Code blue

Code Blue

American Heart Association Basic Life Support, Advanced
Cardiac Life Support, and Pediatric Advanced Life Support
protocols are implemented promptly upon recognition of
cardiopulmonary arrest unless a written physician order
states otherwise
 Associates in areas where patient care is delivered complete a
BLS course or are trained in BLS every two years according to
AHA standards
 Whenever a Code Blue is called, the attending physician is
notified as soon as possible

Code Blue (continued)

Nurses working in critical care,
emergency department, nursing
supervisors, and other key personnel
successfully complete a course in
Advanced Cardiac Life Support (ACLS)
according to AHA standards every two
years
 The first associate to the arrest scene
assesses the situation, calls for help,
and begins CPR


 The code for cardiopulmonary arrest is CODE BLUE
• Code Blue is also called for patients with acute respiratory
distress and/or severe hypotension
 The emergency phone number is 5555
• This number provides a direct line to notify the switchboard
operator of the Code Blue
• When the operator answers, the caller indicates the location
of the arrest by stating Code Blue Room ___
 The operator may also be notified of a Code Blue by activating
the Code Blue button, where present, in the patient room

 On the South Campus the Emergency Code can be called by
activating the Code Blue button in the room or dialing 5555 or by
dialing 66 from the patient room
 When dialing 66 you are automatically on the intercom and may
call the Code by saying “CODE BLUE”, Room ______” three times.
 The operator will then continue to page every 10 seconds until
notified to discontinue the page
 The Paramedic Service is notified by picking up the “Blue Phone”
on the station.
�� The closest exterior entrance doors for Paramedic arrival are
opened by a staff member.
 The paramedic Service dispatch transports the patient to White
County Medical Center Emergency Department

 Important: Let the operator know as soon as the code team is
assembled to discontinue the overhead page
• To do this, dial 5555 and state “STOP PAGING THE CODE”
• The operator will then stop announcing the location of the code
 If a code is called mistakenly, let the operator know by dialing 5555
and state “CODE BLUE ALL CLEAR”
• The operator will then announce “CODE BLUE ALL CLEAR” and
there is no longer any need to respond
• Do not say “CODE BLUE ALL CLEAR” unless the situation has
been resolved or the code was called by mistake and help is not
needed
 These are the only two phrases the operator will recognize relating
to Code Blue


 Advanced Cardiac Life Support is provided by the Code Team
and is continued until:
• Effective spontaneous circulation and ventilation is restored
as determined by the team captain
• The physician makes the decision to terminate resuscitative
efforts based on the evaluation of the cerebral and
cardiovascular status of the patient
 Respiratory Distress/Hypotension
• In the event a patient needs immediate medical attention as
a result of acute respiratory distress and/or severe
hypotension a Code Blue is called


The code team consists of:
• ER physician
• nurse supervisor
• ER nurse
• charge nurse
• primary nurse of the patient
• Cardiopulmonary

Any RN who has successfully completed ACLS may act as team
captain until the MD arrives

Immediate Interventions are as follows:
 Whenever a patient is found to be pulseless a call for help is
made and BLS is initiated
 The patient is ventilated with 100 % oxygen and high quality
compressions are performed
 ECG monitoring is established
 BLS is continued until a defibrillator arrives
 If the patient has Ventricular Fibrillation or Pulseless Ventricular
Tachycardia the RN delivers appropriate defibrillation every 5th
cycle of CPR
 Epinephrine 1:10,000 1mg IVP is given every 3 to 5 minutes.
 The above therapy continues until the physician or an RN that
has completed ACLS is present to direct the team

The primary nurse is responsible for:
 Establishing EKG monitoring if not already done
 Assuring the patient's chart is in the room
 Notifying patient's attending physician of Code Blue
 Observing to determine when CPR team has arrived and
notifying operator to “Discontinue the Page”
 Recording on resuscitation sheet
 Directing CPR team members to appropriate room
 Assisting in clearing room of unnecessary personnel and
equipment - assists with family members
 Obtaining equipment/supplies as needed
 After the code, the primary nurse is responsible for notifying
pharmacy to obtain an exchange cart


