Rapid Response and Advanced Cardiac Life Support (ACLS)

Comprehensive vocabulary flashcards covering Rapid Response team roles, Code Blue management, rhythm recognition, ACLS medications, defibrillator operation, and the reversible H's and T's of cardiac arrest.

Rapid Response

An early intervention safety net called before a patient decompensates into cardiac arrest, bringing expert trained resources to acute care units that are not accustomed to managing higher acuity or critical patient needs.

Rapid Response Team Composition

A multidisciplinary team typically consisting of $2\text{--}7\text{ people}$,

including the Primary Nurse, 2nd and 3rd Nurses, an ICU or ED Nurse/Paramedic, an ED/ICU Physician or Hospitalist, and the Charge Nurse.

Code Blue

An emergency code (also called Dr. Leo) initiated when a patient experiences cardiac or respiratory arrest, requiring full resuscitation and ACLS protocols.

Code Blue Team Composition

A large resuscitation team totaling $16\text{--}25\text{ people}$, comprising the Primary Nurse, 2nd and 3rd Nurses, Charge Nurse, Nursing Supervisor/Manager, House Supervisor, Attending/Resident Physicians, Radiology Technicians, Pharmacist, Respiratory Care Technician, Security, and Clergy.

Code Stork

A hospital emergency code called for an imminent obstetric delivery or labor and delivery emergency.

Code Purple / Code BERT

A specialized emergency activation for a Behavioral Emergency Response Team called to de-escalate aggressive, combative, or psychiatric behavioral crises.

Code Silver

A critical emergency alert signaling an active shooter, armed individual, or hostage situation.

Code Team Role: Airway

Managed by an RN, MD, Anesthesiologist, or RT to control oxygenation and ventilation, assess neurological status, and monitor the team using interventions like

Jaw Thrust

OPA (Oral Pharyngeal Airway (OPA)

NPA (Nasal Pharyngeal Airway (NPA)

LMA (Laryngeal Mask Airway (LMA)

Suction equipemnt intubation

Oxygenation

• Airway devices

• Bag Valve Mask (BVM)

• Rescue Breathing (every 4-6 seconds)

• Assisted Breathing (every 4-6 seconds)

Code Team Role: Compressor

Filled by an RN, Unit Nurse Assistant, or student, responsible for delivering manual chest compressions at a rate of $100\text{--}120\text{ bpm}$ and depth of at least $2\text{ inches}$ with full recoil, rotating every $2\text{ minutes}$ (or $5\text{ cycles of } 30:2$) to prevent fatigue.

Check the pulse every 2 minutes! Do not be off of the chest for more than 10 seconds

Code Team Role: Team Leader

The highest trained responsible individual with ACLS certification (RN, MD, or Anesthesiologist) who stands at the foot of the bed, coordinates all code activities, implements protocols, and directs closed-loop communication.

Also the cpr coah

Code Team Role: Recorder

Filled by an RN or MD who documents code events, tracks cycle times for compressions and medication administration intervals, and records all involved personnel (often utilizing apps such as Code Scribe).

ECG Paper Grid Calibration

Standard ECG paper calibration where $1\text{ small box} = 1\text{ mm} = 0.04\text{ seconds}$, $1\text{ big box} = 5\text{ mm} = 0.20\text{ seconds}$, $5\text{ big boxes} = 1\text{ second}$, and $30\text{ big boxes} = 6\text{ seconds}$.

Normal Sinus Rhythm (NSR)

A normal cardiac rhythm characterized by regular, upright P waves preceding each narrow QRS complex ($<0.12\text{ seconds}$), a normal PRI ($0.12\text{--}0.20\text{ seconds}$), and a heart rate of $60\text{--}100\text{ bpm}$.

Sinus Bradycardia

A regular sinus rhythm with normal P waves and narrow QRS complexes, but occurring at a slow heart rate of less than $60\text{ bpm}$.

Sinus Tachycardia

A regular sinus rhythm originating from the SA node with normal P waves, normal PRI, and narrow QRS complexes, running at an elevated rate greater than $100\text{ bpm}$.

Supraventricular Tachycardia (SVT)

A rapid regular tachyarrhythmia originating above the ventricles, typically presenting with a narrow QRS complex and heart rate exceeding $150\text{ bpm}$, where P waves are frequently buried in preceding T waves.

Ventricular Tachycardia (VT)

A life-threatening arrhythmia originating in the ventricles marked by wide, bizarre, repeating QRS complexes ($\ge 0.12\text{ seconds}$) and rapid rates; can present with a pulse or pulseless.

Ventricular Fibrillation (VF)

A lethal, pulseless shockable rhythm characterized by disorganized, chaotic, quivering ventricular electrical activity with no recognizable P waves, QRS complexes, or systemic perfusion.

V fib you D fib

Adenosine (Adenocard)

An antiarrhythmic used for SVT ('heart too fast') to momentarily block AV node conduction; administered as a first dose of $6\text{ mg}$ rapid IVP followed by a flush, and an optional second dose of $12\text{ mg}$ rapid IVP after $3\text{ minutes}$ (no third dose).

