CODE BLUE

PROCEDURES
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

 CallingHospital 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
 Doctors
 Nurse
 Supporting personel
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
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 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
DEFIBRILLATION
 Ifno pulse check for shockable
rhythm as soon as AED arrives
 Provide shocks as indicated
 Follow each shock immediately with
CPR compressions
Thank You
Advance Cardiac
Life Support Survey
 Airway
 Breathing
 Circulation
 Differential Diagnosis
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
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
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

H’s AND T’s

 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