CODE BLUE PROCEDURES

Luis Enriquez RN, BS.

Los Angeles County USC Medical Center Department of Emergency Medicine

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

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

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 Los Angeles County + USC Nursing Supervisor Medical Center

Code Blue Protocol

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

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

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

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

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

BASIC LIFE SUPPORT

SURVEY
1- Establish Unresponsiveness 2- Activate Emergency Response System 3- Circulation 4- Defibrillation

Simplified adult BLS algorithm.

Berg R A et al. Circulation 2010;122:S685-S705

Copyright American Heart Association

ESTABLISH UNRESPONSIVENESS
Tap

and Shout are you all right Check for absent/abnormal breathing by scanning the chest for movement

ACTIVATE THE EMERGENCY RESPONSE SYSTEM

Call for help or send someone for help

Yell

for help Code Blue protocol

Get the Automatic External Defibrillator

CIRCULATION

Check corotid pulse for 5-10 seconds If no pulse Begin Cardio Pulmonary Resuscitation

Compress center of chest (lower 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

DEFIBRILLATION
If

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

Advance Cardiac Life Support Survey

Airway

Breathing
Circulation

Differential

Diagnosis

AIRWAY

Maintain patent airway in unconscious Pts

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

BREATHING

Supplemental O2 when indicated

O2 to oxygen sat 94% non arrest Pts 100% O2 for Pts in cardiac arrest
Titrate

Monitor adequacy of ventilation and oxygenation

Clinical

criteria: chest rise and cyanosis Quantitative waveform capnography Oxygen saturation

Avoid excessive ventilation

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

DIFFERENTIAL DIAGNOSIS
search for and treat reversible causes

Hs

AND

Ts

Hypoxia Hypovolemia Hydrogen ion (acidosis) Hypo/hyper kalemia Hypothermia

Tension pneumothorax Tamponade cardiac Toxins Thrombosis Pulmonary Thrombosis Coronary

ACLS Cardiac Arrest Algorithm

Copyright American Heart Association

ACLS Cardiac Arrest Circular Algorithm.

Neumar R W et al. Circulation 2010;122:S729-S767

Copyright American Heart Association

Bradycardia Algorithm.

Neumar R W et al. Circulation 2010;122:S729-S767

Copyright American Heart Association

Tachycardia Algorithm.

Neumar R W et al. Circulation 2010;122:S729-S767

Copyright American Heart Association

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.