body temperature below 95*F
Compressor: “Charging 360 joules” or 35*C.
IV-IO MEDICATION: “Preparing 1 mg of epinephrine” Treatment: Gradually warm the patient using external or
Compressor: “Is everybody clear?” advanced techniques such as warm IV fluids, heat packs, or a
All: “Clear!” warming blanket.
Compressor: “Initiating shock in 3, 123.” (Defibrillator: Pindot ng
shock) “Shock delivered.” T’s
Team leader: “Continue high quality CPR” (Defibrillator compress) 1. Tension pneumothorax – accumulation of air is trapped in the
“Administer 1 mg of epinephrine. “ pleural space.
Airway: Give 2 rescue breaths after the 30 compressions. Treatment: Perform needle decompression followed by chest
IV-IO Medication: Administering 1 mg of epinephrine with 20 cc of tube insertion to relieve the pressure.
PNSS for flushing. Elevating the hand of the patient. 2. Cardiac tamponade – accumulation of fluid between the heart
and the pericardium.
Treatment: Perform pericardiocentesis (needle drainage of the
pericardial sac) to relieve the fluid buildup around the heart.
CI: 2 Minutes (4th)
3. Toxins – harmful substances the body produces or from too
Team leader: “Stop, Analyze, Switch”
many administered medications.
Airway: “Still no breathing”
Treatment: Identify the toxin and treat according to its type
Compressor: “Still in ventricular fibrillation” (mag switch na sila ni
(e.g., antidotes like naloxone for opioid overdose, activated
Defibrillator)
charcoal, or specific antidotes for other drugs).
Team leader: “Continue high quality CPR” (Compressor compress)
4. Coronary thrombosis – blood clot that forms in the blood vessel
“Shock 360 joules.”
of the coronary system.
“Prepare 150 mg of amiodarone.”
Treatment: Administer thrombolytics or perform percutaneous
Defibrillator: “Charging 360 joules”
coronary intervention (PCI).
IV-IO MEDICATION: “Preparing 150 mg of amiodarone”
5. Pulmonary thrombosis - blood clot that blocks blood flow to an
Defibrillator: “Is everybody clear?”
artery in the lung.
All: “Clear!”
Treatment: Consider fibrinolytics or surgical embolectomy if
Defibrillator: “Initiating shock in 3, 123.” (Compressor Pindot ng shock)
appropriate.
“Shock delivered.”
Team leader: “Continue high quality CPR” (Compressor compress)
“Administer 150 mg of amiodarone. “ POST ARREST CARE
Airway: Give 2 rescue breaths after the 30 compressions. EVERYONE IN THE GROUP MUST ANSWER EXCEPT KAY TEAM LEADER
IV-IO Medication: Administering 150 mg of amiodarone with 20 cc of KASI SIYA NA GUMAWA HALOS LAHAT. Dapat alam din ng ibang
PNSS for flushing. Elevating the hand of the patient. members yung mga gamot etc. hindi lang si MONITOR & AIRWAY.

Non-shockable
RETURN OF SPONTANEOUS CIRCULATION/ROSC
Monitor/Defibrillator:
Ventricular Asystole/Pulseless Electrical Activity
I will Check:
 BP & PULSE
 PETCO (PARTIAL END TIDAL VOLUME) OF 35-45 MMHG

BP UNSATBLE
Monitor/Defibrillator:
 I will GIVE PNSS/PLRS 1-2 L
Team Leader: “Since we have Ventricular Asystole, then it is NON-  Now, I will DO 4 POINT AUSCULTATION (AIRWAY GAGAWA) (IV-
SCHOCKABLE. For the management; we can continue HQCPR and IO Medication: MAG PUMP NG AMBU)
give Epinephrine 1mg with an interval of 3-5 mins”  GIVE MEDS
 DOPAMINE 10 mcg/kg
Team leader: Administer 1st dose of 1 mg of epinephrine  EPINEPHRINE 2-10 mcg
IV-IO Medication: Administering 1st dose of 1 mg of epinephrine with  NOREPINEPHRINE 2-10 mcg
20 cc of PNSS for flushing and elevating the hand of the patient.
RECORDER: Write the time
Team leader: Administer 2nd dose of 1 mg of epinephrine
IV-IO Medication: Administering 2nd dose of 1 mg of epinephrine
with 20 cc of PNSS for flushing and elevating the hand of the patient.
RECORDER: Write the time
Team leader: Administer 3rd dose of 1 mg of epinephrine
IV-IO Medication: Administering 3rd dose of 1 mg of epinephrine
with 20 cc of PNSS for flushing and elevating the hand of the patient.

