code blue

I am a new RN on a tele unit. I have about two years experience, only 6 months on tele. Anyway, I have never been in a code and I am pretty freaked out at the thought. If I walked into a code do I initiate CPR? We have a code team but I didn't know if you just wait for them or what. Can someone walk me through what would happen in a code. Thanks.

Hi Siri,

I am sure you have BLS. BLS is required for everyone who is employed at a hospital who comes into contact with pts. However, that is just the basics.

Have you taken ACLS? If not, it should be required for a tele floor. I would suggest to take it even if it is not required. It would help you alot.

The first thing is to try to stay calm. First, try to establish responsiveness. If the pt is not responsive, check for a pulse & breathing. CALL FOR HELP!! If you do not have a pulse--give a pulse--start CPR. Get your ambu bag. At the same time, have someone call the code. By this time your immediate staff should be with you and hooking the pt up to the code cart. This is when your ACLS is put to use. Without it..you will be confused. When to shock, when not to shock, pace or not pace.

As the pts nurse, you should be ready to answer questions when the code team arrives. Grab your pts worksheet. You need to give a brief hx of the pt and what preceeded the code.

You may try to get your feet wet first by documenting. You will learn a little that way. Or, push the meds when they are called. The best way to learn is to get in there.

Hope this helps!! Sign up for ACLS asap!

I think the best way to learn how a code works is to first start out documenting and watching everything that's going on....

This represents a classic case of how today's hospital administrations fail to adequately prepare/support their nurses (and ultimately their patients). Tele nurses should not be forced to rely upon an internet message board to learn what should be done prior to the arrival of the code team.

There are many things that you and your coworkers can do.......even if none of you have completed an ACLS course.

Now there are priorities and you can only be at one place at a time. If you activate the Code Blue system/call for help and nobody else arrives before the code team then all you can realistically do is provide good CPR.

But usually others will respond to your calls for help and in time you will gain proficiency in putting them to work. The first order of business is to get someone to bring the crash cart and attach the pads/leads to the monitor defibrillator. It is extremely discouraging to arrive at a code to find some poor soul performing CPR, a crash cart in the room, people standing around and the patient hasn't even been "hooked up" yet.

A key point is that many of today's defibrillators are combination AEDs/manual defibrillators. AED operation should be a part of your BLS course. Early defibrillation when indicated should be a high priority. (It was disturbing to read a recent article in the lay press which showed that a person will receive earlier defibrillation in an airport than a hospital lobby due to higher AED availability.)

See someone else standing around? ........Has the patient's doctor been notified yet? Can they start a large IV in the patient's AC and/or hang some fluid? Has the family been notified? Can they relieve you from doing CPR so you can have the chart, most recent labs etc available? Get the idea?

Bring your concerns to your unit manager and suggest mock codes be initiated. And do not hesitate to initiate BLS including AED use when applicable.

I think one of the most important things you need to remember is that it is your job to get the ball rolling if your patient codes. We respond to too many codes where the nurses have called the code, then actually milled around aimlessly waiting for the code team to show up. If it's your patient, take charge of the situation - start your initial ABCs while directing other staff (if they need direction). Have them get the code cart, hook the patient up, get the backboard under them, send them for supplies - and be ready to give whomever shows up a brief history. After the code team arrives, make sure everybody else gets out of the room except you. Be prepared to answer questions about your patient's history, diagnoses, recent events, etc. Designate someone to wait outside the door to run for supplies. Become familiar with your code cart, and your rooms, so you will know where everything is quickly.