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CODE BLUE

PROCEDURES

Luis Enriquez RN, BS.Los Angeles County USC Medical Center

Departent o! Eergency Medicine

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CODE BLUE TEAM "rained patient care pro#iders $%o per!or

resuscitation on any person $%o sustainsCardiopulonary arrest

Respiratory arrest

 Air$ay pro&le

"rain pro#iders'Doctor 

Nurse

Support (ersonnel

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CODE BLUE ACTIVATION All eployees ust &e educated to acti#ate

Code Blue response in t%e e#ent o! Cardiac arrest

Respiratory arrest Acti#ate Code Blue Response &y

Calling )ospital Eergency *perator

(ro#ide +n!oration' (atient location, Adult(ediatric

)ospital Eergency *perator $ill acti#ate

response $%en noti!ied o! Code Blue e#ent Code &lue pager syste

 Announce o#er%ead t%e location o! t%e code e#ent

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CODE BLUE MEMBERS (%ysician' Eergency Departent

(ediatric attending or senior resident

(%ysician' +nternal Medicine

(%ysician' general Surgery

+ntensi#e Care UnitEergency Nurse

Respiratory "%erapist E- /Electrocardiogra0 "ec%nician

Nursing Super#isor  Los Angeles County + USC

Medical Center

Code Blue Protocol

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ROLE OF THE TEAM MEMBERS

EMERGENCY PHYSICIAN "ea Leader' direct o#erall patient care

Manage t%e Code

Medication De!i&rillation

*t%er procedures' +ntu&ation, copressions

E#aluate Code Blue procedures E!!ecti#eness o! C%est Copression

E!!ecti#eness o! assisted respirations

R%yt%pulse c%ec1

Docuent in t%e edical record

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ROLE OF THE TEAM MEMBERS

EMERGENCY NURSE Maintains air$ayo2ygenation#entilation

 Applies onitor leadsde!i&rillator pads

Starts +ntra#enous access

 Adinister edications

 Adinisters Electrical S%oc1 / ACLS trained0

 Assist $it% intu&ation procedures

Copletes C(R record

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ROLE OF THE TEAM MEMBERS

PRIMARY NURSE  Acti#ate code &lue tea

Bring Eergency Resuscitation Cart

(lace &ac1&oard under patient

+nitiate 3 an Cardio (ulonary Resuscitation

 Adinister #entilations $it% 4556 *3 $it% Bag#al#eas1

 Attac% Electro cardiogra leads

 Attac% 7%ands o!!8 de!i&rillator pads Ensure patient +ntra 9enous access

(repare suction

*&tain supplies !ro C(R Cart:ard Stoc1

Record e#ents on C(R record

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CODE BLUE

NURSING SKILLS +denti!y respiratorycardiac arrest

 Acti#ate Code Blue

*2ygen adinistration' Nasal cannula, as1 Bag;9al#e;Mas1 resuscitation $it% 4556 *3

Cardiac Monitorde!i&rillator pads Application

+ntra 9enous access Medication Adinistration

De!i&rillation /ACLS trained0

C(R docuentation

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ROLE OF THE TEAM MEMBERS

SUPPORT PERSONNEL Respiratory "%erapistMaintains air$ay and o2ygenation#entilation

 Assist $it% intu&ation procedures

E- "ec%nician' (er!ors 43;lead E-

(%aracist' (repares edications

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BASIC LIFE SUPPORT

SURVEY1- Esta&lis% Unresponsi#eness

2- Acti#ate Eergency Response Syste

3- Circulation

4- De!i&rillation

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Simplii!" #"$l% BLS #l&'(i%)m*

B!(& R A !% #l* Ci(+$l#%i', 21.122/S0-S

Copyrig%t < Aerican )eart Association

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ESTABLISH

UNRESPONSIVENESS"ap and S%out 7are you all rig%t8

C%ec1 !or a&senta&noral &reat%ing

&y scanning t%e c%est !or o#eent

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ACTIVATE THE EMERGENCY

RESPONSE SYSTEM Call !or %elp or send soeone !or %elp=ell !or %elp

Code Blue protocol

et t%e Autoatic E2ternal De!i&rillator 

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CIRCULATION

C%ec1 corotid pulse !or >;45 seconds +! no pulse Begin Cardio (ulonary Resuscitation

