CCN ACLS SIMULATION SCRIPT

FIRST SCENE

*Pasok room ni Patient*

TL: Hi sir good afternoon, how are you feeling today?
*Px unresponsive*
TL: Sir?
*pinch px hands* *pain assessment*
*Check the pulse and breathing*
TL: *Start the CPR*
TL: CODE BLUE CODE BLUE!!!
TL: *closes door or curtain for patient privacy*

SECOND SCENE

(IF PX IS IN Ventricular tachycardia)

*Papasok lahat rushing*

TL: Zinnia you’re in charge of the defibrillator and e-cart, Ces and Dianne for CPR and
Ambu Bag, and Yasmina you do the documentation and recording make sure to
document the time and procedure done and I’ll assign you to check if the CPR is
properly executed.
TL: Changing position *Dianne start CPR*
Dianne: Started CPR
TL: We have a ventricular tachycardia, make sure to do the 30:2 ratio
Ces: Start with AMBU bag (make sure na nagbibilang kayo)
TL: attach patient to defib and monitor
*ZIN ATTACH PATIENT TO DEFIB AND MONITOR*
TL: Charge defib to 120 joules
Zin: Clear the patient, 3 2 1 shocking; shock delivered
TL: Continue CPR for 2 minutes
*DIANNE CONTINUE CPR*
TL: Do we have an IV site?
Zinnia: (if meron sabihin mo yes, if wala sasabihin ko okay let’s proceed with
intraosseous)
Zinnia: We have an access site now
TL: Okay good, we still have a VT
TL: Zinnia, kindly prepare 1mg of epinephrine
Zin: 1 mg of epinephrine - Epinephrine preparing - 1mg epinephrine prepared
TL: Okay good.
Yasmina: 2minutes
TL: Okay let’s analyze, Do we have a pulse?
CES AND DIANNE: (bahala na kayo kung ano isasagot)
TL: we still have a vtach - Zin, charge defib to 150 Joules
Zin: Charging defib 150 joules
Zin: Clear the patient, 3 2 1 shocking; shock delivered
TL: Continue CPR, change position Ces and Dianne, please administer epinephrine.
*CES NAMAN FOR CPR* *2mins*
Zin: *push epi* 1 mg of epinephrine given with 20mL IV flush
TL: We have given 2 shocks and 1 epi. Now we will consider amiodarone. Please
prepare 300mg of amiodarone.
Zin: 300 mg of amiodarone, amiodarone preparing. 300 mg of amiodarone prepared.

TAKE NOTE: if possible for advance airway (insert ET)

ET INSERTED MAKE SURE NAGBIBIGAY PARIN NG 1breath every 6minutes

(IF PX IS IN ASYSTOLE)

TL: Zinnia you’re in charge of the defibrillator and e-cart, Ces and Dianne for CPR and
Ambu Bag, and Yasmina you do the documentation and recording make sure to
document the time and procedure done and I’ll assign you to check if the CPR is
properly executed.

TL: Patient on asystole. Zinnia do we have an IV site?

Zinnia: Yes, IV site secured.
TL: Give 1mg EPI ASAP.
Zinnia: 1mg of epi - preparing EPI 1 mg…. 1mg of EPI given.
YASMINA WILL DOCUMENT
TL: Ces, check airway and start ambu bag if airway is clear.
Ces: Airway clear, starting ambu bag.
YASMINA WILL DOCUMENT

*check if rhythm is shockable or not*

if not shockable…
TL: Dianne, start CPR at 30:2 ratio
Dianne: Starting CPR.

If still not shockable consider giving epinephrine

TL: Give 1mg EPI ASAP.
Zinnia: 1mg of epi - preparing EPI 1 mg…. 1mg of EPI given.
YASMINA WILL DOCUMENT
*TL will check rhythm, if the rhythm changed to shockable…*

TL: Zinnia, charge defib to 150 joules.

Zinnia: Charging defib at 150 joules… clear the patient… 3 2 1… shock given.
YASMINA WILL DOCUMENT
TL: Okay, thanks. Dianne and Ces switch positions then continue CPR.
Ces: Continuing CPR.
YASMINA WILL DOCUMENT & INFORM IF 2 MINS DONE
TL: *after 2 minutes* Zinnia, give 1mg Epi second dose.
Zinnia: Preparing EPI 1 mg…. 1mg of EPI second dose given.
YASMINA WILL DOCUMENT

*if rhythm remains shockable*

TL: Okay Zin, charge defib at 200 joules and give shock.
Zinnia: Charging defib at 200 joules… clear the patient… 3 2 1 shock given.
YASMINA WILL DOCUMENT

*check rhythm and announce kung ano na pagbabago, if nag remain…*

TL: Ces/Dianne continue CPR at 30:2 ratio

Ces/Dianne: Continuing CPR.
YAS, DOCU

TL: Zinnia, prepare and give 300 mg bolus.

