CODE BLUE

MANAGEMENT
 CODE BLUE
is generally used to indicate a patient
requiring resuscitation or otherwise in need of
immediate medical attention, most often as a
result of a respiratory or cardiac arrest.

What is Code Blue

 Cardiopulmonary Resuscitation (CPR)
is an emergency procedure performed in an effort
to manually preserve intact brain function/
provide adequate blood circulation until further
measures are taken to restore spontaneous blood
circulation and breathing in a person in cardiac
arrest.

Cardiac Arrest is the

sudden loss of cardiac
of cardiac function,
breathing and
consciousness.
 CODE BLUE CPR
TEAM Committee
• CARDIOLOGY REGISTRAR

• ANESTHETIST

• CARDIOLOGY/SURGICAL RESIDENT

• OVER ALL NURSING SUPERVISOR

• REGISTERED NURSES

• RESPIRATORY THERAPIST
 Criteria for Code Blue
RRT CODE BLUE
• The patient is responsive but • Unresponsive
there is a sudden deterioration
in patient’s status. • Pulseless
• Respiratory distress.
• O2 saturation, BP, pulse is
• Apneic
gradually dropping/below
normal.
 WHAT TO REMEMBER DURING CODE BLUE

RULE #1 CALM DOWN AND DON’T PANIC

 WHAT TO REMEMBER DURING CODE BLUE

RULE #2
Always start with BCLS
 Always BE SYSTEMATIC IN PERFORMING
RULE #3 ACLS
FIRST RESPONDER:

❖ After establishing
unresponsiveness, CALL FOR HELP!
❖ Initiate CPR.

SECOND RESPONDER:

❖ Activate Code blue and bring

the crash cart to patient’s area.
❖Attach the
monitor/defibrillator to
patient.
❖Connect valve-mask bag
device to high flow O2
 CODE BLUE ACTIVATION

>Dial 855-0999 (Overhead paging system)

> State the type of Emergency Code
>Give the exact location (floor, roomnumber)
>Repeat 3 times.
Example:
Code Blue 4th floor room number 401! (3x)
 NURSES ROLES AND RESPONSIBILITIES
DURING CODE BLUE

Nurse #1 AIRWA
Y
✓Assembling materials
needed.
✓Proper bed positioning.
✓Ensuring O2 source and suction
equipment.
✓Ensuring ET is secured
 NURSES ROLES AND RESPONSIBILITIES
DURING CODE BLUE

Nurse #2 MEDICATION/DEFIBRILLATION

✓Must secure IV access promptly if not yet

established.
✓ Prepare and give medications as directed by
team leader.
✓Select the joules as per team leader’s advice,
charge the defibrillator , apply gel on the
paddles before giving to the doctor.
✓Make sure that the doctor has a clear view of
the monitor
 NURSES ROLES AND RESPONSIBILITIES
DURING CODE BLUE

Nurse #3 DOCUMENTATION

✓Ensures all
observation are taken
and recorded.
✓The code blue will be
documented in a code
blue record which will
be signed by the
recording nurse and
code physician.
 NURSES ROLES AND RESPONSIBILITIES
DURING CODE BLUE

Nurse #4 CIRCULATIN
G

✓Ensures all needed

equipment and materials
are available at the
bedside.
✓Responsible for
sending specimens such
as blood gases.
 Post Resuscitation Activities
• Obtaining 12 lead E C G
• Obtaining C X R
• Laboratory work ups
• N G T & I F C insertion
• Coordinate with Critical unit for
transfer
• Documentation
PRIMARY SURVEY
SECONDARY SURVEY
 ARRHYTMIAS

ASYSTOLE PEA

HIGH QUALITY CPR

2MINUTES/5 CYCLES

EPINEPHRINE 1 mg every 3-5

minutes (IV/IO)
 PULSELESS VTACH

POLYMORPHIC VTACH/ TORSADE DE POINTES

VENTRICULAR FIBRILLATION
 BRADYCARDIA

C-Chest pain
A- Altered Mental Status
S- SOB
H- Hypotension
•50 HR - CASH = MONITOR
<50 HR + CASH = DATE

Treatment:
D- Dopamine
A- Atropine
T- transcutaneous pacing
E- Epinephrine
Atropine 0.5mg IV 3-5 minutes as needed.
Maximum dosage is 3mg.
Epinephrine 2-10mcg/min or Dopamine 2-
10mcg/kg/min
Transcutaneous pacing
 SINUS TACHYCARDIA
Treat
underlying
condition

Stable (Narrow QRS Complex) Stable (Wide/ Regular/Monomorphic)

Stable (Narrow QRS Stable (Wide/

Complex) Regular/Monomorphic)

>150 HR – CASH= Consider antiarrythmic infusion.

