Continuing Nursing Education Program

Angham Yahia Majrashi

Nurse Educator
 A message announced over a hospital’s public
address system, indicating that a cardiac
arrest or respiratory arrest requiring CPR is in
progress; to be “coded” is to undergo CPR.

 The King Khalid Hospital code to be used by

all staff to summon a trained team of medical
personnel to undertake cardiopulmonary
resuscitation.
What is the difference between Rapid Response Team (RRT) from Code Blue ?

RRT CODE BLUE

1. The patient is still responsive but 1. The patient is unresponsive
there is a sudden deterioration in
patient’s status 2. No respiration
2. Respiratory distress
3. O2 saturation, Blood pressure, pulse 3. No pulse
is gradually dropping/below normal
 It is the sudden loss of
cardiac function, when
the heart abruptly stops
beating. Unless
resuscitative efforts are
begun immediately,
cardiac arrest leads to
death within a few
minutes.
Pamela Joy Bocala- Blanco
CNEP Coordinator/Nurse Educator
 Team of providers
sometimes called a “code team”
being required to rush to the
specific location and begin
immediate resuscitative efforts in
an emergency situation announced
in a hospital or institution in which
a patient is in cardiopulmonary
arrest.
 The First Responder is not
actually a member of a team but
is the person who identifies and
confirms cardiopulmonary arrest.
1. Medical Specialist On Call/
ER Specialist for ER Code
 Assume overall responsibility or the direction of
activities.
 Communicate with event manager/recorder
 Issues all medical and resuscitative orders including
resuscitation medications.
 Termination of Code Blue and final disposition of the
patient.
 Communicate with patient’s family along with Nursing
Supervisor at the end of the code.
 Complete documentation for medical records.
2. ICU Resident on Duty

 Manage the airway as directed

by the team leader
 Perform bag-mask ventilation
 Prepare and assist with
intubation
 Confirm ETT placement
 Secure ETT
 Complete documentation in the
medical record
3. Anesthesia Resident

 Manage the airway if ICU

resident is delayed
 Respond to instructions from
Team Leader for changing
roles
 Complete documentation in
medical records
4. Resident on Duty in charge
of the patient
 Perform an continue chest
compression as instructed
by team leader.
 Hand over to Compressor
2 when tired.
 Complete documentation in
medical records
5. Medical Resident on Duty

 Relieves Compressor 1
when tired
 Complete documentation in
the medical record.
6. Nursing Supervisor on Duty

 Help rapid transport of blood

samples to laboratory
 Manage crowd control with
security
 Communicate with the family
 Notify patient Affairs, Social
Worker, Interpreter
 Attend to pastoral needs of
the patient
 Coordinate patient transfer
and placement with team
leader.
7. ICU Nurse

 Established vascular access

and ensure patency
 Administer IV medication
as per verbal order of
team leader
 Assist airway and
intubation
 Insert NGT as indicated
8. Ward Shift in Charge Nurse

 Ensure providers assume pre-

assigned roles and that the team
knows who is responsible for what
role
 Assign RN1 as recorder
 Assign RN2 to bring equipment
needed
 Once roles established, ensure
management of the rest remaining
work in the ward/unit.
 Ensure crowd control with the help
of security with in the room/ward.
 Notify the switch board if code is
over.
9. Bedside Nurse (RN 1)

 Provide history using SBAR

communication
 Stay at bedside
 Ensure availability of
workplace
 Continue as the recorder
 Maintain accurate written
record of the timings of all
intervention.
10. Ward Nurse (RN 2)

 Get and ready the crash

cart, other equipment such
as suction.
 Clearly state “I am getting…”
 Distribute code cart supplies
 Operate monitor/defibrillator
 Prepare medication according
to order from team leader
 Receive instruction from ICU
RN or team leader.
11. Respiratory Therapist (RT)

 Helps ICU, anesthesia

residents in airway
management
CODE BLUE
EVENT MANAGER

COMP.2

ICU NURSE

COMP.1
R
N
2

R
N
1

OTHERS
OTHERS
Aswathy George
Prince Sultan Cardiac Center
Director of Nursing
 CATEGORIZED BASED ON
ADMNISTRATION

1. ET ADMINISTRATION

2. IVPB ADMINISTRATION

3. IVP ADMINISTRATION
 Cardiac arrest: VF, pulseless, VT,
asystole, PEA
 Symptomatic bradycardia after
atropine, dopamine, and
transcutaneous pacing
 Severe hypotension
 Anaphylaxis or severe allergic
reactions in combination with
large fluid volumes, corticosteroids,
antihistamines
Cardiac arrest
IV dose: 1mg (10ml of 1:10,000
solution) every 3-5 minutes
during resuscitation with each dose
followed by 20ml IV
flush
 First drug for symptomatic sinus
bradycardia
 May be beneficial in presence of AV
block at the nodal level or ventricular
asystole; will not be effective when
infranodal block is suspected

Asystole or pulseless electrical activity

1mg IVP
Repeat every 3-5 minutes as needed to a maximum dose
of 0.03-0.04mg/kg
Bradycardia
0.5-1mg IV every 3-5 minutes as needed; not to exceed
total dose of 0.04mg/kg
Use shorter dosing interval (3 minutes) and higher doses
(0.04mg/kg) in severe clinical conditions
Tracheal administration
2-3mg diluted in 10ml NS
 Acute treatment for ventricular
arrhythmias from myocardial
infartion or cardiac manipulation (eg.
Cariac surgery.
 When amidiaron is not available
pulseless VT
 A wide variety of atrial and
ventricular tachyarrhythmias
 For rate control of rapid atrial
arrhythmias in patients with
impaired LV function when digoxin
ineffective

