Emergency protocols for non-physician RRTs
The following emergency protocols may be initiated by the appropriate nursing staff (e.g., RRT) prior to
receiving an order by a physician:
1. Respiratory Distress
a. Non-intubated patient
b. Intubated patient
2. Symptomatic hypotension
3. Chest pain
4. Symptomatic bradycardia
5. Sustained ventricular tachycardia
a Hemodynamically stable
b. Hemodynamically unstable
6. Pulseless ventricular tachycardia, ventricular fibrillation
7. Major hemorrhage
8. Acute altered mental status/unresponsiveness
9. Acute stroke
Examples of emergency protocols:
EMERGENCY PROTOCOLS
1. RESPIRATORY DISTRESS
1.1 NON-INTUBATED PATIENT
a. Position patient to open airway
b. Administer supplemental O2
c. Apply continuous pulse oximetry
d. Adjust O2 to keep O2 sat >92%
e. Obtain ISTAT ABG
f. Obtain Stat Portable Chest X-ray
g. Suction as indicated
h. Establish or verify patent large bore IV access
i. If condition continues to deteriorate, use mask bag ventilation with 100% FI 02
Initiate Cardiopulmonary Resuscitation as indicated
Implement AHA Guidelines for ACLS as clinically indicated
Activate Code 500 System
Document clinical assessment and interventions
2. SYMPTOMATIC HYPOTENSION
2.1 Lie patient flat elevate lower extremities
2.2 Administer supplemental O2
2.3 Apply continuous pulse oximetry
2.4 Adjust O2 to keep oxygen saturation >92%
2.5 Establish or verify large bore IV access
2.6 Search for and treat reversible underlying cause
Pulmonary Edema
Volume Problem (shock)
Pump Problem (MI)
Rate Problem (Bradycardia / Tachycardia)
2.7 Rapid bolus infusion of 500cc Normal Saline (in < 30 min)
Use caution patients with cardiac history of poor ventricular function
2.8 Initiate Dopamine Drip titrate to keep SBP > 90mmhg
2.9 If patient becomes tachycardic: wean dopamine
2.10 Initiate Levophed Drip titrate to keep SBP >90mmhg
If patient continues to deteriorate,
Initiate Cardiopulmonary Resuscitation as indicated
Implement AHA Guidelines for ACLS as clinically indicated
Activate Code Blue System as needed
Document clinical assessment and interventions
3. CHEST PAIN
3.1 Administer supplemental O2
3.2 Apply continuous pulse oximetry
33 Adjust O2 to keep oxygen saturation >92%
3.4 Obtain stat 12 lead ECG
3.5 Give NTG 1/150 tablet S/L if SBP >100 mmgh
May repeat x2 if SBP >100mmhg
3.6 Establish or verify patent large bore IV access
3.7 Consider aspirin therapy
Initiate Cardiopulmonary Resuscitation as indicated
Implement AHA Guidelines for ACLS as clinically indicated
Activate Code Blue System
Document clinical assessment and interventions
4. SYMPTOMATIC BRADYCARDIA
Indicated by heart rate < 60 beats / minute with: Symptomatic Hypotension
4.1 Administer supplemental O2
4.2 Apply continuous pulse oximetry
4.3 Adjust O2 to keep oxygen saturation >92%
4.4 Establish or verify patent large bore IV access
5.5 Administer
Atropine 0.5-1 mg IV push every 3-5 minutes
Up to a total dose of 3 mg or 0.04 mg/kg
Prepare for transcutaneous pacing
If patient continues to deteriorate
Initiate Cardiopulmonary Resuscitation as indicated
Implement AHA Guidelines for ACLS as clinically indicated
Activate Code 500 System
Document clinical assessment and interventions
5. SUSTAINED VENTRICULAR TACHYCARDIA
HEMODYNAMICALLY STABLE
5.1 Administer supplemental O2
5.2 Apply continuous pulse oximetry
5.3 Adjust O2 to keep oxygen saturation >92%
5.4 Establish or verify patent large bore IV access
5.5 Administer
Amiodarone 150 mg in 100 cc D5W over 10 minutes
OR
Lidocaine 1-1.5 mg/kg IV push
If patient continues to deteriorate
Activate Code 500 System
Initiate Cardiopulmonary Resuscitation as indicated
Implement AHA Guidelines for ACLS as clinically indicated
Document clinical assessment and interventions
Source: Queen’s Medical Center, Honolulu