Code Blue Presentation

Training/Mock Drill

Summary

To provide an appropriate response to a suspected or eminent cardiopulmonary arrest or a medical emergency for an adult or pediatric patient

SCENARIO

A 59 year-old woman with cardiac history and diabetes is anesthetized, positioned, and draped for a lumbar discectomy in the prone position in OR 4. Ten minutes after the incision is made, the patient develops ventricular tachycardia (VTach) followed by ventricular fibrillation (VFib) cardiac arrest. As a vital part of the team, what will you do to help? What is the best plan of action? How can you save this patient's life?

VITAL SIGNS

Anesthesiologist states, "The patient is in VFib with no pulse, we need to flip! All hands on deck! The anesthesiologist turns off volatile anesthetics and turns on FiO2 to 100% with RR setting to 8.

ECG: VFib

HR: Undetectable

RR: 14

SpO2: 88%

BP: 60/40

ETCO2: 49

Physician/ staff roles during code blue

Primary Anesthesiologist

runs the code, maintains airway

Surgeon/ Surgical Tech

Performs chest compressions-may be relieved by Surgical Tech. Notifies family after code

RN or Second Anesthesiologist

Assists with medication administration (per ACLS guidelines)

Second RN

Places defibrillator pads on patient, delivers shock per Anesthesiologist and ACLS guidelines

Circulating RN

records events on Code Blue Record (including times) and assigns roles to others as they enter room: medication administration, establishing second IV, etc.

**Click each role to learn more

CODE TEAM ROLES

RECORDER

GET PT BELONGINGS

CODE LEADER

COPY CHART

CPR 1

CPR 2

MEDICATION ADMINISTRATION

CALL 911

DEFRILLATOR OPERATOR

IV ACCESS

ESCORT PARAMEDICS TO CODE

CPR 3

CALLING/ INITIATING THE CODE

RN uses emergency page button on the phone to call "Anesthesia Stat to OR 4!"

Available RN/Tech/ORA brings crash cart to OR 4

Circulating RN calls code by pressing the Code Button by OR door

Delegates someone to call 911 for transfer to Washington Hospital

TIMELINE

preparing for acls interventions

• Surgeon covers or packs wound
• Rad Tech moves C-arm away from patient

• Defibrillator is powered on
• Defibrillator pads are placed on the patient

We need to interact with each other. We learn collaboratively.

• OR Assistant brings in gurney and places backboard (from crash cart) on it.
• patient is repositioned onto the gurney in supine position

Zoll M-Series Defibrillator

(click play to watch video on Stat Pads and Cable Connections)

defibrillating with the Zoll M-Series

1. Place the Defibrillator pads on patient's chest
2. Power defibrillator on by turning the dial to "defib" the rhythm will now be read through the pads not the EKG leads.
3. Set the energy on the defibrillator using the up and down arrow "energy select" buttons. Energy ranges from 1-200 joules
4. Press the "charge" button.
5. Clear the patient, "shocking on 3, clear the patient". Visually check and make sure all team members have cleared the patient. "1-2-3 I am shocking."
6. Press the shock button
7. Resume compressions while anylizing response to shock.

(click play to watch video on Zoll M-Series Defibrillator)

(click to learn more about EKG pad placement)

If reading the rhythm through the "monitor", EKG pads must be placed on the patient's chest.

Test Your Knowledge

AED

begin life saving measures

• Chest Compressions are begun
• The first defibrillation shock and a dose of epinephrine are given
• The patient's clinical status does not change
• CPR continues for 2 minutes (the team may change providers performing chest compressions)

02:00

compression to Breath ratio

Current AHA guidelines recommend chest compression to ventilation ratio of 30:2 for basic life support. For a patient with an advanced airway, continuous chest compressions at a rate of 100-120 with asynchronous ventilations approximately every 6 seconds is recommended.

Test your knowledge

SEARCH FOR CAUSES

The team begins to search for a cause by evaluating the 5H's and 5T's of pulseless electrical activity

the patient improves

A second defibrillation shock is delivered and the patient's vital signs change to the following:

RR: 8

ETCO2: 45

HR: 120

Reveal

Reveal

Reveal

Reveal

Reveal

Reveal

SpO2: 90%

B/P: 78/56

Sinus Tachycardia

The patient is prepared for transfer to Washington Hospital via 911 Ambulance

Remeber to send a copy of the patient's chart, transfer papers and patient belongings!

summary

Any healthcare professional is undoubtedly familiar with the chaos that ensues when a patient enters cardiac arrest. A clean, methodical approach and accurate documentation are essential to creating the best chance of resuscitation. Code blue situations are often sudden and unanticipated. Team performance can be improved with better organization, clearly identified roles, and frequent practice. Code blue training can greatly reduce the stress level of all staff members involved in each event.

Thank you for your participation in our annual code blue training.

• The Anesthesiologist directs the resuscitation.
• They are responsible for continued resuscitative measures.
• Provides report to Paramedics and receiving physician.

Visual content is a universal, cross-cutting language, like music. We are able to understand images from millions of years ago, even from other cultures.

• Ensure patent IV route, initiate if required.
• Administer medications as ordered by physician leader.
• Communicates all interventions and responses to recorder nurse.

• Delegates to a code team member to obtain a code cart if not already there.
• Connect patient to defibrillator on code cart.
• Monitor and interpret rhythm status with time and treatment if applicable for each strip communicated to recorder.
• Defibrillate, Cardiovert or Transcutaneous Pace as needed.
• Check and monitor femoral or carotid pulse.

Disciplines like Visual Thinking facilitate the creation of visually rich notes through the use of images, graphs, infographics, and simple drawings. Go for it!

• Record all pertinent facts about the code:
• Time elapsed
• Medications given (name, dose, route, time)
• Cardiac rhythms / patterns
• Observations made by other team members
• Treatments rendered and patient's response
• Pulse, blood pressure, temperature, and respirations
• Communicate all interventions and responses to the other team members

• Places the cardiac board under the patient if not already placed.
• Takes over and continues external compressions.
• Communicates all interventions and responses to the recorder nurse.