Calling Code Blue in ED - page 3

by becca001 12,483 Views | 36 Comments

As part of the Code Blue Team, I am participating in a committee to revamp our Code Blue policies. We are a 100 bed hospital with no tramua level designation. ED is 25 bed unit and sees between 100-190 pts in a 24 hour time... Read More


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    I don't know about any of you, but at my hospital if a code blue is called, so many people arrive that it can spin someones head. We run our own codes in emerg, and it runs smoother then any floor code! The last floor code I went to, as the ER RN I have to manage lines, and do meds....well, I had to plow through 20 people just to get through the door to the patient! For that reason, we do not call ED Code Blues, unless its a mass casuality or something that our doc needs back up..if its just a run of the mill resussitation or trauma, we are quite capable of doing it without the audience of every med resident on site!
    Crux1024 and ZippyGBR like this.
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    I work in a 20 bed ER, and we had a debate about calling codes. On one hand ICU, lab, RT, Xray and the inpatient doc want to know they have priority work coming their way, but on the other hand we get scads of people that don't have a lot of code experience getting in the way, or trying to help with only a vague idea of what they are doing.

    After a series of just gross pediatric codes I spoke with my supervisor. We can page ancillary services and docs, but once people come to watch they get very snotty about being asked to leave. They feel insulted, and that we don't value their skills. Codes are just not a common occurance on the floors, and they have no idea where our equipment is, so no, I don't want them in the way while we try to save a life. I personally don't want any students or people just watching when a parent is losing their child...

    So I asked if we could call extra staff only as we needed them, particularly nursing staff. There was no official written policy made about calling codes in the ER, perhaps because once they thought about the issues it was hard to make hard and fast rules. I have CPEN, and don't need a pediatric nurse to help, but someone with different strengths might let the peds nurse run the show. If someone with burns comes in the ICU nurse will need to come down and help me with drips/meds/lines though.

    I think that no one can be an expert in everything, but in the ER you can expect your staff to be professional enough to know their own strengths and weaknesses. It would also depend on how many of your own staff were available to help out.
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    Quote from srobb11
    Since there is already a team in place in the ER fully capable of handling a code 24/7, it seems extremely counterproductive to have a Code Blue Team respond to the ER. Also, it takes away care from other areas that these members are having to vacate to respond to the code. We do not call code blues in the ER at my facility, unless the nurse/tech/whomever is alone in the room and pushes the button, in which case it will be called overhead, but only ER personnel respond.
    other than a few busy and poorly staffed nights where we were struggling anyway , it's been very very rare in my ED experience to put a crash call out, yes we've fast bleeped the senior ED if they were off the department and fast bleeped an anaesthetist if relevant but not put the crash call out - as it does especially in hours is bring more and more bodies into the resus room , which is pointless if you've already got a an ED doc or 2 and a couple of ED nurses ...
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    I work at a 300 bed hospital, level 2 trauma center. The only place that codes aren't called overhead/hospital wide is in the NICU and Cath lab. Otherwise, they are announced, even in the ED. Our code team is 1 ICU nurse (first nurse), 1 cardiac nurse (IV nurse), 1 medical nurse (recorder), whoever the primary nurse is, hospitalist, sometimes resident, sometimes ED doc (if hospitalist is unavailable), and RT.
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    Quote from HyperSaurus, RN
    I work at a 300 bed hospital, level 2 trauma center. The only place that codes aren't called overhead/hospital wide is in the NICU and Cath lab. Otherwise, they are announced, even in the ED. Our code team is 1 ICU nurse (first nurse), 1 cardiac nurse (IV nurse), 1 medical nurse (recorder), whoever the primary nurse is, hospitalist, sometimes resident, sometimes ED doc (if hospitalist is unavailable), and RT.
    Are all these non-ER folks standing by in the ER waiting for codes or do they have to come from various other places in the hospital? What happens with the dead guy while the team is enroute? ER staff runs the code until the "pros" show up or y'all just wait?

    Seems weird. Codes are what we do. Plus I like having a different role each time. Including running the code - "where's the doc?" "i dunno, continue cpr, when was the last epi?"
    TheSquire, Crux1024, and Altra like this.
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    The ED starts the resuscitation when the team arrives they return to the other ED patients. Many times once the "Team" arrives they are dismissed. Depending on what is going on in the ED it allows the rest of the staff to keep running the ED. The responding "Team" have specific duties. The ED staff member is code leader. ICU #1 giving drugs, IV team to secure IV access and they leave. RT for intubation if necessary and then they monitor the ETT. NICU responds to Code Pinks (under 3 months) and surprise deliveries. Step down/PCU records. It actually works. The place I knew had the hospitalist respond to admit what he can to clear the Department or place lines....freeing the ED doc to do the ED.
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    The hospital I worked at made up a code team, basically to respond to nurse stats ad codes on the floor, so an er RN did not have to leave a already swamped assignment. If the er needs additional staff to work a code, they will call for experienced people for it, maybe the director needs to put on scrubs, mostly its for a specialist...but really don't need help working a basic code for goodness sakes.
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    Quote from HyperSaurus, RN
    I work at a 300 bed hospital, level 2 trauma center. The only place that codes aren't called overhead/hospital wide is in the NICU and Cath lab. Otherwise, they are announced, even in the ED. Our code team is 1 ICU nurse (first nurse), 1 cardiac nurse (IV nurse), 1 medical nurse (recorder), whoever the primary nurse is, hospitalist, sometimes resident, sometimes ED doc (if hospitalist is unavailable), and RT.
    Ok I apologize if I'm just reading to far into this but there's a few things I found a bit odd with this system... 1. I get the no codes called on nicu but why call em in any ICU, OR, or ER period? ER, ICU, & OR staff are specifically trained to handle these situations, not to mention if a pt codes in the OR, is the whole code team gonna rush into the sterile OR and potentially complicate whatever procedure that was in progress pre-code? Besides they already have a scribe and circulating nurse, anesthesia for airway and meds, and pt will obviously have iv access, so what's the point?
    Also, in the described code team, it seems somewhat stereotypical or politically incorrect lol, to have the PRIMARY nurse be from ICU, the IV nurse be a cardiac RN (is that their specialty at your facility), and the medsurg nurse handles the "charting", as if they can't handle anything more complicated. And if they responded to my ED for a code (that would've never been called overhead anyways), we might laugh as they arrive to find that we have already controlled the situation all by our lowly selves lol.
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    Quote from sauconyrunner

    Our ICU actually does not call codes overhead either anymore, because again, there is an intensivist 24/7 in the ICU and all the nurses there are fully trained in code procedures.
    I kind of sound like a big bag of wind, but I think it's kind of an odd idea. the Emergency Dept is for Emergencies.
    Hear, hear. In our hospitals, ICU will call a code because there isn't an intensivist there. So an ED doc does run down there. And ED nurse goes as well just in case the ICU is nuts and more RN hands than just the primary ICU nurse is needed, but the ED RN is almost always sent back to the ED. One of the ED techs because the ICU doesn't have techs and an extra pair of hands may be needed. But sometimes they are sent back too.

    In other words, we go just in case they are short of hands, but they certainly know what they are doing and don't need us for any other reason.

    DC :-)
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    I am a volunteer in the ED until I get into nursing school and the other day I ended up calling a code blue on a 55yr old male. Yes I have the training to call one due to my St. John training. While I started compressions it literally only took 2mins to get help. I all but have secured a job in the ED when I've finished my training :fist pump:


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