*Binuhay na ng CI ung patient*  AIRWAY will do the 4-POINT AUSCULTATION

Return to Sinus Bradycardia  Check for positive or negative breath sounds
Team leader: The patient now has a pulse and is on post arrest care.  Prepare your stethoscope
Team leader: Treat Reversible Cause of 5 H’s and T’s  Identify Points

GRACE 5
 RLE – ADVANCE CARDIAC LIFE SUPPORT (ACLS)
 Listen to the chest at: RIGHT UPPER CHEST  LEFT UPPER  GIVEN FOR 12 -24 HOURS
CHEST  RIGHT LOWER CHEST  LEFT LOWER CHEST  TO MAINTAIN CORE BODY TEMPERATURE OF 32-36°C
LISTEN: Check each point for 1-2 breaths  Do the Sign of the Cross
 Positive: Normal sounds
 Negative: Absent/ abnormal sounds

ACTION:
 If positive, airway is clear – normal
 If negative breath sounds, proceed to AIRWAY BREATHING
(intubation)

NO BREATHING? DO INTUBATION

AB NO BREATHING
Airway: I will now proceed to advanced airway
 INSERT ENDOTRACHEAL TUBE, SECURE THE TUBING, INFLATE,
CHECK PLACEMENT OF TUBE. (AIRWAY: PERFORMS INTUBATION) 1. INSERT NGT – Inserted through one of the nostrils, down the
 How do you perform intubation? Position? nasopharynx, and into the alimentary tract.
AIRWAY: “To intubate the patient, I will hyperextend the Types of NGT:
client's neck. I may use a pillow or a rolled towel to elevate  Levin Tube (single) – most common
the head if needed. I will also ensure I am wearing sterile  Salem Sump tube
gloves. Next, I will use a laryngoscope to visualize the vocal  Miller Abbott tube
cords. I will insert the endotracheal tube through the cords,  Sengstaken Blakemore Tube
following the contour. After the tube is in place, I will inflate Measure:
the cuff to secure the tube, filling it with 10 cc of air. It is  Adult: Measure from the tip of the nose, to the earlobe,
important to never use water, as it can cause aspiration. I to the xiphoid (bottom of the sternum).
will inflate the cuff to prevent self-extubation.”  Infant: Measure from the tip of the nose, to the earlobe,
 Endotracheal tube sizes to the mid-xiphoid and umbilicus (belly button).
 7-8 mm – Adult; pag malaki talaga use 8.5mm
 4-6 mm - Pedia 2. FOLEY CATHETER
 2.5-3.5 mm – uncuffed; neonate (28 days)  Female - Dorsal recumbent
 Nursing Role:  Male - Frog like
 Maintain correct placement
 Maintain proper inflation
 Maintain/monitor ventilation and oxygenation
 Maintain tube patency
 Mouth care; repositioning ET; promote communication

1 Degree DO 5 POINT AUSCULTATION

AIRWAY will do the procedure; IV-IO/ MEDICATION will do the ambu
bag. AIRWAY & IV-IO/MEDICATION should be synchronized.

Procedure: 3. 12 LEAD ECG

 Auscultate the epigastrium to rule out gastric intubation.
EPIGASTRIC - no sound dapat
 Auscultate the bilateral fields in anterior and lateral positions to
confirm equal breath sounds.
If may abnormal findings, what management:
 AIRWAY “For the management, we prevent gastric distention.
So we should deflate, pull it back 1 inch, reinflate, and perform
the 5-point auscultation again.”
 Pag POSITIVE = May GASTRIC DISTENTION
 Once NEGATIVE = INTACT ENDOTRACHEAL TUBE. After that, si
AIRWAY na ulit mag ambug bag hangga’t wala sa ICU at hindi
nakakabit sa mechanical ventilator si client
 V1- Right sternum, @4th ICS – RED
 V2 – Left sternum, @4th ICS – YELLOW
 V3 - between V2 and V4 – GREEN
 V4 - mid-clavicular line, @5th ICS – BROWN
 V5 – in line with V4, @left anterior axillary line – BLACK
 V6 – in line with V4 & V5, @left mid-axillary line – PURPLE

4. XRAY/CVP (Central Venous Pressure)

 Normal Value: 2 to 6 mmHg (or 4 to 10 cm H₂O)
 The CVP is measured through a catheter inserted
into a large vein, often the internal jugular or
subclavian vein, and is used to assess the pressure in
the right atrium or the vena cava.
 Interpretation:
2 degree CAPNOGRAPHY  Low CVP: Can indicate hypovolemia, blood loss, or
 Qualitative - Yellow dehydration.
 Quantitative - 35 to 40 mmHg  High CVP: Can suggest conditions like heart failure,
fluid overload, or pulmonary hypertension (VOLUME
OVERLOAD)

D DISABILITY GCS 3 (RECORDER)

 Glasgow Coma Scale (GCS3) – Neuro Vital Signs
REFER TO ICU FOR ADMISSION
 Patient is on 50/50 if GCS is 8
 Highest 15; 13-15 = GOOD
 Lowest 3 – vegetative case
 Eye Response 1-4
 Verbal Response 1-5
 Motor response 1-6
 Treat Therapeutic Hypothermia
 GIVE PNSS/PLRS, 30 CC/KG, 4°C

GRACE 6