The Elective Rotation: A Critical Care Hospital Pharmacy Podcast

By Pharmacy JoeMedicine Education

Ranking
3rd
on Training
Favorites
157
Followers
Typical duration
4 min
per episode

Based on Podcast App listening data

The Elective Rotation: A Critical Care Hospital Pharmacy Podcast episodes

August 06, 2015 4: Push Dose Pressors: Use Them Once, Shame On Me. Use Them Twice, Shame On You! Critical Care Hospital Pharmacy Podcast Episode 4

Push Dose Pressors, They're Not Just For Anesthesia Anymore!

I like preventing the complications of profound hypotension as much as anyone. Really, I do.
It's why I suggest you focus so much on anticipating patient and provider needs during an emergency situation.
It's why I suggest you put a norepinephrine drip in your pocket whenever hypotension can reasonably be predicted to happen. Maybe even (cringe!) a phenylephrine drip in some circumstances.
It's also why I stress that simply having the drug in the room doesn't do the patient any good - you need IV tubing and an IV pump too. The drip needs to be primed and the pump needs to be set.
These are all things I put in motion when assisting nurses and physicians at codes, rapid responses, intubation procedures, etc...
And so, when hypotension is identified as a problem that needs solving - all the nurse needs to do is connect the IV tubing to a port and press play on the IV pump (I've yet to meet a "Smart" pump even though I've met many pumps that claim to be smart).
Occasionally I don't have the drip set up in time and ready to infuse. In this case, we'll draw medication out of the IV bag into a syringe for IV push administration.
What should you give and how much? I'm so glad you asked! Because have I got a drug for you!
Introducing...Someolol™
Someolol™ was originally an herbal remedy developed in 1842 by Phineas Taylor Barnum. It was subsequently rebranded some time in the 20th century and extensively tested in young, healthy females experiencing hypotension after neuraxial anesthesia in obstetrics.
For use in critical care, Someolol™ has been studied extensively nowhere but you can find anecdotal evidence in many places such as here,
7 min
August 06, 2015 4: Push dose pressors: Use them once, shame on me. Use them twice, shame on you!
Show notes at pharmacyjoe.com/episode4 Push Dose Pressors, They’re Not Just For Anesthesia Anymore!
7 min
August 03, 2015 3: Pharmacists as Members of the Rapid Response Team Critical Care Hospital Pharmacy Podcast Episode 3

Welcome! Today I will be discussing pharmacist participation on rapid response teams. According to the wikipedia definition (don't tell my former professors I referenced that site!):
A rapid response team (RRT) is a team of health care providers that responds to hospitalized patients with early signs of clinical deterioration on non-intensive care units to prevent respiratory or cardiac arrest.

Who can activate a rapid response call? Anyone at my hospital, but it is usually the bedside nurse who calls.
Who is on the team?
- Critical Care Nurse
- Respiratory Therapist
- Hospitalist
- Pharmacist
False alarms
You should accept that you will get some calls that turn out unnecessary. That's OK. The team should never say anything negative if they determine the call was unnecessary - this could lead the same person to avoid calling in the future when they might really need help!
Notification
A beeper system is used at my hospital to notify the rapid response team.
Reaching the room/area
Take the stairs when possible.
Identify yourself to staff already in attendance.
Observe the patient and the care being administered.
Ask for an explanation of the situation.
Pharmacist's role
Obtain needed medications.
Look for medication related causes of the patient's deterioration.
Assist the team as needed, often by reading aloud recent labs and meds administered.
Anticipate and prepare in advance for the patient's pharmacotherapy needs.
Problems encountered during rapid response calls are primarily due to problems with
OXYGEN DELIVERY*
*Sometimes the problem is with ATP generation (hypoglycemia)
Nerdy pharmacist equation:
Oxygen Delivery = stroke volume x heart rate x hemoglobin x %oxygen saturation
Bonus nerdy equation:
Blood Pressure = cardiac output x peripheral vascular resistance
Let's take a moment to review some common causes of decreased oxygen delivery...
Conditions that lower % oxygen saturation
Functional airway obstruction
Caused by a decreased level of consciousness whereby muscles relax and allow the tongue to obstruct the pharynx.
Treatments include:
- Airway maneuvers
- Antidote therapy
- Intubation
Mechanical airway obstruction
This could be caused by aspiration of foreign body, angioedema, bleeding, or stridor.
Treatments include:
-
18 min
August 03, 2015 3: Pharmacists as members of the rapid response team
Show notes at pharmacyjoe.com/episode3 In this episode I will be discussing pharmacist participation on rapid response teams.
18 min
July 27, 2015 2: Pharmacist Response to Code Blue Continued Critical Care Hospital Pharmacy Podcast Episode 2