Cardiac arrest
 300mg IVP diluted in 20-30ml D5W
 Consider additional 150mg IVP in 3-
5 minutes
 Maximum cumulative dose 2.2gm/24
hours IV
 Second drug for symptomatic
bradycardia (after atropine)
 Hypotension (SBP ≤ 70-100 mmHg) with
signs and symptoms of shock

Cardiac arrest

 Use as a premixed bag of

400mg/250ml D5W or put 400mg in
250ml NS; titrate to patient
response
 Alternative pressor to epinephrine in
the treatment of adult shock-
refractory VF
 May be useful for hemodynamic
support in septic shock

 40 units IVP X1.

 Reverse severe hypoglycemia;
symptomatically may
manifest as nausea, hunger,
headache, irritability, lethargy,
ataxia, mental confusion

 Dose: o 10-50ml of Dextrose 50%.

 Drug of first choice for most forms of
narrow-complex PSVT
 Effective in terminating arrhythmias
due to reentry
 involving the AV node or sinus node

 Initial bolus of 6mg IVP over 1-3

seconds, followed
 immediately with 20ml NS flush,
then elevate the extremity
 If needed, repeat with dose of
12mg after 1-2 minutes
 If needed, a third dose of 12mg
may be given after 1-2
 minutes.
 PSVT uncontrolled by adenosine and
vagal maneuvers as
 long as blood pressure stable
 o Stable wide-complex tachycardia of
unknown origin

 20mg/min IV infusion; maximum

total dose 17mg/kg
 oUp to 50mg/min may be
administered to total dose of
 17mg/kg in urgent situations
 If prolonged resuscitation with
effective ventilation or upon
return of spontaneous circulation
after long arrest interval

 1mEq/kg IV bolus
 Repeat half this dose every 10
minutes
 Use arterial blood gas analysis to
guide bicarbonate therapy;
an acute change in PaCO2 of 1 mmHg
is associated with an increase of
decrease in pH of 0.008 U
CRASH CART
 Always check the crash cart for
these emergency drugs (quantity,
expiration date) before starting
your shift.
“By failing to prepare you are preparing to
fail in your role of saving lives”
Gloria Justalero
Nurse Supervisor
Ms. Edna Olarve
ICU Head Nurse-KKH
 King Khalid Hospital-
Najran is committed to
resuscitate any individual
suffering from Cardio
Pulmonary Arrest within
its premises.

 Code Blue is initiated in

such a case to provide
BLS and ACLS to the
victim of cardiopulmanary
arrest.
 King Khalid Hospital will
provide a multidisciplinary
Code Blue Team available
on a 24 hour on call
basis, comprising of
members listed in order in
this policy.

 Cardiac arrest in ICU will

be managed by ICU team
an code is not announced.
 Cardiac arrest in
CCU will be managed
by cardiology team
during working hours
(7:30am to 5:00pm)
and after duty hours
(5:oopm to the next
day morning 7:30 am)
will be managed by
KKH Code Blue team
along with cardiology
on-call.
  Core Standards
1. The standards of the Saudi Heart Association for Basic Cardiac Life
Support (BCLS) and Advanced Cardiac Life Support (ACLS) are
adopted by King Khalid Hospital for Code Blue
2. The CPR committee of KKH has the responsibility for overseeing
an making recommendation on all aspects of Code Blue.

 Certification an Competency
1. All hospital staff should possess valid BLS certificate to be able to
take part in CPR
2. Medical and Nursing staff should renew their BLS every 2 years to
maintain the privilege
 Initiation of Code Blue
1.The first responder, if not CPR
certified will:
Call for HELP and dial “22”
(switchboard) to initiate CODE BLUE
providing the following information
slowly and clearly and repeating the
information if necessary:
o Responder identity
oThe location of the patient
1. If first responder is BLS certified:

She/He will start ABCs of CPR, attach

defibrillator immediately upon arrival of
this equipment and continue CPR until
code team arrives an team leader takes
over.
 The switchboard will
1. Announce “ATTENTION …CODE
BLUE IN (area)” three times
clearly and bleep the Code Blue
team.

2. Continue to be attentive and direct

responders to the location.
 The team leader will identify self as
leader and start conducting the
procedures systematically after analyzing
the rhythm.
 Each member of the team will start
performing his/her role under guidance of
the team leader till told to stop.
 Any change in role will be as per direction
of the team leader and all must stay on
the scene till allowed by him.
 Termination of Code Blue
1. It is decide by the team leader. If MRP
of the patient available on site, his/her
opinion can be sought in making this
decision.
1. The team leader will allow team
members to stand down an return to
regular duties, with exception of the
Medical Specialist an Nursing
supervisor who will asses an coordinate
further intervention, as required.
Dr. Deyaldeen
ICU Resident-KKH
RULE #1
CALM DOWN and DON’T PANIC
RULE #2
Always starts with the BCLS
RULE #3
Always be systematic in performing ACLS
We are hoping to see competent nurses during code
blue.