Code BlueAmerican Heart Association Basic Life Support, AdvancedCardiac Life Support, and Pediatric Advanced Life Supportp...
Code Blue (continued)Nurses working in critical care,emergency department, nursingsupervisors, and other key personnelsucc...
Code Blue (continued) The code for cardiopulmonary arrest is CODE BLUE   • Code Blue is also called for patients with acu...
Code Blue (continued) On the South Campus the Emergency Code can be called by  activating the Code Blue button in the roo...
Code Blue (continued) Important: Let the operator know as soon as the code team is  assembled to discontinue the overhead...
Code Blue (continued) Advanced Cardiac Life Support is provided by the Code Team  and is continued until:   • Effective s...
Code Blue (continued)The code team consists of:   • ER physician   • nurse supervisor   • ER nurse   • charge nurse   • pr...
Code Blue (continued)Immediate Interventions are as follows: Whenever a patient is found to be pulseless a call for help ...
Code Blue (continued)The primary nurse is responsible for:    Establishing EKG monitoring if not already done    Assurin...
Code Blue (continued) The information from the code must be transcribed onto the  resuscitation record if not already In...
Code Blue (continued) - PediatricsIn the event of a pediatric code: The pediatric crash cart and the adult crash cart are...
Code Blue (continued) - PediatricsInterventions continued: Patient is intubated, placement of ET tube is verified with ET...
Code Blue (continued) – South Campus On the South Campus – the Code Team consists of:   • Nurse supervisor   • Charge nur...
Code Blue (continued) – South Campus Paramedics assume charge of the patient arrest  situation upon arrival to the patien...
Code Blue (continued) – Crash CartWhenever the crash cart is opened, an exchange cart is obtained fromthe Pharmacy A Phar...
Code Blue (continued) – Crash Cart All chargeable items used from the cart during a code are  charged in CPSI Medication...
Code Blue (continued) – Crash CartPediatric Crash Carts Pediatric Cardiac arrests are most  often secondary to respirator...
Code Blue (continued) – Crash CartThe Broselow Pediatric Emergency tape groups     children into colored-coded zones rathe...
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Code blue

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Code blue

  1. 1. Code BlueAmerican Heart Association Basic Life Support, AdvancedCardiac Life Support, and Pediatric Advanced Life Supportprotocols are implemented promptly upon recognition ofcardiopulmonary arrest unless a written physician orderstates 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
  2. 2. Code Blue (continued)Nurses working in critical care,emergency department, nursingsupervisors, and other key personnelsuccessfully complete a course inAdvanced Cardiac Life Support (ACLS)according to AHA standards every twoyears The first associate to the arrest scene assesses the situation, calls for help, and begins CPR
  3. 3. Code Blue (continued) 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
  4. 4. Code Blue (continued) 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
  5. 5. Code Blue (continued) 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
  6. 6. Code Blue (continued) 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
  7. 7. Code Blue (continued)The code team consists of: • ER physician • nurse supervisor • ER nurse • charge nurse • primary nurse of the patient • CardiopulmonaryAny RN who has successfully completed ACLS may act as teamcaptain until the MD arrives
  8. 8. Code Blue (continued)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
  9. 9. Code Blue (continued)The primary nurse is responsible for:  Establishing EKG monitoring if not already done  Assuring the patients chart is in the room  Notifying patients 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
  10. 10. Code Blue (continued) 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 patients 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
  11. 11. Code Blue (continued) - PediatricsIn 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 forevaluation of the patients condition in regard to cardiac and respiratorystatus • Patient is ventilated with 100% oxygen and high quality compressions are started as needed and pulse oximetry is applied Interventions continued on next slide
  12. 12. Code Blue (continued) - PediatricsInterventions 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/kgThe above therapy continues until the physician is present to directthe team
  13. 13. 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
  14. 14. 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
  15. 15. Code Blue (continued) – Crash CartWhenever the crash cart is opened, an exchange cart is obtained fromthe 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
  16. 16. Code Blue (continued) – Crash 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
  17. 17. Code Blue (continued) – Crash CartPediatric 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
  18. 18. Code Blue (continued) – Crash CartThe Broselow Pediatric Emergency tape groups children into colored-coded zones rather than assigning individual kilogram weightsThe system can be accessed by weight or length • Length is used in emergencies only because children cannot be weighedIf 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

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