Zinnia: preparing amiodarone 300mg…. 300 mg of amiodarone first dose given.
YAS, DOCU

NOTE: *IF STILL NO SIGNS OF ROSC, PROCEED TO ROSC ALGORITHM*

(IF PX IS ON POST CARDIAC ARREST)

TL: now we have (RHYTHM) continue resuscitation. refer ET tube placement.
Dianne: ET tube placement is done. confirming placement of ET tube.
TL: Ces, start ambu 10bpm.
Ces: starting ambu 10bpm.
TL: Zinnia, refer patient for SPO2 and PaCO2 measurements to the laboratory.
Zinnia: referring px.
TL: Dianne, pls check bp of the px.

IF SYSTOLIC IS GREATER THAN 90 mmHg or MAP is GREATER THAN 65 mmHg,

administer crystalloid or vasopressor.

Dianne: bp is (ANSWER).
TL: Ces place ECG leads.
Ces: placing ECG leads.

TL: is the px CONSCIOUS?

Dianne: px is awake.
TL: check core temperature by rectal / esophageal, continue monitoring EEG.
Dianne: checking core temp, monitoring EEG.
TL: evaluating and treating rapidly reversible etiology. referring expert consultation for
continued management.

TL: is the px UNCONSCIOUS?

Dianne: px comatose.
TL: start TTM, monitor EEG, refer for brain CT.
Dianne: starting TTM, monitoring EEG.
Zinnia: referring for brain CT.
TL: evaluating and treating rapidly reversible etiology. referring expert consultation for
continued management.

BRADYCARDIA

TL: *assess vital signs: pulse, heart rate, BP, oximetry, & cardiac monitor* Px heart rate
is less than 50 bpm (indicating bradyarrhythmia). Dianne, check px airway and assist
breathing (as necessary).
TL: Proceed putting a 12-Lead ECG
Ces: 12-lead ECG preparing. ECG done.

TL: IF persistent bradyarrhythmia is NOT causing complications: Continue monitoring &

observing the px.

TL: IF persistent bradyarrhythmia causing hypotension, acutely altered mental status,

signs of shock, ischemic chest discomfort, or acute heart failure, Zin does patient have
IV site?
Zin: Yes, IV site secured.
TL: Proceed giving Atropine IV dose, 1mg bolus. Repeat every 3-5 mins. Yasmina,
monitor the time.
Zin: Atropine 1mg bolus, first dose prepared. Atropine 1mg bolus, first dose given
through IV.
Yasmina: 3 mins
Zin: Atropine 1mg bolus, second dose prepared. Atropine 1mg bolus, second dose
given through IV….
IF Atropine is ineffective,
TL: Start transcutaneous pacing
Or
TL: Start Dopamine IV infusion, 5-20 mcg/kg per min (usual infusion). (Titrate to px
desired response and taper slowly.)
Zin: Dopamine IV infusion __ mcg/kg per min prepared. Dopamine IV infusion __
mcg/kg per min given.
Or
TL: Start Epinephrine IV infusion, 2-10 mcg/per min infusion. (titrate to px response)
Zin: Epinephrine IV infusion __ mcg/per min prepared. Epinephrine __ mcg/per min
given through IV.

Consider:
TL: referring px to expert consultation for continuous management.
OR
TL: considering transvenous pacing.

TACHYCARDIA
TL: *Assess vital signs: pulse, heart rate and medical history, cardiac monitor*
Patient’s heart rate is more than 150 bpm indicating a tachyarrhythmia. Dianne, check
the airway and assist breathing.
TL: Ces put a 12-lead ECG.
Ces: 12-lead ECG preparing.
Ces: ECG done.
*check ECG results*

*If persistent tachyarrhythmia: proceed to

TL: Zin prepare adenosine 6 mg through IV push with NS flush.
Zin: Preparing adenosine 6 mg.
Zin: Adenosine 6 mg prepared. Ready for administration.

*If not wide QRS greater than 0.12 second*

TL: Place patient in supine position, prepare for vagal maneuver.
TL: Zin prepare adenosine 6 mg through IV push with NS flush. Prepare beta-blocker.\
Zin: Preparing adenosine 6 mg and beta-blocker.
Zin: Adenosine 6 mg and beta-blocker prepared.

*If wide QRS greater than 0.12 second*

TL: Zin prepare adenosine 6 mg through IV push with NS flush. Prepare antiarrhythmic
infusion.
Zn: Preparing adenosine 6 mg. Preparing amiodarone 150 mg through IV.

*If refractory,
TL: *Checks underlying cause such as hypotension, altered mental status, signs of
shock