MANEUVERS /DRUGS Amiodarone
vagal maneuver, Adenosine Patients with unstable
>150 HR + CASH= SYNC tachycardia should be treated
CARDIOVERSION immediately with synchronized
Narrow/reg= 50-100joules cardioversion.
narrow-/irreg=120- Wide/reg=100joules
200joules
 It is a means of
storing and
transporting vital
CRASH CART equipment and drugs
which may be
required during a
code blue (cardiac
emergency) to the
location of
emergency.
TOP AND SIDE OF
TROLLEY (HANG)

EMERGENCY DRUGS
(1st DRAWER)
 CIRCULATOR
Y ACCESS
(2nd DRAWER)

IVF &
MISCELLANEOUS
(3rd DRAWER)
 AIRWAY &
BREATHING
DEVICES
(4th DRAWER)

PPE & OTHER

EQUIPMENT
(5th DRAWER)
1. Crash cart must be checked at the “By failing to
beginning of every shift by the assigned prepare,
CPR nurse. You are preparing
2. Standardization must be maintained. to fail
3.Defibrillator performance check must be In your role to
save lives”
done along with crash cart checking and
keep the test strip for documentation.
4. Crash cart items and medications must
be checked monthly for expiry dates.
5.Each unit will have a crash cart placed in
an easily accessible location.
6. In case of CPR, all items must be
replaced after each use.
EPINEPHRINE

INDICATIONS:
Cardiac arrest: VF/ pulseless VT, asystole, PEA
Symptomatic bradycardia: alternative to dopamine
after atrophine.
anaphylaxis
DOSAGE:
1mg (10ml of 1:10,000 solution) IV/IO every 3-5
min during CPR
Profound bradycardia or hypotension:
2-10mcg/min infusion (titrate according to patient’s
response)
ETT: 2 – 2.5mg
Pedia dose: 0.01mg/kg IV/IO every 3-5 min max
dose : 1mg
CONTRAINDICATIONS/PRECAUTIONS:
Increase cerebral and myocardial oxygen demand
 ATROPINE SULPHATE
INDICATIONS:
First drug for symptomatic bradycardia
Organophosphate poisoning
DOSAGE:
0.5 mg IV every 3-5 minutes as needed
not to exceed total dose of 3 mg.
CONTRAINDICATIONS/ PRECAUTIONS:
Use with caution in presence of MI
and hypoxia.
May not be effective with Type II and
3rd degree AV block
Doses of < 0.5 mg may result in
paradoxical slowing of heart rate.
 DOPAMINE
INDICATIONS:
2ND –line drug for symptomatic bradycardia
Hypotension (SBP <70 mmHg) with signs and
symptoms of shock
Low cardiac output
Poor perfusion to vital organs
DOSAGE:
1-5 mcg/kg/min IV infusion-increase renal blood flow
and urine output
5-15 mcg/kg/min- may increase renal output,
cardiac output, HR and cardiac contractility
10-15 mcg/kg/min-increase BP and stimulate

vasoconstriction (shock)
CONTRAINDICATIONS/ PRECAUTIONS:
Tachyarrhythmia
Severe vasoconstriction
Hypertension
Extravasation
 AMIODARONE
INDICATIONS:
Life threatening arrhythmias:
VF/pulseless VT unresponsive to shock delivery, CPR and vasopressor
Recurrent, hemodynamically unstable VT
Some atrial and ventricular arrhythmias
DOSAGE:
VF/VT Cardiac arrest:
1st dose: 300mg IV/IO push
2nd dose: 150mg IV/IO push if needed
Life threatening arrhythmias:
150 mg diluted with 150 ml D5W IV infusion over 10 minutes.
360 mg over 6 hours (1 mg/ min)
540 mg IV over 18 hours (0.5 mg/min)
Maximum cumulative dose: 2.2g IV over 24 hours
CONTRAINDICATIONS/ PRECAUTIONS:
Hypotension
Risk for substantial toxicity
Terminal elimination is extremely long
Bradycardia
 ADENOSINE
INDICATIONS:
Drug of choice for stable-narrow complex SVT.
DOSAGE:
6-12-12
Initial dose of 6 mg IV rapidly then another 12mg if needed and 3rd dose
of 12mg if still needed.
Flush with 20ml saline
Elevate the extremity.
CONTRAINDICATIONS/ PRECAUTIONS:
Contraindicated with:
-2nd or 3rd degree AV block
-Sick sinus node or symptomatic bradycardia
-suspected bronchoconstrictive or bronchospastic lung disease
-hypersensitivity to adenosine

Transient side effects include flushing, chest pain or tightness, brief

periods of asystole or bradycardia, ventricular ectopy
 LIDOCAINE
INDICATIONS:
Alternative to Amiodarone in cardiac arrest from VF/VT
Stable monomorphic VT with preserved ventricular
function
DOSAGE:
Initial 1-1.5mg/kg IV/IO
For refractory VF may give additional 0.5-.75mg/kg IV
push repeat in 5-10 minutes
Maximum of 3 doses or 3mg/kg.
Maintenance infusion:
1-4mg/ minute
(30-50mcg/kg/min) Pedia dose:
1mg/kg IV/IO
Maintenance infusion: 20-50
mcg/kg/min
CONTRAINDICATIONS/PRECAUTIONS:
Contraindicated in prophylactic used in AMI
Discontinue infusion immediately if signs and symptoms
of toxicity develop
 MAGNESIUM SULPHATE

INDICATIONS:
Torsades de pointes or suspected Hypomagnesemia in cardiac
arrest
Life threatening ventricular arrhythmias due to digitalis toxicity
DOSAGE:
Cardiac arrest due to hypomagnesemia or torsades de pointes : 1-
2 g diluted in 10ml of D5W IV/IO
Torsades de pointes with pulse or AMI with hypomagnesemia: 1-2
g mixed in 50-100ml D5W over 5-60 min IV.
CONTRAINDICATIONS/PRECAUTIONS:
Occasional fall in BP with rapid administration.
Use with caution if renal failure is present