In this episode I will continuing discussing pharmacist response to code blue calls.
I'll wrap up a few things from episode 1 and review the ACLS cardiac arrest algorithm.
I ended episode 1 with the following:
- At the start of the code open and assemble an epinephrine syringe.
- Obtain 6 NS flushes and prepare them for immediate use.
- Attach a needle to a 10 mL syringe.
- Locate additional supplies as necessary for requested medications.
- Stay focused on the physician running the code.
Now its time to dispense some drugs!
When handing medications to the nurse, loudly and clearly state the name and dose of the medication as you hand it over.
Do not hand over an unlabeled medication!
Obtain or prepare another dose of the medication that was just used based on your knowledge of ACLS (i.e. epinephrine, sodium bicarb, amiodarone but not vasopressin).
Keep track of empty boxes/vials as the team often wants to know how many doses of the medications have already been used.
In conjunction with the recording nurse, keep track of timing between doses of epinephrine.
Obtain allergies, weight, height, age, gender when possible.
Always remain focused on the physician running the code.
Watch and be aware of events going on around you.
Never leave a code that is underway without arranging for someone to handle medications (Shout out to "Pharmacy Daniella" for doing this several times for me!).
Assist with resuscitation care if ROSC is obtained.
Obtain medications not already in the code cart by utilizing the appropriate resource.
ACLS algorithm

The point of ACLS training is to make sure everyone is on the same page at the start of the code, minimize errors, and allow a functional team composed of people who may not be familiar with each other.
If your pt is to survive they need 2 things:
1. high quality uninterrupted chest compressions
2. rapid ID and correction of reversible causes <——this is where a pharmacist comes in
In the next episode, I will discuss pharmacist participation on the rapid response team.

If you like this post, check out my book - A Pharmacist's Guide to Inpatient Medical Emergencies: How to respond to code blue, rapid response calls, and other medical emergencies.

13 min
July 27, 2015 2: Pharmacist response to code blue continued
Show notes at pharmacyjoe.com/episode2 In this episode I will continuing discussing pharmacist response to code blue calls.
13 min
July 23, 2015 1: Patients Will Die Less Often If A Pharmacist Responds to Code Blue Calls Critical Care Hospital Pharmacy Podcast Episode 1

Why should Pharmacy Nation respond to code blue calls?
It's simple.
Patients will die less often. To the tune of 12,880 reduced deaths in 2007, p=0.009 according to:
Bond, C. A. and Raehl, C. L., Clinical Pharmacy Services, Pharmacy Staffing, and Hospital Mortality Rates. Pharmacotherapy 2007, 27: 481–493.
Even without any data I still think you should be there at the codes Pharmacy Nation!
A code is a high-stress situation with rapid decisions being made about medications - why shouldn't a pharmacist be involved?
You wouldn't jump from a plane without a parachute despite a lack of evidence that parachutes prevent death from gravitational challenge would you?
Roles and expectations of a pharmacist at a code
Role 1 - Assume responsibility for the provision of pharmacotherapy
- Locate/obtain necessary medications quickly and easily
- Calculate doses, rates, concentrations correctly
- Prepare and label medications appropriately
- Provide IV compatibility information
Role 2 - Actively participate in medical decision making
- Make treatment recommendations
- Determine the cause of deterioration
Role 3 - Anticipate patient and provider needs and prepare in advance to meet those needs
- Be the pessimist in the room and always plan for "what is the worst thing that could go wrong right now?"
Role 4 - Function as a knowledgeable team member
- Make an effort to know the purpose and location of the non-drug contents of the code cart
- Be aware of what is going on around you
Other team members you can expect at the code
- Patient's nurse
- Critical care nurse
- Respiratory therapist
- Patient care technician
- Physician (hospitalist / intensivist / cardiologist / other)
How to respond
Remain calm! Each code will be a different scenario; be alert and pay attention. You will become more comfortable each time you attend a code.
At my institution, notification will come via the overhead page system and code beeper.
Take stairs when possible to reach the site of the code. The elevator will slow you down too much.
When you enter room/area identify yourself to staff already in attendance.
Make your initial observations
Are chest compressions being performed?
What does the patient look like?
Respiratory distress?
Unresponsive?
Alert?
What other team members are present?
Get to work
19 min
July 23, 2015 1: Patients will die less often if a pharmacist responds to code blue calls
Show notes at pharmacyjoe.com/episode1. In this episode I’ll discuss why pharmacists should respond to code blue calls.
19 min

About The Elective Rotation: A Critical Care Hospital Pharmacy Podcast

From the publisher's feed

The Elective Rotation - the number 1 ranked Hospital Pharmacy podcast - is created for YOU Pharmacy Nation! If you are a Pharmacy Student, Resident, Pharmacist, Nurse, Physician, or Critical Care…