Simulated Protected Code Blue

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Simulated Protected Code Blue

• Randy Wax, MD, FRCPC
• Rod MacDonald, RRT
• Human Simulation Program, Mount Sinai Hospital/
• University of Toronto
• Peter Brindley, MD, FRCPC
• Department of Critical Care Medicine, University
  of Alberta
• Revised January 16, 2004

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Present basic concepts of biohazard protection
during resuscitation and Protected Code Blue
protocols
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Simulated biohazard resuscitation scenarios with
post-scenario debriefing
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First responder discovers unstable
situation Activates Protected Code Blue
FIRST RESPONDER
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Place HiOx mask with filter onto patient
FIRST RESPONDER
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Initiate chest compressions if no pulse If First
Responder can provide automated or manual
defibrillation, check and rhythm and shock if
equipment available
FIRST RESPONDER
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First responders should not perform high risk
procedures
FIRST RESPONDER
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PCB Team dons personal protective equipment and
adjunct equipment (PAPR in this simulation)
PCB TEAM
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PCB Team dons personal protective equipment and
adjunct equipment (PAPR in this simulation)
PCB TEAM
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PCB Team members bring resuscitation equipment
into room
PCB TEAM
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PCB Team members bring resuscitation equipment
into room
PCB TEAM
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First Responder gives report to first PCB Team
member entering room then leaves
FIRST RESPONDER
PCB TEAM
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Confirm HiOx mask on patient Attach cardiac
monitor, pulse oximeter Check initial rhythm
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Shock VF or pulseless VT
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Rapid sequence intubation by expert
intubator Manual bag ventilation with filter and
2-person technique only if absolutely necessary
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Confirm ETT placement with disposable CO2
detector, observation Difficult to auscultate
with PAPR Note Should have filter between ETT
and CO2 detector!!!
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Ventilate with filter between bag and ETT
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Is PEA present? Consider tension
pneumothorax Needle decompression /- chest tube
if suspected
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Is PEA present? Consider tension
pneumothorax Needle decompression /- chest tube
if suspected
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Once patient stabilized, begin plans for
transport of patient to ICU (or decontamination
of room and staff if patient to remain in room)
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PCB Team to leave room and decontaminate when
patient stable
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Produced By Human Simulation Program, Division
of Critical Care Medicine, Mount Sinai Hospital,
Toronto, Ontario, Canada And Department of
Critical Care Medicine, University of Alberta,
Edmonton, Alberta, Canada
Dr. Randy Wax Dr. Peter Brindley Rod
MacDonald, RRT