Copress center o! c%est /lo$er ? o! sternu0

Ratio' @5'3 copressions to &reat%s

Dept%' at least 3 inc%es

Rate' at least 455 copressions per inute

 Allo$ coplete c%est recoil

Miniize interruptions

S$itc% pro#iders e#ery 3 inutes

 A#oid e2cessi#e #entilation

+! pulse present start rescue &reat%ing 4&reat% e#ery >; seconds /45;43 &reat%s per in.0

C%ec1 pulse e#ery 3 inutes

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DEFIBRILLATION

+! no pulse c%ec1 !or s%oc1a&le

r%yt% as soon as AED arri#es

(ro#ide s%oc1s as indicated

ollo$ eac% s%oc1 iediately $it%

C(R copressions

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A"#,+! C#("i#+

Li! S$pp'(% Sur#ey

Ai(5#6

B(!#%)i,&

Ci(+$l#%i',Di!(!,%i#l Di#&,'7i7

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AIR8AY Maintain patent air$ay in unconscious (ts)ead tilt c%in li!t

Siple air$ay aduncts'

Use ad#ance air$ay i! needed'Con!ir proper placeent

(%ysical e2a

uantitati#e $a#e!or Capnograp%ySecure De#ice to pre#ent dislodgeent

Monitor air$ay placeent $it% continuous

quantitati#e $a#e!or Capnograp%y

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BREATHING Suppleental *3 $%en indicated

"itrate *3 to o2ygen sat F GH6 non arrest (ts

4556 *3 !or (ts in cardiac arrest

Monitor adequacy o! #entilation and

o2ygenationClinical criteria' c%est rise and cyanosis

uantitati#e $a#e!or capnograp%y

*2ygen saturation

 A#oid e2cessi#e #entilation

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CIRCULATION

Monitor C(R quality

 Attac% onitorDe!i&rillator 

Monitor !or arr%yt%ias or arrest r%yt%s

(ro#ide de!i&rillationCardio#ersion

*&tain +9+* access

i#e appropriate drugs

i#e !luids i! needed

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DIFFERENTIAL DIAGNOSIS

7!#(+) '( #," %(!#% (!!(7i9l! +#$7!7

H:7AND )ypo2ia

)ypo#oleia

)ydrogen ion /acidosis0

)ypo%yper 1aleia )ypot%eria

T:7 "ension pneuot%ora2

"aponade cardiac

"o2ins "%ro&osis (ulonary

"%ro&osis Coronary

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ACLS

C#("i#+A((!7%

Al&'(i%)m*

Copyrig%t < Aerican )eart Association

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ACLS C#("i#+ A((!7% Ci(+$l#( Al&'(i%)m*

N!$m#( R 8 !% #l* Ci(+$l#%i', 21.122/S2;-S0

Copyrig%t < Aerican )eart Association

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B(#"6+#("i# Al&'(i%)m*

N!$m#( R 8 !% #l* Ci(+$l#%i', 21.122/S2;-S0

Copyrig%t < Aerican )eart Association

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T#+)6+#("i# Al&'(i%)m*

N!$m#( R 8 !% #l* Ci(+$l#%i', 21.122/S2;-S0

Copyrig%t < Aerican )eart Association

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NSR with Ectopy> VT>VF>NSR 

I A 48 year old iron worker is brought to theEmergency Department by co-workers following anonset of sudden sever “pressure-type” chest painradiating to his neck !aw and left arm"

I #e is pale slightly diaphoretic and very an$ious"

Wide-complex tachycardia >VF>NSR 

I A %&-'ear-old woman alcoholic with a history of

(#) is brought to the hospital by her daughters becouse of worsening symptoms of dyspnea coughand whee*ing"

I +he looks moderately ill but denies chest pain"