CODE BLUE PROCEDURES Luis Enriquez RN, BS. Los Angeles County
USC Medical Center Department of Emergency Medicine
Slide 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
Slide 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
Slide 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
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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
Slide 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
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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% O 2 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
Slide 8
CODE BLUE NURSING SKILLS Identify respiratory/cardiac arrest
Activate Code Blue Oxygen administration: Nasal cannula, mask
Bag-Valve-Mask resuscitation with 100% O 2 Cardiac
Monitor/defibrillator pads Application Intra Venous access
Medication Administration Defibrillation (ACLS trained) CPR
documentation
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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
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BASIC LIFE SUPPORT SURVEY 1- Establish Unresponsiveness 2-
Activate Emergency Response System 3- Circulation 4-
Defibrillation
Slide 11
Simplified adult BLS algorithm. Berg R A et al. Circulation
2010;122:S685-S705 Copyright American Heart Association
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ESTABLISH UNRESPONSIVENESS Tap and Shout are you all right
Check for absent/abnormal breathing by scanning the chest for
movement
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ACTIVATE THE EMERGENCY RESPONSE SYSTEM Call for help or send
someone for help Yell for help Code Blue protocol Get the Automatic
External Defibrillator
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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
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DEFIBRILLATION If no pulse check for shockable rhythm as soon
as AED arrives Provide shocks as indicated Follow each shock
immediately with CPR compressions
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Advance Cardiac Life Support Survey Airway Breathing
Circulation Differential Diagnosis
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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
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BREATHING Supplemental O 2 when indicated Titrate O 2 to oxygen
sat 94% non arrest Pts 100% O 2 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
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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
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DIFFERENTIAL DIAGNOSIS search for and treat reversible causes
Hs AND Hypoxia Hypovolemia Hydrogen ion (acidosis) Hypo/hyper
kalemia Hypothermia Ts Tension pneumothorax Tamponade cardiac
Toxins Thrombosis Pulmonary Thrombosis Coronary
Slide 21
ACLS Cardiac Arrest Algorithm. Copyright American Heart
Association
Slide 22
ACLS Cardiac Arrest Circular Algorithm. Neumar R W et al.
Circulation 2010;122:S729-S767 Copyright American Heart
Association
Slide 23
Bradycardia Algorithm. Neumar R W et al. Circulation
2010;122:S729-S767 Copyright American Heart Association
Slide 24
Tachycardia Algorithm. Neumar R W et al. Circulation
2010;122:S729-S767 Copyright American Heart Association
Slide 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.