code blue question

  1. 0
    hello everyone! i have a question about guidelines on calling for code blue. see ive been working on the hospital for 2 months now and im still under the training phase. this is my first time to work after i passed the licensure exam. and to tell u, i havent experienced a code yet! and im so so nervous really

    so once in a while im getting pretty nervous on when to call for a code blue. now my question is...

    -if the patient has no breathing but with pulse, what should i do?

    -if a patient has breathing but has no pulse, what should i do?

    another, what if there is a carotid pulse but it is weak, should i start chest compression? if the pulse is palpatory, should i call for a code?
  2. 28 Comments so far...

  3. 1
    Where I work a code blue is called on a patient who meets any of the following:
    - absent or inadequate respirations
    - absent femoral or carotid pulse
    - threatened airway
    - decerebrate posturing

    All other medical emergencies (eg RR >46, GCS drop >2, PR <40) are reasons to initiate a Medical Emergency Team response.
    sevensonnets likes this.
  4. 3
    If you have a weak pulse then you need a set of vitals (BP especially). I think a palpable pulse indicates some circulation to the brain, though I would flatten the bed.

    If the vitals are dumping fast you have to call something, and I'd go with whatever team is fastest, plus yell from the room for a coworker and crash cart. It's also OK to move the crash cart closer to the room if you anticipate a problem, and clear the room of extra junk. Make sure suction is ready, and ambu bag is out and connected.
  5. 6
    Not breathing start bagging and call code because they wont have a pulse for long if they are apneic .
    No pulse start CPR immediately and then call code.

    With a weak carotid you need some vitals because you may need to initiate cpr if your not profusing.
  6. 5
    Quote from maiohmai
    hello everyone! i have a question about guidelines on calling for code blue. see ive been working on the hospital for 2 months now and im still under the training phase. this is my first time to work after i passed the licensure exam. and to tell u, i havent experienced a code yet! and im so so nervous really

    so once in a while im getting pretty nervous on when to call for a code blue. now my question is...

    -IF THE PATIENT HAS NO BREATHING BUT WITH PULSE, WHAT SHOULD I DO?

    -IF A PATIENT HAS BREATHING BUT HAS NO PULSE, WHAT SHOULD I DO?

    another, what if there is a carotid pulse but it is weak, should i start chest compression? if the pulse is palpatory, should i call for a code?

    Umm...you may want to read a bit more...it is phyiscally impossible to be breathing and have no pulse....FYI...

    Good rule of thumb is if YOU THINK you need to call a code...then by all means do so...if your wrong...oh well no harm done, however if you don't call a code when you should have then the patient is not going to have a very good day!!!
    NaKcl, sevensonnets, systoly, and 2 others like this.
  7. 0
    Whenever you're in doubt stay with the patient and hit your emergency button (some are on locators on your badge or on the in-room call system) call for backup from your fellow nurses/charge nurse. In some cases it may be necessary to call a rapid response team before the patient actually codes.
  8. 6
    Perhaps you should consider taking a BLS or ACLS refresher course. I would also become familiar with my hospital's protocols for Rapid Response and Code Blue-if you are still in orientation do you have a clinical mentor you could ask?
    noyesno, 3rdcareerRN, sevensonnets, and 3 others like this.
  9. 2
    TAKE ACLS and PALS. Its great practice and you know concretely which steps to take for which situations.
    sevensonnets and CCL RN like this.
  10. 8
    It's very good that you are asking these questions, being new you've not experienced what "GOING BAD" really is

    First NEVER, NEVER EVER leave your patient... scream, call out, hit the emergency button call a code with the patients own phone, but don't leave them..... well ok, you can stick your head out the door and scream for help.

    Then the ABC's starting with you....assess yourself, deep breath and check airway, breathing and circulation. Guppy breathing... 5 times a minute or agonal does not count, nor does the non responsive can't maintain their airway and they are a limp doll, it's an emergency.....

    So is a thready pulse when you can't get a BP... just compress... the patient WILL OBJECT if you shouldn't be doing it, and they'll object quickly.

    After you've called a code, you don't leave, you direct your team to check a blood sugar AND shut off the PCA pump and give narcan if they have a med pump...the usual culprits if patient not septic and surgical.

    Order someone to page the MD stat, get you the chart and pull up the am labs.... while the code begins... YOU don't code, you're needed then once the team arrives to talk with the doc, call the family and answer a ton of questions... let the code team then do their work... don't leave!

    I"m missing a ton of advice, but time is brain tissue... don't try taking a bp for 10 minutes... if you can't palpate femoral pulses and no bp registers, get on that chest stat...not breathing well... ambu them.... if on a pca, reverse it... and check a blood sugar asap.

    You don't have to do it all, shout out those needs until the code team arrives and NEVER leave your patient.

    Thats the best advice I can give as and ICU nurse who runs to floor codes and frequently finds an almost dead patient alone, with no interventions having been done when I get there.
    NeoNurseTX, NaKcl, MomRN0913, and 5 others like this.
  11. 8
    Really need to add... what ever you policy is... for god's sake... please... please make sure the patient is NOT, NOT a DNR FIRST before you begin.... or check very quickly after you've asked for a code to be called. Don't even get me started on that one... if people snicker after running so be it.. but LOOK! Coding and reviving a DNR only to get transferred to the ICU on a vent is hell for the patient, the family and you.
    NaKcl, 3rdcareerRN, MomRN0913, and 5 others like this.


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