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Code Blue

This document provides an overview and instructions for an introductory code blue simulation for learners, including the objectives to practice leadership, teamwork and acute care management skills. It outlines the case scenarios, roles, equipment, algorithms and treatments for common code blue rhythms and conditions like ventricular fibrillation, tension pneumothorax, acute coronary syndrome and anaphylaxis. Effective team dynamics during codes are also emphasized, including closed-loop communication, knowledge sharing and constructive intervention.

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Jenny Candra
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPTX, PDF, TXT or read online on Scribd
173 views26 pages

Code Blue

This document provides an overview and instructions for an introductory code blue simulation for learners, including the objectives to practice leadership, teamwork and acute care management skills. It outlines the case scenarios, roles, equipment, algorithms and treatments for common code blue rhythms and conditions like ventricular fibrillation, tension pneumothorax, acute coronary syndrome and anaphylaxis. Effective team dynamics during codes are also emphasized, including closed-loop communication, knowledge sharing and constructive intervention.

Uploaded by

Jenny Candra
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
You are on page 1/ 26

WARNING

Learners, please complete the Learner Survey

1
INTRO TO CODE BLUE

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INTRO TO CODE BLUE
PURPOSE

Experience management of code blues Suggest plans for acute care cases

Practice leadership and teamwork skills Practice early CPR and defibrillation

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INTRO TO CODE BLUE
CASES

Tension PTX | Pulseless VT

ACS | VF

Anaphylaxis | Asystole Upper GI Bleed | PEA

4
INTRO TO CODE BLUE
LOGISTICS

SIM Debrief TEAM LEADER (MD)

AIRWA CPR MEDS/DE


Y (RN) FIB
(RT) (RN)

RECORDER (RN)

5
INTRO TO CODE BLUE
OSCE FORMAT
PRIMARY SURVEY
Assessment Action
ABCs Help, O2, IV, Monitor

SECONDARY SURVEY
Assessment Action
History, Vitals, Exam Targeted Treatment

CODE BLUE
Assessment Action
Rhythm, Pulse CPR/Defib, Epi, Hs&Ts, Team
INTRO TO CODE BLUE
PRIMARY SURVEY
Primary Survey Assessment Action
Examples Examples
Immediately Airway: patency, Call for help
life-threatening secretions,
obstruction O2

Breathing: RR, O2 Needle


Sat, work of decompression
breathing, lung
sounds, tracheal IV
deviation
Monitor
Circulation: HR, BP,
LOC, bleeding, Fluids
temperature 7
INTRO TO CODE BLUE
SECONDARY SURVEY
Secondary Assessment Action
Survey
Systematic survey History (SAMPLE) Investigations
Signs and symptoms
Allergies Differential diagnoses
Medications
PMHx Treatments
Last oral intake
Events prior

Vitals

Head-to-toe Exam

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INTRO TO CODE BLUE
ARREST RHYTHMS

VF
Only 2 “shockable”
(defib) arrest rhythms

Pulseless VT

Asystole Other arrest


rhythms, including
asystole and PEA,
Everything else with NO pulse is
PEA (Pulseless Electrical PEA should NOT be
defib
Activity)
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INTRO TO CODE BLUE
CODE BLUE ALGORITHMS
Pulseless VT, VF
2min CPR 2min CPR
SHOCK Rhythm/Pulse SHOCKEPI Rhythm/Pulse

Asystole, PEA
2min CPR 2min CPR
Nothing Rhythm/Pulse Nothing EPI Rhythm/Pulse

Shockable (Pulseless VT, VF): try 2 shocks before EPI


Non-shockable (Asystole, PEA): may give EPI early
1:10,000 EPI 1mg IV q4 min
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INTRO TO CODE BLUE
CODE BLUE EXAMPLE
No response, not breathing
Rhythm Pulse Assessment Action
VT None Pulseless VT Start CPR
arrest 200J shock/defib
2 minutes of CPR
VF None VF arrest Resume CPR
200J shock/defib
1mg epi 1:10,000
IV
2 minutes of CPR
Asystole None Asystole Resume CPR
No shock/defib
2 minutes of CPR
Bradycardia None PEA Resume CPR
No shock/defib
1mg epi 1:10,000
IV
11
2 minutes of CPR
INTRO TO CODE BLUE
EARLY CPR, EARLY DEFIBRILLATION