PUSH IT FAST

Atropine Sulfate

An anticholinergic agent used for symptomatic bradycardia ('heart too slow'); dosed at $1\text{ mg}$ IVP every $3\text{--}5\text{ minutes}$ up to a maximum cumulative dose of $3\text{ mg}$.

Amiodarone HCl (Cordarone)

A class III antiarrhythmic used in cardiac arrest for refractory VF/pulseless VT ('heart confused'); dosed as a $300\text{ mg}$ IV PUSH first dose in 3-5 minutes, followed by a second dose of $150\text{ mg}$ IV (no maximum dose in cardiac arrest).

Epinephrine (Adrenalin)

A primary vasopressor given in cardiac arrest at a concentration of $1:10{,}000$; administered as $1\text{ mg}$ rapid IVP every $3\text{--}5\text{ minutes}$ with no maximum dose limit.

Defibrillation

An unsynchronized high-energy electrical shock designed to completely stop chaotic, disorganized ventricular electrical activity (VF or pulseless VT) so the natural pacemaker can resume control.

Say clear before you actually shock the patient to ensure safety and readiness.

Synchronized Cardioversion

A low-energy electrical shock timed specifically to synchronize with the R wave to convert unstable organized tachyarrhythmias (such as unstable SVT or VT with a pulse) back to sinus rhythm.

Transcutaneous Pacing

The external delivery of repetitive electrical impulses across the chest (e.g., set at $70\text{ mA}$) designed to supplement inadequate cardiac rate in symptomatic, drug-refractory bradycardia.

Defibrillator Operator Safety

A mandatory command procedure where the defibrillator operator takes command of the room, loudly announces 'EVERYONE CLEAR!!', and performs a direct head-to-toe visual scan before discharging an electrical shock.

H’s and T’s reasons for cardiac arrest

Hypovolemia

Hypoxia

Hydrogen ions (acidosis)

Hypo / hyperkalemia

Hypo/hyper-thermia

Toxins

Tamponade

Tension Pnumothorax

Thrombosis (cardiac) STEMI

Thrombosis (respiratory) PE

Hypovolemia (ACLS Reversible Cause)

A critical loss of intravascular fluid volume leading to arrest; managed primarily by securing rapid vascular access, administering rapid IV fluid challenges, and identifying and stopping active hemorrhage.

Hypoxia (ACLS Reversible Cause)

Inadequate tissue and cerebral oxygenation; treated during arrest by securing an open airway, ensuring proper oxygen connection, confirming bilateral breath sounds, and providing effective bag-mask ventilations.

Hydrogen Ion Acidosis (ACLS Reversible Cause)

Severe acidosis diagnosed by arterial blood gas (ABG) or i-STAT; managed by optimizing alveolar ventilations for respiratory acidosis and administering sodium bicarbonate when indicated for metabolic acidosis.

Hyperkalemia (ACLS Reversible Cause)

Critically elevated serum potassium causing cardiac arrest, recognizable on ECG by tall, peaked T-waves and progressive widening of the QRS complex.

Hypokalemia (ACLS Reversible Cause)

Critically depleted serum potassium causing arrest, manifesting on ECG as flattened T-waves, prominent U-waves, and potential QRS widening (never administer undiluted IV potassium).

Hypothermia (ACLS Reversible Cause)

A drop in core body temperature rendering the patient refractory to standard ACLS drugs or electrical shocks; requires immediate active rewarming measures to raise core temperature above $86^\circ\text{F}$ ($30^\circ\text{C}$).

Toxins (ACLS Reversible Cause)

Overdoses of tricyclic antidepressants, digoxin, beta-blockers, calcium channel blockers, or cocaine (the most common street drug causing pulseless arrest); manifested by bradycardia, pupillary signs, and neuro changes, requiring Poison Control consultation.

Cardiac Tamponade (ACLS Reversible Cause)

Fluid accumulation in the pericardial sac preventing ventricular filling; characterized by narrow QRS tachycardia, jugular venous distention (JVD), muffled heart sounds, and weak/absent pulses, treated via pericardiocentesis.

Tension Pneumothorax (ACLS Reversible Cause)

Air trapped under pressure in the pleural space causing intrathoracic mediastinal shift; identified by narrow QRS tachycardia, JVD, tracheal deviation, absent unilateral breath sounds, and difficulty ventilating, treated via needle decompression.

Cardiac Thrombosis (ACLS Reversible Cause)

Coronary artery occlusion causing acute myocardial infarction (AMI); indicated by ST-segment changes, T-wave inversions, Q waves, and elevated cardiac enzymes, treated via PCI (angioplasty and stenting) or fibrinolytics.

Pulmonary Thrombosis (ACLS Reversible Cause)

Massive pulmonary embolism causing acute respiratory collapse followed by arrest; recognized by narrow QRS tachycardia, JVD, positive D-dimer, and prior DVT/PE history, treated via pulmonary thrombectomy or fibrinolytic therapy.

Adult Cardiac Arrest Circular Algorithm

The standardized ACLS management loop integrating continuous CPR quality monitoring, 2-minute rhythm checks, defibrillation for shockable rhythms (VF/pVT), vasopressors/antiarrhythmics, advanced airways, and treating reversible H's and T's.