Code Blue Lab

1
Code Blue Lab

• Janie Best, RN, MSN, ACNS-BC, ONC

2
Objectives

• Analyze professional and legal dimensions that
  guide a nurses responsibilities during a code,
  including do not resuscitate (DNR) status

3

• Almost ½ of all patients who code exhibit warning
  signs up to 6 hrs prior to their arrest
• heart rate lt 45 , gt 125
• Respiratory rate lt 10,
• gt 30
• Chest pain
• Altered mental state

4
Signs of Impending Code

• Changes can be acute or gradual!
• Recognizing vital signs trends and changes is
  CRUCIAL!
• It takes a more perceptive nurse to anticipate
  and prevent a code, than to run a code well.

5
Before a Code is called

• Assess the patient
• Look for signs of
• Restlessness
• Dizziness
• new pain in any location
• changes in
• level of consciousness
• vital signs
• labs, CBC, or electrolytes such as potassium,
  sodium, calcium

6
What to Do I Do If I Think My Patient is Going to
Code?

• Let the nurse responsible for the patients care
  / Charge nurse / your clinical instructor know
  immediately of changes in your patients
  condition !
• PCAT team can be called as soon as the nurse
  identifies changes in the patients condition
• Reassess the patient frequently

7
Calling the Code

• Call the Emergency number
  for the facility
• Identify the Code
• Give the location of the Code
• Note the time using the clock in the patients
  room
• The primary nurse must be in the patients room
  until the end of the code

8
Prior to the Code Team Arriving

• Put on appropriate PPE
• Start CPR
• Airway
• Breathing
• Circulation
• 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

9
Code Team Their Roles

• Intensivist team leader intubation, gives
  orders
• Critical Care Nurse gives meds
• Supervisor / Staff nurse documents
• Respiratory therapist assists respirations,
  draws blood gases
• NA CPR, place AED pads, bring cart / chart,
  assist with taking family to quiet location, help
  with other patients
• Student CPR, observation

10
The Crash Cart

• Top
• Defibrillator
• Procedure Manual
• Respiratory Drawer
• Front drawers
• Meds
• IV equipment
• Fluids
• Trays

11
The Crash Cart

• Side Drawers
• Respiratory (Blood Gas kits, Oxygen tubing)
• Gloves
• Flashlight, batteries, sutures
• Portable suction
• Oxygen tank
• Ambu bag

12
Once the code team arrives

• Do not stop CPR when the first team member
  arrives
• Continue until someone is ready to take over
• Defibrillation requires electrical safety
  measures --- everyone OFF the bed including your
  scrub jacket!

13
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.

14
Post Code Responsibilities

• Patients 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

15
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

16
Do Not Resuscitate

• State of North Carolina
• Full code or No Code
• Documentation on chart of
• MD order
• MD discussion with patient / family
• Chart labeled
• Rounds report labeled
• What if family changes their mind??

17
Students Role in a Code

• Assessment / reassessment
• Notify nurse immediately of changes in the
  patients status
• Perform CPR
• Observe during the Code
• Help with patients family

18
Emergency Medications

• Oxygen
• Atropine
• Adenosine (Adenocard)
• Amiodarone
• Diltiazem
• Digoxin
• Epinephrine

• Lidocaine
• Magnesium Sulfate
• Dobutamine
• Dopamine
• Narcan

19
NCLEX Questions

• The nurse finds the client unresponsive on the
  floor of the bathroom. Which action should the
  nurse implement first?
• Check the client for breathing
• Assess the carotid artery for a pulse
• Shake the client and shout
• Call a code via the bathroom call light

20
NCLEX Questions

• The patient has continuous ECG monitoring, and
  the monitor show that the rhythm has changed to
  ventricular tachycardia. Which of the following
  is the FIRST action that the nurse should take?
• Administer IV lidocaine according to emergency
  protocol
• Obtain the defibrillator and defibrillate the
  patient
• Quickly assess the clients level of
  consciousness, blood pressure, and pulse
• Administer a precordial thump

21
References

• Smeltzer, S.C., Bare, B.G. (2008). Management of
  patients with dysrhythmias and conduction
  problems. In Brunner Suddarths Textbook of
  Medical Surgical Nursing, 11th ed. Pp.
  969-973.
• Presbyterian Healthcare Code Blue Policy and
  Procedures