Code Blue

Relax. Take a breath.  The patient has already died. All you can do is help.

Speak loudly, clearly and calmly. Point to a person and look them in the eye when you want them to do something and confirm they hear you with closed loop communication.

Establish you are the code leader
Q: “Does the patient have a pulse?” If yes – are they breathing?
Q: “Do we have access?

1 – “Start compressions. Deep and fast (2in at 100bpm). Minimize interruptions”
2 – “Get the defibrilator pads in place and let me know when we are ready to evaluate a rhythm” – this is key to determining which algorithm you are on.
3 – “Give one breath every 10sec. Anesthesia – intubate through compressions when they are ready”
4 – Assign jobs
– time keeper – “let me know every time we approach 2min of CPR and 3min since last epinephrine”
– RN – “obtain access, if not already done. collect BMP/CBC/INR/trop”
– Stat RN – “get an ABG”
– Intern/med student – “chart biopsy”
– Charge/Stat RN – “control the volume and flow of the room”
– back up for chest compression – “stand next to the person doing chest compressions and make a smooth transition at next rhythm check”

Scenario one

50 year old man with DM admitted three days ago for tib/fib fracture.

1st ECG image 1
2nd ECG image 2
3rd ECG image 3


Scenario two

40 year old woman POD 1 for open cholecystectomy

1st ECG image 4
2nd ECG image 5

Scenario three
1st ECG image 6
2nd ECG image 2
3rd ECG image 5

From UpToDate, reprinted from: Adult Advanced Cardiovascular Life Support: 2010. American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. © 2010 American Heart Association, Inc.

Take Home Points:

  • Good CPR is the most important thing
  • Time to rhythm check and shock is next most important
  • Be calm. The room should feel quiet and controlled.

Leave a Reply

Your email address will not be published. Required fields are marked *