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Flashcards in Code Deck (40)
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When should a code blue be called?

- When a patient is unresponsive, apneic and/or pulseless
- Call for help (who should formally call for the code blue) and immediately initiate CPR


What should happen once a code blue team arrives?

- Members of code team should identify themselves and their role (e.g. "I'll take the airway" or "I'll document")
- A member at the nurses' station should contact the patient's healthcare provider as soon as the code is called


What is the key to running an effective code blue?

- Quality and timeliness of interventions
- Early, high-quality CPR and rapid defibrillation (when indicated) before advanced cardiovascular life support
- Ensuring interventions such as vascular access and drug delivery sites are available in addition to having CPR done


Describe the role of the compressor:

- The first HCP to respond assumes the role of compressor and immediately initiates chest compression's
- Ensure backboard is placed when additional personnel arrive
- Switch out with another compressor every 2 minutes or 5 cycles to prevent decreased quality compression's
- Restart compressions immediately after a patient has been defib'd
- Research supports delaying airway management and ventilation until additional help arrives, as passive delivery of air should be sufficient for first few minutes where chest compression's are most important


Describe the role of the airway manager:

- Provides ventilation's using a bag-mask device attached to an oxygen source
- Set O2 levels to max rate (15 L/min) and ensure O2 is as close to 100% as possible
- Placement of an oropharyngeal airway may be placed to ensure airway patency while delivering ventilation's with the bag-mask device
- Assist RT to perform intubation when necessary
- If available, a continuous waveform capnography can confirm and monitor endotracheal tube placements


What are shockable rhythms examples?

- Pulseless ventricular tachycardia
- Ventricular fibrillation


Describe the role of the defibrillator manager:

- Defibrillation of shockable rhythms, which is the only other therapy proven to increase survival
- Hands-free pads over handheld paddles are recommended as the safer and quicker option
- Ensures patient connected to a 3- or 5-lead cardiac monitor
- Have a good understanding of arrhythmias
- Understand the type of defibrillators available on the unit (monophasic vs. biphasic)
- When a shockable rhythm is identified, defib manager sets energy level (directed by team leader), announces when shock to be delivered (clear) and then repeat amount delivered after
- After 5 cycles of CPR, recheck rhythms again


Describe the role of the crash cart manager:

Positions self on same side as patient's venous access and has room to open drawers for easy access to contents (e.g. medications)


Describe the role of the code team leader:

- Directs resuscitation efforts
- Communicates with all team members
- Monitors patient's cardiac rhythm
- May be taken on by a physician or advanced care provider
- Takes over role until transferred to another physician (e.g. ICU physician)
- Respond to environment (e.g. ensuring there is enough space, arranging for extra patients in the room to be moved)
- Direct people who are present and not helping (e.g. wait outside until further help is needed)
- Communicate outcomes with MRP and family


Describe the role of the recorder:

- Documents entire process
- Reminds team leader q2 minutes when it's time for a compressor role switch and the time, name and dose of last medication administered
- Documents cardiac rhythms before delivering shock, and the ventilation efforts of patient
- Print rhythm strips
- Identify all patient indicators
- Note time of discontinued efforts, patient disposition and time of death if applicable


Why is the postcode debriefing important?

- Discussion of what went well and what needs improvement
- Support for newer staff members
- Identify areas of needed staff education


Describe basic code skills that will be used during a code blue:

- Initiate code blue
- Start CPR
- Position bag-mask device with attached oxygen
- Place the backboard
- Bring crash cart to room
- Arrange room for best patient and crash cart access
- Locate supplies and equipment on cart
- Attach ECG leads
- Attach defib pads
- Charge defibrillator and defib
- Administer medications
- Set up intubation equipment (e.g. endotracheal tube, laryngoscope, suction)
- Set up con't waveform capnography
- Assume various roles
- Coordinate code
- Collaborate with other HCP's


Describe the role of the primary nurse as the first responder:

- Calls for help and activates code blue
- Initiates CPR and AED
- Remains with patient at all times; if no response after 1 minute, call code blue
- Remain available to provide chest compression's and assist code blue team as required


