Patient conditions to notify physician. The ALS RN or ALS RT will immediately notify the physician:

Transcription

1 1 CURRENT EFFECTIVE DATE March 1995 REVISED DATE June 2011 MANUAL: NICU/PICU ALS TRANSPORT TRACKING # [ ] P O L I C Y/PROCEDURE [ X] STANDARDIZED PROCEDURE [ ] PLAN [ ] GUIDELINE [ ] PLAN Specialty Review [ ] Multidisciplinary [ ] Information Services [ ] Nursing Council [ ] Infection. Control [ ] RT Council [X] Interdisciplinary Practice [ ] SW Council [ X] Pharmacy & Therapeutics [ ] Child Life [ ] Forms [ ] Human Resources [ ] Med Staff [ ] EOC/Safety [ ] Specialty Review TITLE: PEDIATRIC ALS TRANSPORT Cardiac Defibrillation PERFORMED BY: PEDIATRIC ALS TRANSPORT RN PEDIATRIC ALS TRANSPORT RT Council Review [ ] Back to Basics [ ] Clinical Ops [ ] Med Staff Executive [ ] Center Ops [ ] Board ACCREDITATION/STANDARD I. POLICY: A. Function: This standardized procedure is designed to establish guidelines that will enable the Advanced Life Support Registered Nurse and Respiratory Therapist to perform cardiac defibrillation while on transport. B. Circumstances: 1. Supervision/Collaboration: When possible, the RCHSD PICU attending should be contacted before the procedure. In all emergencies, the RCHSD PICU Attending will be notified as soon as possible while advanced life support is being initiated. Under all circumstances the Advanced Life Support team will carry out urgent resuscitation according to the procedure. In the event that an Advanced Life Support policy or procedure is altered via a referring physician (verbal or written order) then the ALS nurse will inform the physician that he/she is not competent to carry out the altered plan and must either adhere to the procedure or relinquish responsibility to the physician.

2 2 Patient conditions to notify physician The ALS RN or ALS RT will immediately notify the physician: a. In an emergency as soon as possible while advanced life support is being initiated. b. After three rounds of defibrillation. 2. Population Pediatric Transport patients requiring defibrillation. 3. Setting The Advanced Life Support (ALS) Registered Nurse or ALS Respiratory Therapist may perform the outlined procedure while on transport. The competency validated RN or RT may perform the outlined procedure at RCHSD under the direct supervision of the PICU attending or designee. II. PROTOCOL A. Definition: Defibrillation is the definitive treatment for ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT) confirmed by EKG monitoring. It is the asynchronous, untimed depolarization of a critical mass of myocardial cells to allow spontaneous organized myocardial depolarization to resume. B. Database: 1. Subjective: a. Historical Information relevant to present medical illness including reactions and/or allergies to medications. 2. Objective: a. Physical exam with focus on pulmonary and cardiovascular systems. 3. Assessment: Decision for defibrillation will be based upon subjective and objective data and in collaboration with the attending physician when not an emergency life saving procedure. A rhythm disturbance in a child should be treated as an emergency only if it compromises cardiac output or has the potential to degenerate into a lethal (collapse) rhythm to the point of being hemodynamically unstable or fatal. 4. Plan: After three rounds of defibrillation, assess for a pulse and confirm EKG on monitor. If a pulse is present, continue to monitor and call PICU Intensivist for further orders.

3 If there is no pulse and/or rhythm, continue CPR, administer Epinephrine 0.01mg/kg and call PICU Intensivist for further orders. 3 III. REQUIREMENTS 5. Record Keeping: Observe the child's status, and upon stabilization, document procedure including joules utilized, the number of defibrillation attempts, vital signs of the child before and after procedure, and any complications on the transport record. A. Education/Training/Experience: 1. The ALS nurse and therapist will attend the required Advanced Life Support didactic training (minimum 40 hours). The ALS RN and ALS RT will pass all written and performance tests administered during the course with a minimum of 94% accuracy on final exam. 2. The ALS RN and ALS RT will successfully complete initial and annual competency requirements B. Initial and Ongoing Competency Evaluation: a. Initial Competency will be validated by signatures from the Transport Program Manager. b. The ALS RN and ALS RT will perform return demonstration on the transport defibrillator with annual competencies. c. The ALS RN and ALS RT will exhibit knowledge and skills to perform defibrillation during annual competency review. IV. Development and Approval of this Standardized Procedure as stated in the IDP policy CPM V. REFRENCES: Nichols, D. (2008). Rogers Textbook of Pediatric Intensive Care 4 th Ed. Baltimore: Lippincott Williams and Wilkins Curley, M. et al (1996), Critical Care Nursing of Infants and Children. Philadelphia: Saunders. Ralston, M et al (2006). Pediatric Advanced Life Support. Dallas,TX: American Heart Association. MacDonald, M. et al (2003). Guidelines for Air and Ground Transport of Neonatal and Pediatric Patients. Elk Grove, IL: American Academy of Pediatrics

4 4 VI. CROSS REFRENCES: A list of Competency Validated Pediatric ALS RN s and ALS RT s will be kept in the CHET office. VIII. ATTACHMENTS: None IX. APPROVALS A. Pediatric Transport Team B. Interdisciplinary Practice Committee

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