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INTRO TO CODE BLUE
Hs AND Ts
Hypovolemia Tension PTX

Hypoxia Tamponade

Hydrogen ion Toxins

Hyper/hypokalemia Thrombosis (pulmonary)

Hypothermia Thrombosis (coronary)

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INTRO TO CODE BLUE
Narrow VS Wide Complex PEA

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INTRO TO CODE BLUE
ACUTE CORONARY SYNDROME (ACS)

O2 ASA
Nitroglycerin
Morphine Ticagrelor or Clopidogrel

UFH or LMWH Thrombolytic


βB PCI
ACEi/ARB CABG
Statin
Lifestyle changes
RISK
REDUCTION
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INTRO TO CODE BLUE
ANAPHYLAXIS

57% unrecognized or not labeled in ED


Multisystem syndrome
Distributive shock (widespread
vasodilation)

Hypovolemic shock
(fluid extravasation, reduced venous return)
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INTRO TO CODE BLUE
ANAPHYLAXIS SYMPTOMS

Derm (80-90%): flushing, itching, urticaria, angioedema


Resp (70%): nasal sx, throat sx, cough, wheeze, SOB
GI (45%): N/V/D, abd pain, dysphagia
CVS (45%): faint, tachycardia, hypotension, collapse
CNS (15%): dizziness, headache, LOC
Other: metallic taste in mouth

17
INTRO TO CODE BLUE
ANAPHYLAXIS DX

Exposure to allergen & either:

sB 2+
P <90
Adults
Decrease Do NOT need to know allergen if:
- Derm/Resp
30% - Derm/CVS

18
INTRO TO CODE BLUE
ANAPHYLAXIS TX

1st LINE = ADJUNCTS


EPINEPHRINE
1:1000 epinephrine IM Shock/CVS: fluids
anterolateral thigh Resp: oxygen, salbutamol
Adults: 0.3 mg Derm: H1 and H2 blocker
Peds: 0.15 mg βB: glucagon

PREVENTION OF 2nd LONG-TERM


Steroids may prevent Epinephrine injector
biphasic or protracted
Wear/carry allergy
anaphylaxis
identification

19
INTRO TO CODE BLUE
EPINEPHRINE IS FIRST LINE

α1
Vasoconstriction
Increased peripheral vascular resistance
Decreased mucosal edema and membrane leakage

β1 Increased inotropy (contractility)


Increased choronotropy (heart rate)

β2 Bronchodilation
Decreased mast cell and basophil mediator release

20
INTRO TO CODE BLUE
TENSION PNEUMOTHORAX

Needle decompression: 14G needle 2nd ICS mid-clavicular


line
Alternate site: 5th ICS just anterior to mid-axillary line
21
INTRO TO CODE BLUE
TENSION PNEUMOTHORAX

Chest tube: 5th ICS just anterior to mid-axillary line

22
INTRO TO CODE BLUE
Acute Upper GI Bleed
Manage Early
Fluids, O negative blood Intubation
Crossmatch (note: 1 unit = 10 Consider if:
Hb) 1. Ongoing hematemesis
Transfuse blood (if Hb < 70) 2. Altered respiratory status
Consults 3. Altered mental status

Consider: Meds
1. GI
Antibiotics for cirrhotic pts.
2. ICU
Consider PPI (ulcers) and
3. General Surgery
octreotide (varices), but may
4. Interventional Radiology
not decrease mortality rate.
23
INTRO TO CODE BLUE
ACLS EFFECTIVE TEAM DYNAMICS
Closed-loop communication*
Clear messages*

Clear roles and responsibilities*


Knowing one’s limitations
Knowledge sharing

Constructive intervention

Re-evaluation and summarizing*


Mutual respect
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