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Rapid Response System

A Practical Guide

Edited by Raghavan Murugan and Joseph M. Darby
Series edited by John A. Kellum

Pittsburgh Critical Care Medicine

Highlights practical evaluation and management aspects of common medical emergencies
Extensive focus on patient management will be invaluable to rapid response team members at the bedside
A useful reference for junior physicians and nursing staff

Rapid Response System

A Practical Guide

Edited by Raghavan Murugan and Joseph M. Darby
Series edited by John A. Kellum

Pittsburgh Critical Care Medicine

Description

Rapid Response System: A Practical Guide provides a practical approach to the evaluation, differential diagnosis, and management of common medical and surgical emergencies such as cardiac arrest, acute respiratory failure, seizures, and hemorrhagic shock occurring in hospitalized patients. Less common and special circumstances such as pediatric, obstetric, oncologic, neurologic and behavioral emergencies as well as palliative care for terminally ill patients encountered in the context of rapid response team events are also discussed. An overview of commonly performed bedside emergency procedures by rapid response team members complements the clinical resources that may need to be brought to bear during the course of the rapid response team event. Finally, an overview of organization, leadership, communication, quality and patient safety surrounding rapid response team events is provided.

This book is written with medical students, junior physicians and nursing staff in mind working in both academic and community hospital settings. Both a novice and an experienced healthcare provider involved in a rapid response system will find this handbook to be valuable supplement to the clinical experiences gained though active engagement in the system.

Hospital administrators and senior management staff will also find this book to be useful in the evaluation of quality and performance of the rapid response system, management of staff attitudes and behavior, performance of peer review, care for second victims and implementation of countermeasures for patient safety problems discovered in the course of rapid response system reviews.

Rapid Response System

A Practical Guide

Edited by Raghavan Murugan and Joseph M. Darby
Series edited by John A. Kellum

Pittsburgh Critical Care Medicine

Foreword Introduction to Rapid Response Team
Michael A. DeVita
Part I: Rapid Response Teams
1 Evolution and Evidence for Rapid Response Teams
Richard L. Simmons and Muhammad Tahseen, MD
2 Rapid Response Team Organization and Activation
Carol Curio Scholle, MSN, RN
3 Leadership and Crisis Management
Brad W. Butcher, MD
Part II: Common Emergency Syndromes and Management
4 In-Hospital Cardiac Arrest
Jonathan Elmer, MD, MS, and Abhishek Freyer, MD
5 Atrial Fibrillation and Other Cardiac Arrhythmias
Rinaldo Bellomo, MD, PhD, and Antoine Schneider, MD, PhD
6 Hypoxemia and Respiratory Failure
Jeffrey K. Javed, MD, and Jason E. Moore, MD, MS
7 Seizures and Altered Mental Status
Ruchira Jha, MD, Jodi Manners, MD, and Kiruba Dharaneeswaran, MD
8 Hypotension and Shock
Christopher K. Schott, MD, MS, RDMS, FACEP, and Jessica A. Fozard, NREMT-P, BS
9 Hypertensive Emergencies
Chenell Donadee, MD, and Hitesh Gidwani, MD
10 Bleeding Emergencies
Michael C. Reede, MBBS, MPH, DPhil, FANZCA, FCICM, and Patrick C. Finn, MBBS.
11 Chest Pain and Acute Coronary Syndrome
Stephen D'Auria, MD, and Ravi Ramani, MD
12 Major Trauma
Louis H. Alarcon, MD, and Patrick R.Varley, MD
13 Sepsis
David T. Huang, MD, MPH, and Munish H. Lapsia, MD
Part III: Special Circumstances
14 Pediatric Emergencies
Cameron Dezfulian, MD, Christopher M. Horvat, MD, and Melinda F. Hamilton, MD, MSc
15 Obstetric Emergencies
David Muigai, MD, MMM, and Amir Shamshirsaz, MD
16 Behavioral Health Emergencies
Robin Valpey, MD, and Amy Crawford-Faucher, MD, FAAFP
17 Oncologic Emergencies
Harry S. Rafkin, MD
18 The Difficult Airway
Dennis Phillip, DO, and Joshua Knight, MD
19 Acute Stroke
Alexis Steinberg, MD, and Bradley J. Molyneaux, MD, PhD
20 Pulmonary Embolism
Agnes Koczo, MD, and Belinda Rivera-Lebro, MD, MS
21 Ventricular Assist Devices
Rajagopala Padmanabhan, MD, and Penny Sappington, MD
22 Management of Exsanguinating Hemorrhage: Hemostasis and Reduction
Sara P. Myers, MD, MA, MS, and Matthew D. Neal, MD
23 Palliative Care Interventions: Role in Rapid Response Team Events
Taylor Lincoln, MD, Jane Schell, MD, and Shannon Haliko, MD
Part IV: Emergency Procedures
24 Airway Management
James M. Dargin, MD, and Lillian L. Emlet, MD, MS
25 Emergency Vascular Access
Rajagopala Padmanabhan, MD, and Holt N. Murray, MD
26 Critical Care Ultrasound
Christopher K. Schott, MD, MS, RDMS, FACEP
27 Tube Thoracostomy
Matthew R. Rosengart, MD, MPH
Part V: Equipment
28 The Emergency Crash Cart
Sarah Martin-Cua, MBA, MSN, RN
29 Airway Equipment
Lillian L. Emlet, MD, MS, and James M. Dargin, MD
30 Point-of-Care Testing
Douglas E. Morgan, MBA, MSN, RN, CCRN
31 Portable Monitors and Defibrillators
Robert Bauer, MSN, CRNP, AG-ACNP-BC, and Raghavan Murugan, MD, MS
Part VI: Organization and Administration
Chapter 32: Hospital Policy
Carol Curio Scholle, MSN, RN
Chapter 33: Communication and Coordination of Care
Jeannine DiNella, RN, DNP, CCNS, and Terri Kress, RN, MSN, CEN
Chapter 34: Patient Safety and Quality Improvement
Lisa M. Painter, DNP, RN, Cheryl Janov, BSN, RN, and Richard L. Simmons

