medical ppt that can help you to observe

1. CODE BLUE
PROCEDURES
Luis Enriquez RN, BS.
Los Angeles County USC Medical Center
Department of Emergency Medicine

2. CODE BLUE TEAM
 Trained patient care providers who perform
resuscitation on any person who sustains
Cardiopulmonary arrest
Respiratory arrest
Airway problem
 Train providers:
Doctor
Nurse
Support Personnel

3. CODE BLUE ACTIVATION
 All employees must be educated to activate
Code Blue response in the event of
 Cardiac arrest
 Respiratory arrest
 Activate Code Blue Response by
 Calling Hospital Emergency Operator
 Provide Information: Patient location, Adult/Pediatric
 Hospital Emergency Operator will activate
response when notified of Code Blue event
 Code blue pager system
 Announce overhead the location of the code event

4. CODE BLUE MEMBERS
 Physician: Emergency Department
 Pediatric attending or senior resident
 Physician: Internal Medicine
 Physician: general Surgery
 Intensive Care Unit/Emergency Nurse
 Respiratory Therapist
 EKG (Electrocardiogram) Technician
 Nursing Supervisor Los Angeles County + USC
Medical Center
Code Blue Protocol

5. ROLE OF THE TEAM MEMBERS
EMERGENCY PHYSICIAN
 Team Leader: direct overall patient care
 Manage the Code
 Medication
 Defibrillation
 Other procedures: Intubation, compressions
 Evaluate Code Blue procedures
 Effectiveness of Chest Compression
 Effectiveness of assisted respirations
 Rhythm/pulse check
 Document in the medical record

6. ROLE OF THE TEAM MEMBERS
EMERGENCY NURSE
 Maintains airway/oxygenation/ventilation
 Applies monitor leads/defibrillator pads
 Starts Intravenous access
 Administer medications
 Administers Electrical Shock (ACLS trained)
 Assist with intubation procedures
 Completes CPR record

7. ROLE OF THE TEAM MEMBERS
PRIMARY NURSE
 Activate code blue team
 Bring Emergency Resuscitation Cart
 Place backboard under patient
 Initiate 2 man Cardio Pulmonary Resuscitation
 Administer ventilations with 100% O2 with Bag/valve/mask
 Attach Electro cardiogram leads
 Attach “hands off” defibrillator pads
 Ensure patient Intra Venous access
 Prepare suction
 Obtain supplies from CPR Cart/Ward Stock
 Record events on CPR record

8. CODE BLUE
NURSING SKILLS
 Identify respiratory/cardiac arrest
 Activate Code Blue
 Oxygen administration: Nasal cannula, mask
 Bag-Valve-Mask resuscitation with 100% O2
 Cardiac Monitor/defibrillator pads Application
 Intra Venous access
 Medication Administration
 Defibrillation (ACLS trained)
 CPR documentation

9. ROLE OF THE TEAM MEMBERS
SUPPORT PERSONNEL
 Respiratory Therapist
Maintains airway and oxygenation/ventilation
Assist with intubation procedures
 EKG Technician: Performs 12-lead EKG
 Pharmacist: Prepares medications

10. BASIC LIFE SUPPORT
SURVEY
1- Establish Unresponsiveness
2- Activate Emergency Response System
3- Circulation
4- Defibrillation

11. Simplified adult BLS algorithm.
Berg R A et al. Circulation 2010;122:S685-S705
Copyright © American Heart Association

12. ESTABLISH
UNRESPONSIVENESS
 Tap and Shout “are you all right”
 Check for absent/abnormal breathing
by scanning the chest for movement

13. ACTIVATE THE EMERGENCY
RESPONSE SYSTEM
 Call for help or send someone for help
Yell for help
Code Blue protocol
 Get the Automatic External Defibrillator

14. CIRCULATION
 Check corotid pulse for 5-10 seconds
 If no pulse Begin Cardio Pulmonary Resuscitation
 Compress center of chest (lower ½ of sternum)
 Ratio: 30:2 compressions to breaths
 Depth: at least 2 inches
 Rate: at least 100 compressions per minute
 Allow complete chest recoil
 Minimize interruptions
 Switch providers every 2 minutes
 Avoid excessive ventilation
 If pulse present start rescue breathing
 1breath every 5-6 seconds (10-12 breaths per min.)
 Check pulse every 2 minutes

15. DEFIBRILLATION
 If no pulse check for shockable
rhythm as soon as AED arrives
 Provide shocks as indicated
 Follow each shock immediately with
CPR compressions

16. Advance Cardiac
Life Support Survey
 Airway
 Breathing
 Circulation
 Differential Diagnosis

17. AIRWAY
 Maintain patent airway in unconscious Pt’s
Head tilt chin lift
Simple airway adjuncts:
 Use advance airway if needed:
Confirm proper placement
 Physical exam
 Quantitative waveform Capnography
Secure Device to prevent dislodgement
Monitor airway placement with continuous
quantitative waveform Capnography

18. BREATHING
 Supplemental O2 when indicated
Titrate O2 to oxygen sat ≥ 94% non arrest Pt’s
100% O2 for Pt’s in cardiac arrest
 Monitor adequacy of ventilation and
oxygenation
Clinical criteria: chest rise and cyanosis
Quantitative waveform capnography
Oxygen saturation
 Avoid excessive ventilation

19. CIRCULATION
 Monitor CPR quality
 Attach monitor/Defibrillator
 Monitor for arrhythmias or arrest rhythms
 Provide defibrillation/Cardioversion
 Obtain IV/IO access
 Give appropriate drugs
 Give fluids if needed

20. DIFFERENTIAL DIAGNOSIS
search for and treat reversible causes
H’s AND
 Hypoxia
 Hypovolemia
 Hydrogen ion (acidosis)
 Hypo/hyper kalemia
 Hypothermia
T’s
 Tension pneumothorax
 Tamponade cardiac
 Toxins
 Thrombosis Pulmonary
 Thrombosis Coronary

21. ACLS
Cardiac
Arrest
Algorithm.
Copyright © American Heart Association

22. ACLS Cardiac Arrest Circular Algorithm.
Neumar R W et al. Circulation 2010;122:S729-S767
Copyright © American Heart Association

23. Bradycardia Algorithm.
Neumar R W et al. Circulation 2010;122:S729-S767
Copyright © American Heart Association

24. Tachycardia Algorithm.
Neumar R W et al. Circulation 2010;122:S729-S767
Copyright © American Heart Association

25. NSR with Ectopy > VT>VF>NSR
• A 48 year old iron worker is brought to the
Emergency Department by co-workers following an
onset of sudden sever “pressure-type” chest pain
radiating to his neck, jaw and left arm.
• He is pale slightly diaphoretic, and very anxious.
Wide-complex tachycardia >VF>NSR
• A 63-Year-old woman alcoholic with a history of
CHF is brought to the hospital by her daughters
becouse of worsening symptoms of dyspnea, cough
and wheezing.
• She looks moderately ill but denies chest pain.