Code Blue, Code Blue!!!! Whats a nurse to do? Unit V.

Code Blue, Code Blue!!!! What’s a nurse to do?

Unit V

Objectives

Discuss cardiac emergency to include the use of the crash cart and the importance of BLS

Identify Rapid Response Team and Code Blue Team

Patient Emergency

50 % patients who code exhibit warning signs up to 6 hrs prior to arrest

RRT consists of ICU nurse, RT, sometimes MD, and bedside nurse

RRT at bedside within minutes to assess patient

Criteria for calling RRT

Change in heart rate (<40 or >130)Change in Systolic BP (<90 or >200) Change in resp. rate (<8 or >24) or

threatened airway or change in SaO2 Change in mental status New, repeated, or prolonged seizuresUO <50mL/4 hours Failure to respond to treatment to an acute

problem/symptom Nurse, patient, or family member is concerned

What to Do I Do If I Think My Patient is in trouble?

Tell nurse responsible for patient’s care (also clinical instructor) immediately of changes in patient’s condition

Rapid Response Team (RRT) team – can be called as soon as the nurse identifies changes in the patient’s condition

Reassess the patient frequently

Calling Code Blue

Determine unresponsiveness Call out for help Push Code Blue button at the head of bed or Pick up the phone and dial______

Identify the emergency – Code Blue Identify the location and the room #

Note time using the clock in patient’s room

Prior to the Code Team Arriving

Start CPRCirculationAirwayBreathing

Defibrillation (AED only)Obtain the Crash Cart/AEDRemove extra furniture from the roomUnit Secretary will: Page Chaplain for Family support Call attending MD Chart to Room

Once the code team arrives Do not stop CPR

when the first team member arrives

Continue until someone is ready to take over

Code Team & Their Roles

Hospitalist or ER doctor– team leader – intubation, gives orders

Critical Care Nurse – gives meds Supervisor / Staff nurse – documents Respiratory therapist – assists

respirations, may intubate as well Lab – ABG, BMP, CBC NA –CPR, brings crash cart and chart,

help with other patients Chaplain - assist with taking family to

quiet location Student – CPR, observation

What the Code Team Needs to Know

Current Diagnosis / Recent Treatments or Procedures

Events Leading Up to Code Recent Meds Primary MD Code Status Other Pertinent History: Allergies,

MRSA Status, Diabetic, Cardiac, respiratory history, etc.

Post – Code Responsibilities Patient’s nurse gives report to

receiving nurse Family Care Code Summary printed EKG Strips charted Completed Code Sheet signed by

physician in charge of the code Code Evaluation completed and sent

to Risk Management Cart Exchange Documentation

Documentation Patient assessment ECG rhythm (strip) Notification of MD, orders

received Treatments initiated &

patient response, post treatment rhythm (strip)

If transferred, mode of transport, transfer note, receiving unit bed number, receiving nurse

The Crash Cart Top

1. Defibrillator2. Intubation equipment3. Possibly meds

O2 tank, portable suction, ambu bag

Front drawers andSide drawers

1. Meds2. IV equipment + fluids3. Resp supplies4. Trays 5. Misc (gloves, sutures,

flashlight, batteries)

Example

Emergency Medications

Oxygen Epinephrine Amiodarone Atropine Adenosine

(Adenocard) Diltiazem Digoxin

Lidocaine Magnesium Sulfate Dobutamine Dopamine Narcan

Do Not Resuscitate

Full code or No CodeDocumentation on chart of

MD order MD discussion with patient / family Chart labeled MAR labeled

What if family changes their mind??

Student’s Role in a Code

Assessment / reassessment Notify nurse immediately of

changes in the patient’s status

Perform CPR Observe during the Code Help with patient’s family