Rapid Response System

A Practical Guide

Edited by Raghavan Murugan and Joseph M. Darby
Series edited by John A. Kellum

Pittsburgh Critical Care Medicine

Author Information

Edited by Raghavan Murugan, Associate Professor of Critical Care Medicine; Medical Director, Critical Care Outreach Service, University of Pittsburgh Medical Center, and Joseph M. Darby, Professor of Critical Care Medicine, University of Pittsburgh Medical Center

Series edited by John A. Kellum, Professor and Vice Chair, Department of Critical Care Medicine, University of Pittsburgh Medical Centre

Dr. Raghavan Murugan is an Associate Professor in the Departments of Critical Care Medicine and the Clinical and Translational Science at the University of Pittsburgh School of Medicine. He is currently the Medical Director of the Rapid Response System at the University of Pittsburgh Medical Center and Chief of Intensive Care Unit at Magee Womens Hospital of UPMC.

Dr. Joseph M. Darby is Professor of Critical Care Medicine and Surgery at the University of Pittsburgh School of Medicine. He is a former Medical Director of the Rapid Response System at the University of Pittsburgh Medical Center. He is currently the Chief of Critical Care at UPMC Hamot Hospital and Co-Director of the NeuroTrauma ICU at the Presbyterian Hospital.

Contributors:

Louis H. Alarcon, MD,
Division of Trauma Surgery,
Department of General Surgery,
University of Pittsburgh Medical Center,
Pittsburgh, PA.

Robert Bauer MSN, CRNP, AG-ACNP-BC,
Department of Critical Care Medicine,
University of Pittsburgh School of Medicine,
Pittsburgh, PA.

Rinaldo Bellomo, MD, PhD,
Intensive Care Unit,
Austin Health, Heidelberg,
Melbourne, Victoria, Australia.

Brad W. Butcher, MD,
Assistant Professor of Critical Care Medicine,
Department of Critical Care Medicine,
University of Pittsburgh School of Medicine,
Pittsburgh, PA.

Amy Crawford-Faucher, MD, FAAFP,
Program Director,
Allegheny Health Network Forbes Family Medicine Residency Program,
Monroeville, PA.

Stephen D'Auria, MD,
University of Pittsburgh Medical Center Heart and Vascular Institute,
Division of Cardiology, Department of Medicine,
University of Pittsburgh School of Medicine,
Pittsburgh, PA.

James M. Dargin, MD,
Department of Pulmonary and Critical Care Medicine,
Lahey Hospital and Medical Center,
Burlington, MA.

Cameron Dezfulian, MD,
Safar Center for Resuscitation Research,
Department of Critical Care Medicine,
University of Pittsburgh School of Medicine,
Pittsburgh, PA.

