Code Blue
Do you know
what to do?
Department of Clinical Education 2009
CODE BLUE
An IMPENDING or ACTUAL
CARDIAC/RESPIRATORY
ARREST
How To Call A Code Inside Stony Brook Hospital
•DIAL 321 from inhouse phone.
•Identify yourself (give name)
•Announce Code Blue for adults or Code Blue
Pediatrics for a child
•Indicate EXACT FLOOR, TOWER & ROOM
NUMBER OF PATIENT
•Example: Code Blue, T-16 North, room 240
•Wait for the operator to repeat and confirm
location before hanging up.
•Do not hang up on the operator, let them hang
up on you.
Response System For Cardiac/Respiratory
Emergencies occurring outside of main hospital
East Campus: HSC & Basic Science Tower
Call University Police at 333 or by
dialing 632-3333
University Police will contact EMS to
respond
Off Site locations: Tech Park, Ambulatory
Center
First person on the scene activate 911 to
dispatch EMS ambulance
Adult Code Blue Team
Senior Medical Resident (team leader)
 Anesthesiologist or Anesthesiology
Resident
 Respiratory Therapist
 Unit Staff Nurse
 ICU Nurse will respond as assigned
 Primary RN stays with Patient!!!

ICU Nurse will respond as
assigned:
18S ( SICU) responds to 13N, 14N, 18N,
19N, 19S
 17S (MICU) responds to 17S ( dialysis ),
16S,16N,15N, 15S, 12S, 14S (
Endoscopy), 10N ( Adult Psychiatry), 12N
(Antepartum)
 ED responds to Level 1-4 (except burn
and MRI) Maternity Center, 8N, 8S, 9N, 9S
 CTICU responds to Burn, MRI
 CCU responds to Level 5 including CACU

Who arrives for a pediatric code?
Some members will include:
 Pediatric Transport Resident
 If Ped. Transport Resident is
unavailable, the Senior Pediatric Urgent
Care Resident
 Pediatric Resident on Call for the ER
will respond to codes in Pediatric
Urgent Care
 Unit Staff Nurse
 PICU Nurse
 Anesthesiologist
 Respiratory therapist

Additional Staff Responders
All Codes
Nurse Manager/Off Shift &/or designee
 Transporter
 Public Safety Officer for all codes in
non-patient areas
 Others involved:


Telephone operator, Unit Clerk, CNA,
Distribution Services & Elevator transport
TEAM
Responsibilities
In A Code
NSC/ Secretarial support






Assure the Code Blue has been called
Calls code: 321 in Hospital
911-out of hospital
Prepares forms & Labels
Makes phone calls/collects patient
records as directed
Post Code: calls distribution services
to return cart
NURSING ASSISTANTS/PCT

Assist with moving Code cart to the
patient room

Listen & Follow Directives from the RN

Clean patient area post code

Help transport patient to ICU unit if
needed
HOSPITAL ATTENDANT

Is an employee from Distribution
Services

Responds to the unit with a new code
cart

Returns secured used cart to central
sterile
Telephone Operator




Once code is received, initiates code
blue page over address system and
repeats 3 times
Alert Code Blue team members via
pocket pagers
Alert MICU, OR and Anesthesia
Alert the ED or nearest patient care
area if public address system or back
up pocket pagers should fail
MEDICAL DOCTORS






Senior Medical Resident takes charge &
clears the area
If certified, may intubate patient
Administer emergency meds as needed
Notifies patients’ attending of arrest
Communicates with family at the
earliest possible moment
Decides on termination of the code
MD’s Continued
Code Successful—initiate arrangement
for transfer to critical care unit
 Code Unsuccessful—pronounces
patient’s death & refers to autopsy
 Completes progress note and
reviews/signs Code Blue Resuscitation
Record


Authorizes all medication/interventions
Anesthesia

Proceed to area of code blue

Serve as 2nd/3rd rescuer until team
assembles

Inserts ETT when indicated and verifies
position with CO2 Detector

Assists in attaching ETT to ventilator

Remains with patient until RT is able
to maintain respiratory function of
patient
Respiratory Therapist