 The information from the code must be transcribed onto the
resuscitation record if not already
 Information on the resuscitation record need not be documented
again in CPSI
 Rhythm monitoring is included and is mounted and identified with
patient's name, chart number, date, time, and then attached to
the appropriate form
 A Code Review form is completed for every code by the shift
supervisor who then directs the form to the clinical manager of
the area

Code Blue (continued) - Pediatrics

In the event of a pediatric code:
 The pediatric crash cart and the adult crash cart are both taken to
the scene
 In the event of any delay in the arrival of a physician to the code
blue location, the following therapy is instituted by the
appropriate Code Blue team member:
An ACLS or PALS RN acts as team captain and is responsible for
evaluation of the patient's condition in regard to cardiac and respiratory
status
• Patient is ventilated with 100% oxygen and high quality
compressions are started as needed and pulse oximetry is applied

Interventions continued on next slide

Code Blue (continued) - Pediatrics

Interventions continued:
 Patient is intubated, placement of ET tube is verified with ETCO2
device, and tube is secured as soon as possible
 Defibrillate Ventricular Fibrillation or Pulseless Ventricular
Tachycardia
 Defibrillate once if needed, using 2J/kg
 Then defibrillate as needed after every 5 cycles of CPR using 4 J/kg
The above therapy continues until the physician is present to direct
the team

Code Blue (continued) – South Campus
 On the South Campus – the Code Team consists of:
• Nurse supervisor
• Charge nurse
• Primary nurse of the patient
• Cardiopulmonary
• CSA/HUC
 On the South Campus - BLS, use of the AED every two
minutes, starting an IV of normal saline, and giving epinephrine
1:10,000, 1mg IVP every 3 to 5 minutes while BLS is being
provided is performed by the code team until one of the following
occurs:
• Spontaneous circulation and ventilation is restored
• Decision is made to terminate resuscitative efforts

Code Blue (continued) – South Campus

 Paramedics assume charge of the patient arrest
situation upon arrival to the patient room
 The Code Team supports the paramedics with
care of the patient
 The patient is prepared for emergency transport
to the WCMC emergency department.
 Copies will need to be made of the
MAR, History, Face Sheet, and Progress Notes.
 Report is then called to the Emergency
Department as soon as possible, once patient is
in ambulance

Code Blue (continued) – Crash Cart

Whenever the crash cart is opened, an exchange cart is obtained from
the Pharmacy
 A Pharmacy requisition should be sent with the patient’s label on it
along with “replace crash cart”
 Nursing transfers items on top of the cart such as the defibrillator and
suction machine to the new cart
 Pharmacy takes the used cart and refills it
 If the exchange cart is unavailable, the used drawers are replaced with
stocked, sealed drawers – the cart is then resealed with a seal obtained
from Pharmacy
 Be sure to return the clear drawer covers and remove any used
equipment from the cart before calling pharmacy to obtain an
exchange cart


 All chargeable items used from the cart during a code are
charged in CPSI
 Medications used are charged by the Pharmacy when
replaced
 Other used items are charged to the patient with a
sticker or through the computer system by the area
where the supplies were used
 Remember to charge all stickered items used from the
cart in CPSI
 Each cart is checked monthly for outdated drugs and
other supplies by the Pharmacy


Pediatric Crash Carts
 Pediatric Cardiac arrests are most
often secondary to respiratory
arrest
 All areas that care for pediatric
patients have age appropriate
equipment available for emergency
 The adult crash cart (which contains
additional medications) is taken to
the emergency situation along with
the Broselow Pediatric cart –
Pediatric carts are color-coded with
the Broselow tape


The Broselow Pediatric Emergency tape groups
children into colored-coded zones rather than
assigning individual kilogram weights
The system can be accessed by weight or length
• Length is used in emergencies only because
children cannot be weighed
If your patient’s length falls at the extremes
(upper or lower) of a respective color on the
Broselow’s tape, consider the next closest
color category and always follow clinical
guidelines
• Never use force to achieve it

Code blue

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