Describe the role of the second nurse as the second responder:

- Initiate code blue if not yet done (calls ARHCC Help desk using 7111 and states "Code Blue with location" two times"
- Ensures first responder equipment (AED) and patient chart brought to location
- Prepares location for code team (e.g. remove head of bed)
- Assists first responder with CPR
- Remains available to assist code blue team


Describe the role of the PCC or charge nurse:

- Assumes responsibility for recording or designates to another until CCU nurse arrives
- Ensure appropriate number of staff available to assist, with runners designated PRN
- Ensures notification of MRP and family physician at start of code
- Assists primary nurse
- Ensure con't function of unit
- Initiate follow-up as required
- Designs unit RN to restock first responder equipment and return to proper location


Describe the role of the ICU nurse:

- Respond to code blue, bringing primary crash cart
- Assume role of monitor/electrical therapy nurse
- Identify self to team with role
- In absence of physician takes on leadership role, coordinating resp and cardiac efforts
- Works collaboratively with code blue team


Describe the role of the emergency RN:

- Respond to code blue, bringing crash cart (if location is med imaging)
- Assumes responsibility for IV access and drug administration
- Identify to team and role
- Work collaboratively with code blue team
- Bring back-up crash cart in event of multiple codes


Describe the role of the CCU RN:

- Responds to all code blue calls
- Identifies self to team and identifies roles
- Completes code blue record
- Ensures signing of code blue record
- Downloads and prints AED report
- Ensures documentation up to date
- Ensure copy of arrest record forwarded to ICU CNE for follow u


Describe the role of the RT:

- Assist with basic and advanced airway management at direction of the Code Blue
- Assists with patient transport as required


Describe how the ARHCC Helpdesk participates in code blue:

- Initiates overhead message
- Ensures calls are sent to all Code Blue phones/pagers
- Initiates security response


Describe the role of the site director:

- Oversee functioning of code blue responder's
- Coordinate patient transfers
- Facilitate communication between MRP, emergency physician, patient and family


When do you use an AED?

- If pulse absent and AED available, apply AED immediately and shock as advised (will tell you if there is a shockable rhythm). After one shock resume CPR for 5 cycles and begin again.
- If pulse absent and AED NOT available, immediately initiate CPR.


When do we stop CPR?

- Until relieved by another individual
- Until victim regains spontaneous pulse and respiration's
- Until rescuer exhausted and unable to perform CPR effectively
- Until physician d/c CPR


What makes up the primary survey?

Check Circulation, Airway, Breathing and Defibrillation


Describe the components of Circulation:

- Checking carotid pulse on adult or child
- Initiate compression's if no pulse in 10 seconds
- Place victim on hard surface, flat


Describe the components of Airway:

Open airway using either head tilt-chin lift (no suspected cervical trauma) or jaw thrust (suspected cervical trauma)


Describe the components of Breathing:

- Attempt ventilation's with mouth-to-mouth using barrier device, pocket mask or bag-mask
- If available insert oral airway
- Suction secretions PRN


Describe the components of secondary survey:

- Implementation (calling code blue, giving report to code team)
- Analysis of cardiac rhythm (defib PRN; establish IV access; continue CPR until indicated to stop)
- Intubate airway (assist team with intubation)
- Confirmation of airway and ventilation (assist in confirmation of ET tube placement, resp assessments, and bag ventilation)
- Differential diagnosis (assist physician obtain labs and diagnostic studies to determine underlying problem)


What are the most common mistakes made during codes?

1) Failure to recognize arrest
2) Failure to act and call for help appropriately
3) Failure to provide effective compression's
4) Failure to provide effective ventilation's (both to patient and self)
5) Failure to anticipate the next move
6) Failure to remain calm and focused
7) failure to know and locate necessary equipment
8) Failure to keep skills and knowledge current
9) Failure to know strengths
10) Failure to debrief or problem solve after code completion


Describe failure to recognize arrest:

- Reluctant to believe there is an actual problem, losing time before resuscitation begins
- While it is important to verify asystole (e.g. check leads are on properly), the golden rule is still that if there is no pulse, initiate CPR immediately