Kiruba Dharaneeswaran, MD,
Neurology Resident, Department of Neurology,
University of Pittsburgh School of Medicine,
Pittsburgh, PA.

Jeannine DiNella, RN, DNP, CCNS,
Programmatic Nurse Specialist,
Cardiovascular and Pulmonary Medicine Services,
University of Pittsburgh Medical Center,
Pittsburgh, PA.

Chenell Donadee, MD,
University of Pittsburgh Medical Center,
University of Pittsburgh School of Medicine,
Pittsburgh, PA.

Jonathan Elmer, MD, MS,
Assistant Professor, Departments of Emergency Medicine and Critical Care
Medicine,
University of Pittsburgh School of Medicine,
Pittsburgh, PA.

Lillian L. Emlet, MD, MS,
Department of Critical Care Medicine,
University of Pittsburgh School of Medicine,
Pittsburgh, PA.

Patrick C. Finn, MBBS,
Department of Emergency Medicine,
Monash Health, 4th Combat Service Support Battalion, Australian Army,
Melbourne, Victoria, Australia.

Jessica A. Fozard, NREMT-P, BS,
Lake Erie College of Osteopathic Medicine,
Erie, PA.

Abhishek Freyer, MD,
Department of Critical Care Medicine,
University of Pittsburgh School of Medicine,
Pittsburgh, PA.

Hitesh Gidwani, MD,
University of Pittsburgh Medical Center,
Pittsburgh, PA.

Shannon Haliko, MD,
Clinical Instructor,
Division of Pulmonary, Allergy, and Critical Care Medicine,
Department of General Internal Medicine,
University of Pittsburgh School of Medicine,
Pittsburgh, PA.

Melinda F. Hamilton, MD, MSc,
Department of Critical Care Medicine,
University of Pittsburgh School of Medicine,
Pittsburgh, PA.

Christopher M. Horvat, MD,
Safar Center for Resuscitation Research,
Department of Critical Care Medicine,
University of Pittsburgh School of Medicine,
Pittsburgh, PA.

David T. Huang, MD, MPH,
Department of Critical Care Medicine,
University of Pittsburgh School of Medicine,
Pittsburgh, PA.

Cheryl Janov, BSN, RN,
Corporate Risk Management,
University of Pittsburgh Medical Center,
Pittsburgh, PA.

Jeffrey K. Javed, MD,
University of Pittsburgh Department of Critical Care Medicine,
University of Pittsburgh,
Pittsburgh, PA.

Ruchira Jha, MD,
Assistant Professor, Department of Critical Care Medicine,
University of Pittsburgh School of Medicine,
Pittsburgh, PA.

Joshua Knight, MD,
Department of Anesthesiology,
University of Pittsburgh Medical Center,
Pittsburgh, PA.

Agnes Koczo, MD,
Internal Medicine Department,
University of Pittsburgh School of Medicine,
Pittsburgh, PA.

Terri Kress, RN, MSN, CEN,
Advanced Clinical Education Specialist,
University of Pittsburgh Medical Center,
Pittsburgh, PA.

Munish H. Lapsia, MD,
Department of Critical Care Medicine,
University of Pittsburgh School of Medicine,
Pittsburgh, PA.

Taylor Lincoln, MD,
Hospice and Palliative Medicine Fellow,
Department of General Internal Medicine,
University of Pittsburgh School of Medicine,
Pittsburgh, PA.

Jody Manners, MD,
Neurology Resident, Department of Neurology,
University of Pittsburgh School of Medicine,
Pittsburgh, PA.

Sarah Martin-Cua, MBA, MSN, RN,
University of Pittsburgh Medical Center,
Pittsburgh, PA.

Bradley J. Molyneaux, MD, PhD,
Department of Neurology, Department of Critical Care Medicine,
University of Pittsburgh School of Medicine,
Pittsburgh, PA.

Jason E. Moore, MD, MS,
Department of Critical Care Medicine,
University of Pittsburgh School of Medicine,
Pittsburgh, PA.

Douglas E. Morgan, MBA, MSN, RN, CCRN,
Department of Critical Care Medicine,
University of Pittsburgh School of Medicine,
Pittsburgh, PA.

David Muigai, MD, MMM,
Assistant Professor, Section of Pulmonary, Critical Care, and Sleep Medicine,
Department of Medicine, Baylor College of Medicine.
Medical Director, Critical Care Medicine,
Texas Childrens Hospital, Pavilion for Women,
Houston, TX.

