Cardiorespiratory Arrest

Preparing the room before they arrive, running the code, and what the job becomes after ROSC.

Cardiorespiratory Arrest (Full Arrest): My Experiences

Cardiac Arrest: Preparing for Arrival

In most cases, you'll receive advance notice that a full arrest patient is en route. Use this critical time to prepare your room, team, and equipment.

1. Set Up Supplies & Equipment

• Bring the crash cart to the bedside and ensure defibrillation pads are ready to apply • Set up suction and a bag-valve mask (BVM) • Have a glucometer available • Prepare a pressurized normal saline (NS) bag • Gather supplies to connect the patient to the cardiac monitor • Have IV supplies or the IO gun ready • Ensure the ultrasound and ECG machine are on standby

2. Notify Essential Team Members

• Alert the ER provider, respiratory therapy, registration, technicians, and fellow nurses that a cardiac arrest is incoming

3. Assign Roles Clearly

Before the patient arrives, establish who will be responsible for each of the following tasks: • Crash cart & defibrillator (preparing meds and managing shocks) • IV or IO access and medication administration • CPR • Connecting monitor leads and pads • Airway management (BVM, suction, intubation support) • Blood glucose check Note: You'll often be the one recording and keeping track of timing for medications, compressions, and rhythm checks.

4. Ask the Provider Early On:

• "How often do you want to do epinephrine and pulse/rhythm checks?" (While the standard is every 3–5 minutes, clarify their preferences.)

5. Know What's in the Crash Cart

Be familiar with the emergency medications typically stocked: • Epinephrine • Amiodarone • Magnesium Sulfate • Lidocaine • Sodium Bicarbonate • Calcium Chloride • Dextrose • Adenosine

6. Know How to Use the Defibrillator

• How to defibrillate (for V-Fib/pulseless V-Tach) • How to cardiovert (for unstable but perfusing rhythms like SVT or A-Fib) • How to pace (for symptomatic bradycardia unresponsive to meds)

Cardiac Arrest: Patient Arrival

When the patient arrives, things move quickly—your role is to ensure everything is coordinated, efficient, and safe. Here's how to stay in control:

1. Ask EMS the Right Questions

• When was the last dose of epinephrine given? • What is the approximate downtime overall? • How long has CPR been ongoing? Was there bystander CPR? • What was the initial rhythm and have any shocks been delivered? • What's the story? What happened? Any relevant medical history?

2. Ensure Key Interventions Are Happening Immediately

• Patient is connected to the pads and cardiac monitor • CPR is high-quality and continuous • IV or IO access is placed promptly • Medications are being administered on time • Rhythm and pulse checks are occurring as indicated • Defibrillation is performed when appropriate • End-tidal CO2 (ETCO2) monitoring is placed to guide resuscitation

3. Keep Track of Time and Interventions

Ask your provider early on: • "How often would you like epinephrine and pulse/rhythm checks?" If following the standard (e.g., epinephrine every 3 minutes), track the time yourself: • At 2 minutes and 30 seconds, call out: "Epi due in 30 seconds." • When it's time, say: "Epi is due now." Use the same approach for pulse checks: "Pulse check in 30 seconds," then "Pulse check now." You're responsible for tracking: • Medication doses • Time of each intervention • Total downtime You will be asked: "How many epis have we given?" "What's the total downtime?"—so keep that information ready. While some hospitals use real-time charting, many nurses find it helpful to take handwritten notes during the code and chart everything afterward.

4. Use the Ultrasound (If Available)

Have the ultrasound machine ready at bedside. Providers may use ultrasound to assess: • Cardiac activity • Cardiac tamponade • Right heart strain (suggestive of pulmonary embolism) Before ceasing resuscitative efforts, it's crucial to check for cardiac activity—sometimes the heart may still have weak contractions that are not generating a palpable pulse.

5. Assist with Identifying Reversible Causes

• Help the team work through the H's and T's: o H's: Hypoxia, Hypovolemia, Hydrogen ion (acidosis), Hypo-/Hyperkalemia, Hypothermia o T's: Tension pneumothorax, Tamponade, Toxins, Thrombosis (MI or PE), Trauma

Post-Cardiac Arrest: After ROSC (Return of Spontaneous Circulation)

If ROSC is achieved, your job is far from over. The patient remains critically unstable and requires close monitoring and aggressive supportive care.

1. Circulatory Support

• Is the patient hypotensive? Consider: o Vasopressors o IV fluids o Blood products (if bleeding or severely anemic)

2. Neurological Protection

• Is targeted temperature management (therapeutic hypothermia) indicated?

3. Cardiac Evaluation & Monitoring

• Obtain a 12-lead ECG • Provider will place an arterial line for continuous blood pressure monitoring and a central line for vasopressor administration and access

4. Airway & Ventilation

• Ensure the patient is intubated and ventilated for proper oxygenation and CO2 clearance • Insert a foley catheter, OG tube, and apply soft restraints if indicated

5. Labs & Ongoing Interventions

• Send a full set of labs (as ordered) • Continue treatment of reversible causes • Correct any electrolyte abnormalities or acid-base imbalances

6. Vigilant Monitoring

• Monitor closely—re-arrest is common in the post-ROSC phase • Keep defibrillator pads on the patient • Keep the crash cart nearby, and restock medications as needed

Updated 30 Aug 2026