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
Nursing Supervisor
Los Angeles County + USC
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
Titrate
O2 to oxygen sat 94% non arrest Pts
100%
O2 for Pts in cardiac arrest
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
HsAND
Hypoxia
Hypovolemia
Hydrogen ion (acidosis)
Hypo/hyper kalemia
Hypothermia
Ts
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.
