Running a code

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During a code blue in the OR, what task does the circulator do?

Specializes in ICU, Trauma, CCT,Emergency, Flight, OR Nursing.

While working in South Africa in ICU, I got called to the OR for a code. The pt was undergoing a Cystoscopy & TURP (in the old days) .What I walked in on still shocks me today. No one was doing CPR; no code drugs had been given; the anesthesiologist seemed to be in a catatonic state and just bagging the pt through the anesthetic machine and not doing anything else. There was no leader. The surgeon had left the Theatre and gone to the surgeons lounge!! I started from the A (airway secured) check. Pt being ventilated. Check (What is the ETCO2?) If low or absent we have NO perfusion of the pulmonary vasculature.Is there a pulse/cardiac output? No pulse, no SpO2 waveform or arterial waveform if pt has an A Line.Is the ETCO2 low or undetectable? (low or no perfusion state in the lungs?) Then start CPR! Hard and fast 30 compressions.Whats the rhythm on the ECG? is it shockable? 2 minutes CPR then if Vent Fib-> shock.

This got things started.I kept coding for about 30 minutes with all different rhythms but asystole finally ensued and the end was called. It still baffles me today that the surgeon never returned to the room and the anesthesiologist was totally inept in providing any kind of leadership during that situation. Fortunately my ICU experience and ACLS and ICU training stood me in good stead.

It really is the worst thing that can happen and not enough people are prepared to deal with it. My advice would be to have the hospitals code blue team respond to the OR. They are used to dealing with these situations all the time and do not get flustered.

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