Establishes and maintains airway
Performs tracheal suctioning
Assists/performs intubation if certified
Provides adequate ventilatory support
via manual resuscitator &/or mechanical
ventilator according to MD orders
Maintain & monitor ventilatory status
Draw & analyzes ABG’s when indicated
Assist in transfer of patient as indicated
Clinician/Charge Nurse/Nurse
Manager/ADN
Ensure Code Cart/defibrillator
present
 Ensure Code Team has responded
 Assign responsibilities as needed

 Code
Cart/Medication Nurse
 Documentation

Assist as needed
 Removal
of other patients & family
members, crowd control, pt. transfer
Registered Nurse/Code Cart RN
Apply multifunction electrode pads
 Prepare cart for use/opens cart
 Puts intubation tray at patient’s
head
 Prepare & dispense emergency
meds
 Clearly announces name and
amount of meds handed off
 Prime IV tubing & make IV labels

Code Cart Nurse continued
Charge defibrillator as per team leader
order
 Distribute supplies as needed from code
cart (bld. specimen tubes, ABG kits, etc.)
 At the end of the code, return all nondisposable items (ie. O2 flow meter &
suction) back to the used cart & LOCK
 Ensure cart exchanged/new & checked for
completeness. Sign check sheet

Nurse Recorder






Document code activities, assessments and time
performed on the CPR Documentation Record
Can report on medications given including dose and
time
Writes progress note on CPR Documentation Record
Complete code Blue Debriefing report and attach to
copy of Documentation record
Place white copy of code blue sheet on patients’ chart
along with all EKG strips or “complete disclosure”
record
Send yellow copy to NM/ADN for review and forward
to nursing office
Additional Nurse/designee
Get suction equipment set up and ready
for use
 Starts IVs/draws blood as needed
 Administers meds as directed by team
leader and calls out to Nurse Recorder
 Assist with compressions
 Assist team as directed

Code Team Positions

Coming soon—All staff members will be
assigned Code positions daily

This will decrease confusion of roles and
improve patient outcomes!

Training has begun on 16S
Pediatric Codes

Refer to Pediatric Unit for specific
policy
How will you Repond?
A Person Collapses
Possible Cardiac Arrest

ASSESS responsiveness

ACTIVATE emergency response system
321
NOTE THE TIME!
Military Time Only
CHECK for Airway,
Breathing and Circulation
FOCUS: Basic CPR and
Defibrillation

A= airway: open the airway

B= Breathing: check breathing, provide
positive-pressure ventilations

C= Circulation: check circulation, give
chest compressions

D= Defibrillation: assess for and
shock/pulseless VT and V-Fib
Help is on the way

Senior Medical
Residents

( team leaders)

Anesthesiologist/
Resident

Respiratory Therapist
ACLS




A=Airway: place airway device as soon as
possible
B=Breathing: confirm proper placement by PE
B=Breathing: confirm proper placement by
2nd method
- End-tidal CO2
- Esophageal detector devices
B= Breathing: prevent airway device
dislodgment:
 Use ETT holder
 Use proven tape and tie
B= Breathing: monitor oxygenation and
ventilation
ACLS

C= Circulation: establish IV access

C= Circulation: identify rhythm

C=Circulation: give rhythm and condition
appropriate drugs.

D=Differential Diagnosis: search for and
treat identified reversible causes.
The Code Cart has arrived!
Once The cart is here:
Get Ambu bag/ ambu patient
 Attach ambu to 15L/02
 Roll patient-place on backboard and place
pacer pads on
 Place chest leads-ZOLL
 Empty bottom drawer- equipment to head
of the patient
 Hook up suction
 Prepare drugs
 Document

DRAWER 1
ACLS 1st Line Meds for 30-40 minute code

Adenosine

Amiodarone

Furosemide

Magnesium

Naloxone
•Procainamide
•Vasopressin
•Lidocaine
•Sodium Bicarbonate
•Atropine
•Epinephrine
•Dextrose
DRAWER 2
ABG kits
 NG tube (salem sump)
 5 in 1 connector
 Zoll pads
 EKG paste/paper
 Gauze/ tape
 Pulse ox monitoring cables

