CODE BLUE IN HOUSE (UGH!!!) We only have ONE shot at this!!!

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1 CODE BLUE IN HOUSE (UGH!!!) We only have ONE shot at this!!!

2 Realities We are all nervous! What happens What should happen Room is Chaotic Everyone is yelling, screaming Strict order must be kept Only one person speaks/ One Leader 20 People in room Only the Code Team should be present The Patient s RN NOT in room Waiting for ED MD to begin MEDS NO labs are available Everyone is running wild The pt s RN MUST be present Start at once Labs and recent results must be made available to the Code MD Remain CALM and FOCUSED

3 CHAOS REMAIN CALM 1. Call the Code 2. Begin ABC s 3. Begin MEDS 4. Do not leave bedside 5. Take Control and Maintain control until CODE MD and Code TEAM arrives

4 Everyone screaming in room NO NO NO NO NO!!!!! Once the ED Physician and the CODE team arrives: ONLY one person speaks and gives orders Only ONE Physician must lead code Only one person must be documenting Only one person must be pushing meds ONLY one person must be preparing meds ONLY one person must be ventilating At least 2-3 persons must be alternating compressions to ensure no stopping

5 20 people in ROOM NO NO NO NO NO!!!!! Once the ED Physician and the CODE team arrives: ED Physician Anesthesiologist (if deemed necessary by EDP) Respiratory Therapist X2 Patient s NURSE Nursing Supervisor ED Nurse ED tech x 2 TOTAL =9

6 20 people in ROOM ED PHYSICIAN Team Leader: direct overall patient care Manage the Code Order Medication Order Defibrillation if needed Other procedures: Intubation, compressions Evaluate Code Blue procedures Effectiveness of Chest Compression Effectiveness of assisted respirations Rhythm/pulse check

7 20 people in ROOM Anesthesiologist Intubate if EDP cannot Assist EDP if called upon 2 nd in charge 1-2 Respiratory Therapist Ventilate the pt at all times Assist with chest compressions Prepare Suction

8 20 people in ROOM 1. Patient s Nurse (VIP) - Must remain in room at ALL times - Activate code blue team - Bring Emergency Resuscitation Cart - Place backboard under patient - Initiate 2 man Cardio Pulmonary Resuscitation - Administer ventilations with 100% O 2 with Bag/valve/mask - Attach Electro cardiogram leads -Ensure patient Intra Venous access -Obtain supplies from CPR Cart/Ward Stock Inform the EDP the events immediately before the code occurred Inform the EDP and Team why the pt is in the hospital Provide all PMHx, PSHx and allergies to EDP and Code team Provide all LABS, TESTS and Procedures

9 20 people in ROOM ED Nurse Applies monitor leads/defibrillator pads Starts Intravenous access Administer medications Administers Electrical Shock Nursing Supervisor Record events on CPR record Procure meds from the crash cart ED Tech Maintain chest compressions Start IV access Place Backboard

10 Patient s RN not in room NO NO NO NO NO!!!!! 1. The patient s nurse is quite possible the most important person in the room 1. KNOWLEDGE

11 Wait for EDP to begin meds NO NO NO NO NO!!!!! 1. Start giving meds the moment you call the code 1. Every patient has an IV while in hospital 2. USE it.

12 NO Labs available NO NO NO NO NO!!!!! 1. The EDP and Code team must me given pertinent information upon arrival 1. Hospital code vs community code 2. Knowledge is power

13 Running wild NO NO NO NO NO!!!!! 1. Remain calm and collected 1. A smooth machine 2. Quiet yet loud through actions 3. Everyone is expected to AUTOMATICALLY assume their pre-determined roles and act accordingly in unison ONLY ONE SHOT AT THIS!!!

14 In Hospital ACLS No longer ABC but rather CAB However for ACLS in-hospital providers, the AHA states that, it is reasonable for healthcare providers to tailor the sequence of rescue actions to the most likely cause of arrest. Thus: Knowledge is power!! Start CPR with 30 compressions, each 2 deep Check Pulse Open Airway, check Breathing. If (-) give 2 breaths (one cycle) Check Pulse If No pulse: Push hard and fast (100/min) On backboard

15 In Hospital ACLS BRADYCARDIA

16 In Hospital ACLS ASYSTOLE

17 In Hospital ACLS PEA

18 In Hospital ACLS Tachycardia

19 In Hospital ACLS Hypotension

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