Code blue
Code blue:
An emergency situation announced in a
hospital or institution in which a patient is in
cardiopulmonary arrest, requiring a team of
providers (sometimes called a 'code team') to
rush to the specific location and begin
immediate resuscitative efforts.
assessment should include Airway, Breathing,
and Circulation
Airway
Assess the patency of the airway by observing
and checking:
air entry into the lungs
if the amount of air is adequate
the position of the head
for any signs of obstruction (stridor, hoarse
voice dyspnea)
Breathing
Assess the effectiveness of ventilation and oxygenation
by observing/checking:
chest expansion (e.g. equal and symmetrical)
adequate inspiration and expiration
ease of breathing, are there signs of increased work of
breathing - head bobbing in infants, retractions, nasal
flaring, gasping, grunting etc
audible breath sounds on auscultation - snoring,
grunting, wheezing
oxygen saturation
colour (e.g. pink versus pale or cyanotic)
Signs of Deterioration
Air way/breathing
Early Signs and
•Tachypnea (increased respiratory rate)
•Retractions - in the child this is due to a soft compliant chest
wall, horizontally placed ribs and poorly developed
intercostal muscles
Symptoms
•Tachypnea with increased effort- will lead to bradypnea
Late Signs and when fatigued or the inability to maintain own airway (e.g.
Symptoms evidenced by gasping)
•Diminished breath sounds
Arrest •Gasping, ineffective breathing or no respiratory effort
Circulation
Assess the effectiveness of circulation by observing/checking:
skin color (pallor, mottling and cyanosis)
skin temperature - warm centrally, cool peripherally
heart rate - fast, slow or normal
presence of peripheral (radial and pedal) and central (carotid,
femoral, bracheocephalic) pulses - weak or strong
blood pressure
capillary refill time - normal or prolonged
level of consciousness
irritability or lethargy
decreased response to pain
decreased response to surroundings
decreased muscle tone
Signs of Deterioration
Circulation
•Tachycardia (increased heart rate) - this is an early sign of
cardiovascular compromise
•Pale and cool extremities
Early Signs and Symptoms
•Normal blood pressure
•Oliguria - this occurs when the kidneys are not adequately
perfused. The child produces <1mL/kg/hr of urine
•Cyanosis
•Mottled and/or poorly perfused skin
•Cyanosed mucous membranes - mouth and nipples may be the
Late Signs and Symptoms
best place to observe cyanosis in children with dark skin
•Hypotensive - low blood pressure is a late sign; 20-25% of blood
loss may occur before hypotension develops
•Bradycardia - low heart rate is a late sign of cardiovascular
compromise
Arrest •Weak thready pulse with poor perfusion
•Arrhythmia
•Asystole (no cardiac contractions)
Resuscitation Cart
There is a resuscitation or 'crash' cart available on
every unit and in all clinic and diagnostic areas.
Unit resuscitation drug boxes are locked at all
times to assure their supplies and equipment are
available, clean and in good working condition in
the event of a Code Blue.
The resuscitation or “crash” cart is stocked in the
order of how cardio-respiratory support
requirements would progress in a Code Blue
situation.
The following items are located on the top of
the Resuscitation Cart:
Orange Resuscitation Drug Box
Resuscitation Record
Resuscitation drug dosage guidelines and
calculator
Portable Suction
Who is on the team?
– Critical Care Nurse
– Respiratory Therapist
– Hospitalist
– Pharmacist
Pharmacist’s role
Obtain needed medications.
Look for medication related causes of the
patient’s deterioration.
Assist the team as needed, often by reading
aloud recent labs and meds administered.
Anticipate and prepare in advance for the
patient’s pharmacotherapy needs.
INTRO TO CODE BLUE
OSCE FORMAT
INTRO TO CODE BLUE
SECONDARY SURVEY
ARREST RHYTHMS
CODE BLUE ALGORITHMS
INTRO TO CODE BLUE
CODE BLUE EXAMPLE
No response, not breathing
Rhythm Pulse Assessment Action
VT None Pulseless VT Start CPR
arrest 200J shock/defib
2 minutes of
CPR
VF None VF arrest Resume CPR
200J shock/defib
1mg epi
1:10,000 IV
2 minutes of
CPR
Asystole None Asystole Resume CPR
No shock/defib
2 minutes of
CPR
Bradycardia None PEA Resume CPR
No shock/defib
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ANAPHYLAXIS TX
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