DRAWER 3

Venipuncture Supplies

Phlebotomy Supplies
DRAWER 4

Emergency Cricothyrotomy Set

2 Trachs

CO2 Detector

Suction Catheters (red rubber)
DRAWER 5

IV solutions

IV tubings

Premixed Drips


Dopamine
Lidocaine
DRAWER 6





Laryngoscope Box
Intubation Box
Suction set up
O2 Set up
Central Lines
 2 Triple Lumen Catheters
 Bipolar Pacing Wire
ZOLL-Stat-Padz
NOTE: WHEN PLACING PATIENT ON THE
BACKBOARD PLACE stat-padz ON THE
PATIENT!
Place pads in anterior/posterior position
(sandwich left side of heart) if possible
Stat-padz will Monitor, Defibrillate and
Pace as needed
Connect to the Multifunction Cable
Paddles

Not recommended, but if used apply
small chest electrodes to monitor rhythm
White to the right;
 Smoke (black) over fire (red) on the left
 MFC must be attached to paddles
 Apply electrode gel to metal face
 Place one paddle at apex & one paddle at
the base of the heart

ZOLL
 Turn
ZOLL on ( GRAY )
 Gray
area on ZOLL indicates
monitor
**In an emergency situation, threatened by a
lethal arrhythmia (V. Fib, pulseless V.
Tach) a LIP/ACLS certified RN/PA may
perform defibrillation
TO DEFIBRILLATE
Think Red 1,2,3 & MD order
 Stat Padz or paddles
 CHARGE ( default setting is 120
joules), use arrows up or down to
change as per MD order
 DISCHARGE

 Numbers
1,2,3 match numbers on
the ZOLL
 “I’m clear, you’re clear, everybody
clear??”
TO PACE OR CARDIOVERT
 Think
green and MD order to
transcutaneous pace
 When
cardioverting remember the
sync mode (soft key on bottom)
 Joules
will automatically default
back to 120 ( ready to treat a
lethal arrythmia)
Post Defibrillation
Document on CPR Record
 Continuous monitoring of the cardiac
rhythm is maintained. Document any
changes (include EKG strips if possible)
 Wash “paddle sites” carefully. Burns may
result even with good technique
 Change Statz Pads every 8 hours if left
on/monitoring

LOCK THE CODE
CART
AFTER USE AND
BEFORE
RETURNING IT
HOW DO WE FILL OUT
THE CODE BLUE SHEET?
CODE CART
Locked at all times
Check lock
Check Expiration Dates
Check Items on Cart
CPR board, IV pole, checklist & forms,
Portable oxygen, ZOLL, Pediatric Color
Medication Cards
Check once every 24 hours
Complete checklist
ZOLL
Clean Unit
Inspection
Supply availability
Power on sequence
Defibrillator
Pacemaker operation
Recorder function
Respiratory Arrest/ STAT Intubation
Preparation Recommendations
1. Have Code Cart or STAT intubation
tray readily available at patient’s
bedside. Med/ Surg units will find
the STAT Intubation kit in the
bottom of the Code Cart.
2.Place patient on 100% nonrebreather face mask at
10L/minute or assist respirations
with Ambu-bag as indicated
(Note: Use with caution in patients
with severe COPD with known
CO2 retention).
3. If Code Blue has not been called
thena. Call anesthesiologist on call
for emergencies (4-7481).
b. STAT page Respiratory
Therapist
c. STAT page Primary Team
d. Consider calling RRT
4. Connect patient to all essential
monitors, including but not limited to;
BP cuff, EKG, pulse oximetry
5. Ensure Ambu-bag is at bedside.
6. Ensure suction system at
bedside; canister, tubing and
yankeur and check that system is
properly functioning.
7.Assess patient’s IV access for
patency. Insert new PIV if
necessary. Consider Intra Osseous
catheter for pediatric patients.
Have available and primed at
bedside; 1 liter bag of 0.9 Normal
Saline ( or Lactated Ringer’s
solution) to be infused upon
MD/NP/PA order.
8. Anticipate pre-intubation
sedation needs.
Are there any Questions??