Code Blue!

babynursewannab · Sep 16, 2005

You always check your ABC's first. Call out for help when you see the patient down (as you're approaching them). Then check airway (clear? not?), breathing (do you see the chest rising/can you feel it on your cheek or hear it), and, then, circulation (does the patient have a pulse?).

If the airway is blocked, and you can safely dislodge it, do so. If it comes down to the patient has a clear airway and is not breathing, give two breaths (AMBU BAG!!!!) and check for chest rise. Check for pulse. No pulse? Then you get to start compressions. You then follow the usuall CPR guidelines for breaths to compressions and checking. The idea is that if you are totally alone, give CPR for 1 full minute and then call for further help. If it is feasible to do so, you can probably hit that code button before that since it is right there. Plus....you're still calling out for help if it hasn't arrived yet.

If someone comes to aid, the first responder (you) would be in charge of bagging the patient and the second responder would bring crash cart and start compressions. In a full code, you would be surprised at how quickly people respond in the hospital so you would not be alone long. I cannot attest to other care facilities (LTC, etc...) but I feel free in assuming people are on it at an appropriate speed.

Always approach a code situation as if you are the only responder until you are greeted with help.

Hope this helps...If I left anything out, please pipe up anyone.

HappyNurse2005, RN · Sep 16, 2005

First thing would be to assess the pt-are they breathing/have a pulse/responsive?

then scream for help.

Editorial Team / Admin · Sep 16, 2005

This is going to sound really silly as I've had CPR classes twice now! But I honest to goodness would freak out if one of my patients coded one day. I'm a PCA and I *know* it is bound to happen sometime and possibly during clinicals as well. I just wouldn't really know what to do first I guess.
For instance, what if your patient fell in the bathroom and they code...what do you do first? Get on top of them and start doing chest compressions? Or do you run out in the hallway, grab the resuscitation mask and then go? Do you do it without a resuscitation mask if no one comes? (I know that one's a little desperate as everyone's gonna come running during a code) Do I get off once more experienced personnel come along? I feel like I'd freak out and just be in someone's way, but I REALLY want to know what to do should the emergency arise.

Hello, PinkAurora,

Valid concerns.

When you see a patient who appears to be unresponsive, the first thing you need to do is, establish unresponsiveness. Gently shake the victim and ask, "Are you o.k.? Can you hear me?" If they do not respond, call for help and then remember A-B-C. Check airway and breathing by jaw thrust. Breathe twice. Then check a pulse. If no pulse, start chest compressions.

It is just like you learned in CPR.

If you have a mask readily available get it and shout for help. When the personnel come, you may be asked to step aside and you may be asked to continue.

You must establish unresponsiveness before you act, because you do not want to do CPR on a patient who just happened to fall asleep on the floor.:)

hrtprncss · Sep 16, 2005

Just a quick clarification, CPR for one minute is only done now for children less than 8 years of age or victims from drowning or drug ingestion. Call for help first before initiating compressions if it is an adult victim. Updated by AHA awhile back.

needs help · Sep 18, 2005

The posters above have pretty much got the answer covered. Try to relax for now. You will learn more as you go on in classes and clinicals. Your instructors may even run a "staged" code blue with a resuscitation Annie, maybe even more than one, especially if you ask them to. That will give you more 'hands on' to help calm you. Don't get me wrong, when it happens you will probably be a bundle of nerves either during or after. But, your training WILL kick in and you will manage. I can tell you some interesting stories of "codes" I've been involved with but I didn't here because some can make you more nervous. If you or any one is interested in hearing them let me know.

Best of luck in classes. You are going to be a great nurse! How do I know? Because I have found that the ones that worry about making sure they know for sure how to do things are some of the best nurses I've met. :)

Thanks for taking time to read this. Let me know if I can be of any further assistance. Rhonda

Chad_KY_SRNA · Sep 18, 2005

Well I can walk you through a Long Term Care Full Code. You enter the resident room to provide care. You notice that his skin is a very poor cyanotic color. You can pretty well skip shaking them to establish unresponsiveness, you open the airway, look listen and feel for breathing, check for a pulse, if both are absent you go to the nurses station, check code status and then call a code blue, run back into the room and start CPR. The other staff will bring the crash cart and help you. Its not hard to do CPR, just find the hand placement and go at it. The other staff can trade out with you when you need a break.

Editorial Team / Admin · Sep 18, 2005

Well I can walk you through a Long Term Care Full Code. You enter the resident room to provide care. You notice that his skin is a very poor cyanotic color. You can pretty well skip shaking them to establish unresponsiveness, you open the airway, look listen and feel for breathing, check for a pulse, if both are absent you go to the nurses station, check code status and then call a code blue, run back into the room and start CPR. The other staff will bring the crash cart and help you. Its not hard to do CPR, just find the hand placement and go at it. The other staff can trade out with you when you need a break.

Beg to differ, here, Chad_KY_SRNA,

After you establish unresponsiveness, not breathing, no pulse.....you do not leave the patient and go check the chart.

This is NOT ACLS protocol.

Chad_KY_SRNA · Sep 18, 2005

In my nursing home, you make sure they are a full code and call a code blue before you start CPR. We do not have the tools to do ACLS codes, we do BLS until the county ambulance service arrives and then they start ACLS. Isn't it assault to do CPR on someone who has a DNR? :uhoh3:

Fun2, BSN, RN · Sep 18, 2005

In my nursing home, you make sure they are a full code and call a code blue before you start CPR. We do not have the tools to do ACLS codes, we do BLS until the county ambulance service arrives and then they start ACLS. Isn't it assault to do CPR on someone who has a DNR?

I understand if the patient is *your* patient, you should know whether or not the person is DNR. What happens if the patient is DNR, but is not your patient and you find them in a full code status?

Do hospitals have the DNR patients wearing a certain color band like a red allergy band for allergies?

Editorial Team / Admin · Sep 18, 2005

In my nursing home, you make sure they are a full code and call a code blue before you start CPR. We do not have the tools to do ACLS codes, we do BLS until the county ambulance service arrives and then they start ACLS. Isn't it assault to do CPR on someone who has a DNR?

O.K.......In BLS, there is no statement that states to go the the desk and determine DNR status before initiating CPR.

control · Sep 18, 2005

If you're ever in that situation, you stay with the patient until you are relieved by someone. That's pretty important.

Initially, if I found someone in a condition that calling a code could be necessary, I'd be assessing them for responsiveness (shaking, calling there name, checking for breathing and a pulse) and calling out for help at the same time.

Then everything else (ABCs, CPR, ACLS, etc.) would follow.

Every nurse should know the patient's code status. It would also be nice if there is some kind of notice in the room stating the person is a DNR, that's how it was at the last hospital I worked at, whether it's on the patient's body or on the wall above the patient's bed.