一位註冊護理師與呼吸治療師正在加護病房中應對一位發生心室顫動 (VF) 的病患所引發的『藍色急救代碼 (Code Blue)』。由於人力短缺，單位顯得相當混亂。主治醫師趕到現場並大聲要求護理師立刻推注 1 mg 神經性腎上腺素 (Epinephrine)。護理師的哪一項行動在緊急復甦中展現了最佳的跨團隊合作？
A registered nurse and a respiratory therapist are responding to a 'Code Blue' in the ICU for a client experiencing ventricular fibrillation. The unit is chaotic due to being short-staffed. The primary care provider arrives and loudly demands the nurse push 1 mg of epinephrine immediately. Which action by the nurse represents the best interdisciplinary collaboration during an emergency resuscitation?
- AInform the physician that according to unit protocols, epinephrine must only be pushed by the code team pharmacist.告知醫師根據單位規範，腎上腺素僅能由急救小組藥師推注
- BDraw up the medication, state 'I am pushing 1 mg of epinephrine IV now,' and wait for the physician's acknowledgement.抽吸藥物，聲明「我現在要靜脈推注 1 mg 腎上腺素」，並等待醫師確認正確答案
- CAsk the respiratory therapist to pause chest compressions for 30 seconds to ensure the IV medication flows smoothly into the central line.請呼吸治療師暫停胸部按壓 30 秒，以確保靜脈藥物順利流入中心靜脈導管
- DSilently draw up and push the epinephrine as quickly as possible to avoid interrupting the physician's flow.默默抽吸並盡快推注腎上腺素，以避免打斷醫師的流程
- B抽吸藥物，聲明「我現在要靜脈推注 1 mg 腎上腺素」，並等待醫師確認
本題測驗緊急狀況下的閉環溝通 (Closed-loop communication / Interdisciplinary collaboration)。在任何急救小組 (Code team) 運作中，減少失誤與維持團隊合作的核心技術是『閉環溝通 (Closed-loop communication)』。當醫師下達口頭命令給藥時，護理師的標準專業行為絕不能是默默執行（選項 D 錯誤，因為如果沒人確認，可能會被重複給藥或給錯劑量）。正確的標準流程是：護理師覆誦該指令，大聲宣告自己正在執行什麼動作（『我現在正在從靜脈推注 1 mg 的 Epinephrine』），並確保團隊領袖（通常是醫師）已經聽到並確認。這能確保整個跨科團隊對急救藥物的注射進度保持同步（選項 B 正確）。選項 C 錯誤，CPR 按壓絕對不能為了打藥而暫停 30 秒，維持胸腔按壓 (Chest compressions) 才是 VF 存活的最優先事項。選項 A 錯誤，在急救中護理師完全有資格與權力推注常規急救藥物，不需要全部依賴藥師。
- A告知醫師根據單位規範，腎上腺素僅能由急救小組藥師推注
註冊護理師在藍色急救代碼情況下常規地會推注高級心臟救命術 (ACLS) 藥物。
- B · 正確答案抽吸藥物，聲明「我現在要靜脈推注 1 mg 腎上腺素」，並等待醫師確認
閉環溝通安全地確認了正確劑量，並主動通知整個跨界團隊該介入措施已完成。
- C請呼吸治療師暫停胸部按壓 30 秒，以確保靜脈藥物順利流入中心靜脈導管
在主動進行心肺復甦期間，絕不可為了給藥而中斷高品質的胸部按壓。
- D默默抽吸並盡快推注腎上腺素，以避免打斷醫師的流程
在心跳停止期間默默給藥會滋生致命的醫療錯誤、重複給藥以及團隊混亂。
ACLS 急救流程與團隊溝通中的 Closed-loop communication (閉環溝通) 在全世界都是強制標準。收到口頭醫囑，必定大聲覆誦，施打當下也要喊出來讓紀錄者 (Recorder) 聽見。
English explanation
Option B is correct because the nurse should use closed-loop communication during emergency resuscitation. After receiving the verbal order, the nurse draws up the medication, clearly repeats that 1 mg of epinephrine is being pushed IV, and waits for the team leader to acknowledge the message. This process keeps the interdisciplinary team synchronized about medication administration and reduces errors. Option A is incorrect because a nurse is qualified and authorized to push routine emergency medications during resuscitation and does not need to depend entirely on a pharmacist. Option C is incorrect because chest compressions must not be paused for 30 seconds merely to help the IV medication flow; maintaining chest compressions is the highest priority for survival during ventricular fibrillation. Option D is incorrect because silently administering the medication prevents confirmation and could result in a repeated dose or an incorrect dose.
最近修訂：2026-10-04