What are the steps to manage an emergency rapid code?

Emergency Rapid Code Management Protocol

In an emergency rapid code situation, follow the American Heart Association's 2020 guidelines for cardiopulmonary resuscitation, which provide a systematic approach to maximize survival outcomes through immediate recognition and high-quality interventions. 1

Initial Assessment and Actions

Scene Safety and Patient Assessment

1. Verify scene safety before approaching the patient
2. Check for responsiveness by tapping and shouting
3. Shout for nearby help immediately upon finding an unresponsive patient
4. If alone, activate emergency response system via mobile device (if appropriate)
5. Look for no breathing or only gasping and check pulse simultaneously
   • Check carotid pulse for no more than 10 seconds
   • Note: Agonal gasping should not be confused with normal breathing

Response Based on Initial Assessment

If Patient Has Normal Breathing and Pulse:

• Monitor until emergency responders arrive
• Position in recovery position if no trauma concerns
• Continue to assess breathing and circulation

If Patient Has No Normal Breathing but Has Pulse:

• Provide rescue breathing: 1 breath every 2-3 seconds (20-30 breaths/minute)
• Assess pulse rate for no more than 10 seconds
• If heart rate <60/min with signs of poor perfusion, start CPR
• If heart rate adequate, continue rescue breathing and check pulse every 2 minutes

If Patient Has No Breathing/Only Gasping and No Pulse:

• Start CPR immediately
• Determine if collapse was witnessed or unwitnessed

CPR Protocol

Single Rescuer CPR

• Perform cycles of 30 compressions and 2 breaths
• Compression rate: 100-120 compressions per minute
• Compression depth: 2-2.4 inches (5-6 cm) for adults
• Allow complete chest recoil between compressions
• Minimize interruptions in compressions (< 10 seconds)
• After about 2 minutes, if still alone, activate emergency response system and retrieve AED

Multiple Rescuer CPR

• First rescuer remains with patient and begins CPR
• Second rescuer activates emergency response system and retrieves AED/emergency equipment
• When second rescuer returns, perform cycles of 15 compressions and 2 breaths
• Switch compressors every 2 minutes to maintain high-quality compressions

AED Use

1. Apply AED as soon as it is available
2. Turn on the AED and follow voice/visual prompts
3. Check rhythm - is it shockable?
   • If shockable: Give 1 shock, then immediately resume CPR for 2 minutes
   • If non-shockable: Resume CPR immediately for 2 minutes
4. Continue this cycle until advanced life support providers take over or the patient shows signs of life

Advanced Considerations

Airway Management

• Open airway using head tilt-chin lift maneuver
• Remove any visible obstructions from the mouth
• Consider advanced airway management if trained personnel available

Medication Administration

• Establish IV/IO access when possible without interrupting CPR
• For cardiac arrest, administer epinephrine 1 mg IV/IO every 3-5 minutes
• For refractory VF/pVT, consider amiodarone or lidocaine
• For suspected opioid overdose with pulse but no normal breathing, administer naloxone

Documentation

• Designate a team member as recorder when possible
• Document:
  • Time of arrest and interventions
  • Medications given with dosages and response
  • Rhythm checks and shocks delivered
  • Return of spontaneous circulation if achieved
  • Patient condition throughout resuscitation

Common Pitfalls to Avoid

• Delayed CPR initiation: Never delay CPR to check for pulse beyond 10 seconds
• Poor quality compressions: Ensure adequate depth and rate, and minimize interruptions
• Failure to use AED promptly: Apply AED as soon as available
• Inadequate team communication: Clearly assign roles and communicate actions
• Neglecting personal safety: Always ensure scene safety before approaching patient
• Forgetting post-resuscitation care: Continue monitoring vital signs after return of spontaneous circulation

Remember that high-quality CPR with minimal interruptions is the cornerstone of successful resuscitation. The systematic approach outlined in the American Heart Association guidelines provides the best chance for patient survival with good neurological outcomes.