C ODE

Managem
ent
"Code Blue" is generally used to indicate a patient
requiring resuscitation or otherwise in need of immediate
medical attention, most often as the result of a respiratory
arrest or cardiac arrest. When called overhead, the page
takes the form of "Code Blue, (floor), (room)" to alert the
resuscitation team where to respond.
 Stage 1: Activation Phase
In every situation, there is someone who first identifies that a
patient has had (or is about to have) a cardiac arrest. The Unit
where a patient has arrested will be asked to do the following
(“The Three C’s”):

Call for help – call a Code Blue Team

CPR – initiate chest compressions (CAB)
Crash cart – staff in the Nursing Unit are expected to bring the
crash cart as soon as the code is called. Whoever is closest
should bring it.
 Stage 2: Staggered arrival – Chaotic
Phase
Although all members of the team are activated at the same
time, not all members will arrive simultaneously. The priorities of
the team members who arrive first are to:

Ensure that the initial priorities (the “Three C’s”) are being
addressed. CPR should be in progress. The crash cart should be at
the bedside.

Backboard and Defibrillator pads should be applied to the

patient, and the defibrillator should be turned on.
 Stage 2: Staggered arrival – Chaotic
Phase
The AIRWAY manager should be ventilating the patient
using a bagvalve‐mask.

Two people should be delegated to continue CPR

IV access should be confirmed by NSS flushing.

A Medicine nurse should be delegated to find, prepare,

and hand medications to the IV nurse.
 Stage 3: Organized Team
Function Phase
As the team members converge, they will
move to their designated positions around the
patient. These positions may have to be
modified depending on the location of the
patient.
What do we prepare during CODE?

Bagvalve-mask
Cardiac monitor
Defibrillator
Crash cart
Do you remember these drugs?
Lidocaine Ca Gluconate
Amiodarone Nicardipine
Diltiazem Aspirin
Verapamil Morphine
Atropine Nitroglycerine
Adenosine Heparin
Digoxin Dopamine
Epinephrine Dobutamine
Magnesium
How do we go about the CODE?

BLS Survey
V
ACLS Survey
Visualize, verbalize, VS

O Oxygenate if O2<92% / 94%

M Attach to cardiac monitor

I IV/IO access

T Treat
5 H
Hypovolemia
Hypoxia
Hydrogen ion acidosis
Hypo/hyperkalemia
Hypothermia

T
Tension pneumothorax
Tamponade, cardiac
Toxins
Thrombosis, pulmonary
Thrombosis, Coronary
A
What doAdvance airway,
we do after ROSC? confirm

B Volume; pressors
placement

C
D
Therapeutic
Hypothermia
Astoflo/Astotherm/Animec
How do we render post-cardiac arrest
care?NGT
CXR
ECG
IFC
 Alarms and settings

• low pressure
• high pressure
• Ventilator has • Ventilator has no
met resistance resistance in
and needs more inflating the lung
pressure • Disconnected,
• Patient leak in the
coughed, needs ventilator
suctioning, circuit
changed
position
 Check for… 


• Obstructi
on

• Displace • DO • Pneumo-

PE
ment thorax

• Equipm
ent

European Committee for
Standardization
Classify alarm

American Association for
Respiratory Care
Patient-ventilator system checks
Requires health care providers to
verify and document that
appropriate alarms are activated

High priority Level 1

= urgent situation =immediately
threatening if left
immediate unattended for short
attention periods
(power failure, apnea)

Medium priority
= dangerous situation Level 2 Color coded alarms:
= potentially life
quick response
threatening if left High priority= red
needed
unattended for longer
periods of time
Low priority=yellow
(circuit leak, PEEP
Low priority alarms, autocycling)
=alert situation
provider’s
attention needed Level 3
=non-ventilator
events, not likely life
threatening but a
possible source of pt.
harm if not addressed
Are you ready for some action?