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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