Holt N. Murray, MD,
Assistant Professor, Department of Critical Care Medicine,
University of Pittsburgh School of Medicine,
Chief of Critical Care Services,
UPMC Mercy Hospital,
Pittsburgh, PA

Raghavan Murugan, MD, MS,
Associate Professor of Critical Care Medicine,
University of Pittsburgh School of Medicine,
Pittsburgh, PA.

Sara P. Myers, MD, MA, MS,
Department of General Surgery,
University of Pittsburgh School of Medicine,
Pittsburgh, PA.

Matthew D. Neal, MD,
Department of Surgery and Critical Care Medicine,
University of Pittsburgh School of Medicine,
Pittsburgh, PA.

Rajagopala Padmanabhan, MD,
Chief Fellow, Department of Critical Care Medicine,
University of Pittsburgh Medical Center,
Pittsburgh, PA.

Lisa M. Painter, DNP, RN,
Director, Corporate Risk Management,
University of Pittsburgh Medical Center,
Pittsburgh, PA.

Dennis Phillips, DO,
Clinical Assistant Professor, Departments of Anesthesiology-Cardiothoracic Division and Critical Care Medicine,
University of Pittsburgh Medical Center,
Pittsburgh, PA.

Antoine Schneider, MD, PhD,
Adult Intensive Care Unit and Burn Center,
Centre Hospitalier Universitaire Vaudois,
Lausanne, Switzerland.

Amir Shamshirsaz, MD,
Maternal Fetal Medicine Fellow,
Maternal Fetal Medicine Program,
Department of Obstetrics and Gynecology,
Baylor College of Medicine,
Houston, TX.

Harry S. Rafkin, MD,
Medical Director, MICU, Department of Pulmonary Medicine,
University of Pittsburgh Medical Center,
Pittsburgh, PA.

Ravi Ramani, MD,
University of Pittsburgh Medical Center Heart and Vascular Institute,
Division of Cardiology, Department of Medicine,
University of Pittsburgh School of Medicine,
Pittsburgh, PA.

Michael C. Reade, MBBS, MPH, DPhil, FANZCA, FCICM,
Burns, Trauma and Critical Care Research Centre,
University of Queensland, Brisbane, Queensland, Australia.
Joint Health Command, Australian Defence Force,
Canberra, Australian Capital Territory, Australia.

Belinda Rivera-Lebron, MD, MS,
Assistant Professor of Medicine, Internal Medicine Department,
Division of Pulmonary, Allergy, and Critical Care Medicine,
University of Pittsburgh School of Medicine,
Pittsburgh, PA.

Matthew R. Rosengart, MD, MPH,
Associate Professor, Departments of Surgery and Critical Care Medicine,
University of Pittsburgh School of Medicine,
Pittsburgh, PA.

Penny Sappington, MD,
Medical Director of Cardiothoracic/Surgical Intensive Care Units,
Assistant Professor, Department of Critical Care Medicine,
University of Pittsburgh Medical Center,
Pittsburgh, PA.

Jane Schell, MD,
Assistant Professor,
Section of Palliative Care and Medical Ethics,
Department of General Internal Medicine,
University of Pittsburgh School of Medicine,
Pittsburgh, PA.

Carol Curio Scholle, MSN, RN,
Clinical Director,
University of Pittsburgh Medical Center,
Pittsburgh, PA.

Christopher K. Schott, MD, MS, RDMS, FACEP,
VA Pittsburgh Healthcare System,
Departments of Critical Care Medicine and Emergency Medicine,
University of Pittsburgh School of Medicine,
Pittsburgh, PA.

Richard L. Simmons,
Department of Surgery,
University of Pittsburgh Medical Center,
Pittsburgh, PA.

Alexis Steinberg, MD,
Department of Neurology,
University of Pittsburgh School of Medicine,
Pittsburgh, PA.

Muhammad Tahseen, MD,
Department of Critical Care Medicine,
University of Pittsburgh School of Medicine,
Pittsburgh, PA.

Robin Valpey, MD,
Psychosomatic Fellow, Department of Psychiatry,
University of Pittsburgh Medical Center,
Western Psychiatric Institute and Clinic,
Pittsburgh, PA.

Patrick R. Varley, MD,
Department of General Surgery,
University of Pittsburgh Medical Center,
Pittsburgh, PA.