CODE BLUE QUICK SHEET:
ACLS algorithm
CPR 2 min → check pulse & rhythm Q2 min of CPR
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SHOCK→ wait to see rhythm; NO MEDS yet
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CPR 2 min → check pulse & rhythm Q2 min of CPR
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SHOCK
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GIve EPI = 1 mg Q 3-5 min IV push @ beginning of
compressions (NOT with breaths)
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SHOCK→ wait to see rhythm; NO MEDS yet
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CPR 2 min
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SHOCK
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CPR
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Amiodarone = 300 bolus 1st dose IV push,
150 2nd dose,
NO 3rd dose. (Dilute in 20-30 ml D5W)
(Should wait 15 min between doses)
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**Hang whatever fixes pt heart**
NOTE: You can only do all this for so long→ intubate pt
CPR
30 compressions - 2 breaths - 30 compressions - 2 breaths
Breathing/Circulation:
○ 1 breath/sec
○ Tight seal around mouth/nose -- stand at HOB, tilt
head back, hold mask & chin w “C”-shaped hand
○ Give 15L of O2 (Ambu bag fully inflated)
Compressions:
○ Hands middle @ nipple line
○ 2 inches deep; 100-120 per minute
○ Place backboard under pt
Defibrillation/Cardioversion
Pads can 1) cardiovert, 2) pace, 3) defibrillate
**defibrillate IF pt is dead→ VTach/ VFib
**cardiovert IF pt alive → Aflutter or symptomatic AFib
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Then think: What needs fixed to keep this pt alive?
Cardioverting→ converts to sinus rhythm from FAST
rhythms OUTSIDE the ventricles. SHOCKS are
delivered with R waves→ energy used to control RATE.
SE: physically exhausting → give meds to relax (versed)
ROSC:
Return of Spontaneous Circulation
1. Maintain O2 saturation ≥94% via face mask
HOB 30 deg
Advanced Airway?
2. Treat HoTN (SBP <90mmHg) → IV bolus (1-2 L NS
or LR) and vasopressor infusion (Epi, Dopamine,
Norepi)
- then focus on treatable causes that may have
precipitated the cardiac arrest
3. 12-lead ECG
- To identify pt’s w STEMI or high suspicion of AMI
4. Assess coronary reperfusion
Initiate Temperature management (mild hypothermia
is optimal for good neurological outcome)
Neuro checks
Airway
● NO oral airway if AWAKE→ gagging/aspiration risk
● Nasal trumpet CI for deviated septum or trauma pt
● PRIORITY: adjust head/neck position 1st
ETT/Vents: used for
1. inability to maintain airway (LOC issue) and
2. oxygenation issues (lungs)
→Sedate first (need order to sedate- restraint)
→ 10 cc syringe w air to inflate balloon (to keep air IN)
→ measure tube in cm @ gums or teeth
→ oral care to prevent VAP and infxn; bite block (tubing)
*CHECK placement: (1) Auscultate stomach (2) base of
L/R lungs (3) higher on lungs (4) physical rise of chest
even? (5) check CO2 detector
NO XRAY to verify (this is a DR thing)
Code Blue Drugs
● Amiodarone→ use FILTER; no 3rd dose
● Adenosine→ FLUSH FAST; 12 lead EKG, used for
chemical cardioversion
● Epi→ All pressors are compatible
● Atropine→ symptomatic brady (NOT CPR/code blue!)
● Lidocaine→ antiarrhythmic
Pt may need LR to expand vasculature; (don’t have to flush line
during med administration if giving fluids)
During code → DOCUMENT (when did code start?
Meds given? When? Dose? etc)
☆ Treat the PATIENT, not the monitor ☆