Transcript Slide 1

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
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Patient Emergency
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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 seizures
 UO <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
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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 #
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Note time using the clock in patient’s room
Prior to the Code Team Arriving
Start CPR
Circulation
Airway
Breathing
Defibrillation (AED only)
Obtain the Crash Cart/AED
Remove extra furniture from the room
Unit Secretary will:
 Page Chaplain for Family support
 Call attending MD
 Chart to Room
Once the code team arrives
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Do not stop CPR when
the first team member
arrives
Continue until someone
is ready to take over
Code Team & Their Roles
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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
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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
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Documentation
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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
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Top
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3.
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Defibrillator
Intubation equipment
Possibly meds
O2 tank, portable
suction, ambu bag
Front drawers and
Side drawers
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2.
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Meds
IV equipment + fluids
Resp supplies
Trays
Misc (gloves, sutures,
flashlight, batteries)
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Example
Emergency Medications
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Oxygen
Epinephrine
Amiodarone
Atropine
Adenosine
(Adenocard)
Diltiazem
Digoxin
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Lidocaine
Magnesium Sulfate
Dobutamine
Dopamine
Narcan
Do Not Resuscitate
Full code or No Code
 Documentation
on chart of
MD order
 MD discussion with patient / family
 Chart labeled
 MAR labeled
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 What
if family changes their mind??
Student’s Role in a Code
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Assessment / reassessment
Notify nurse immediately of
changes in the patient’s status
Perform CPR
Observe during the Code
Help with patient’s family