Code Blue System:

Nursing
Perspectives

Cirebon City West Java

Indonesia

Prepared by: Donald S. Escano. BSN RN MANc

-International Nurse Speaker

-National Lecturer for Philippine Nursing

Licensure Examination
Cardiopulmonary Arrest
-abnormal heart rhythm, sudden loss of
blood flow resulting from the failure of
the heart to effectively pump that may
result into death without immediate
resuscitation.

Resuscitation
-is the process of correcting physiological
disorders (such as lack of breathing or
heartbeat) in an acutely ill patient
-cardiopulmonary resuscitation and
mouth-to-mouth resuscitation.

Defibrillation
-Delivering high energy electric shock to
the heart of someone who is in cardiac
arrest to restore normal sinus rhythm

Code Blue Team-

What is Code Blue?
Code blue is the term used by most
medical institutions to indicate that a
patient is having cardiopulmonary arrest
and needs immediate resuscitation. The
resuscitation is done by the “code team”

-------------------------------------------------

Code blue: An emergency situation

announced in a hospital or institution in
which a patient is in cardiopulmonary
arrest, requiring a team of providers
(sometimes called a 'code team') to rush
to the specific location and begin
immediate resuscitative efforts.
Criteria for CODE BLUE
-Unresponsiveness

-No respiration

-No pulse
CODE BLUE
The first healthcare provider
to respond assumes the role
of “compressor” and
immediately begins chest
compressions at a rate of at
least 100-120 compressions
per minute
-every 2 minutes (or after
about 5 cycles of
compressions (2in pedia
1.5in) and ventilations at a
ratio of 30:2to prevent
decreases in the quality of
compressions.
 Second Responder
-Bring the e-cart and other emergency equipment on the
site of code.
- Secure the backboard under the patient.
-Manage airway by using an ambu bag or a pocket mask
with one-way valve.
-Switch role with the first responder in giving chest
compressions to the patient.

Third Responder
-Turn on the AED/defibrillator and use it for pulseless
patients to restore normal sinus rhythm (Doctors order)
E-CART
DEFIBRILLATOR
-As soon as the shock is
delivered, resume chest
compressions immediately

-After about 5 cycles of CPR

(about 2 minutes), ending with
compressions, the cardiac
rhythm should be checked
during the change of
compressor roles(DR). If an
organized electrical rhythm is
present, check for return of
spontaneous circulation
(ROSC) by checking the carotid
pulse.
Fourth Responder
Ensure that IV fluids and emergency medications
are ready for use of the Code Team.

Fifth Responder
In-charge with documentation.
Code Blue Team – CERTIFIED BLS
TRAINED

Critical Care/ICU RN
-Serves s the code team leader until the
physician arrives
-Manages and monitors defibrillator and
cardiac rhythm strips
-Relays ECG findings to the physician and
to the nurse documenting the code
-Administers emergency drugs as directed
-Establish Vascular acess

Physician/Specialist
– Serves as the code team leader (E.R
SPECIALIST, MEDICAL SPECIALIST)
– Directs medical management to be
followed by the rest of the Code Team
-Termination of the code
ICU Resident on duty:
Insert INTUBATION: airway
-Ambu Bag

Anesthesia Resident:
Manages Intubation

Client Resident on Duty:

Compressor 1

Medical Resident On Duty

Compressor 2
Unit RN
-Assists the Code Team as needed
-Initiates basic life support.
Runner: Ward Nurse
-Recorder: Bed side Nurse
-when it's time for a compressor role switch
and the time (q 2mins
-medication administered. It's
-cardiac rhythm before a shock is delivered
and that compressions were immediately
resumed after the shock.

Pharmacist
-Prepares emergency medications
-Calculates infusion rates
-Ensures drug incompatibilities are
avoided
-Ensures the e-cart is properly restocked
Respiratory Therapist
In-charge of airway management and respiratory
assessment
Assists in intubation
Secures settings of mechanical ventilator
Obtains and reports arterial blood gases as ordered

Clinical Supervisor
Facilitates communication between the physician
and the patient’s family
Assists patient’s family in the waiting area as the
code progresses
Facilitates transfer of patient to a critical care unit
once revived
Assists nurse in charge of documentation to ensure
proper recording of the events that took place

ED Techs
Performs chest compressions
May serve as runner of the team
Assists in the transfer of patient to the critical care
unit once revived
When to stop Resuscitation?
Normal Sinus Rhythm

Ventricular Fibrillation

Ventricular Tachycardia
Successful Resuscitation

-Normal Sinus Rhythm

-Palpable Regular Pulse
-Near to normal
-If the client has no
spontaneous breathing
continue to secure airway
and maintain with Ambu
bag hooked in O2 or
Mechanical Ventilation
TERMINATION OF CODE BLUE
Do’s

1. Get involved- Gain valuable experience as a nurse.

2. Participate in mock codes – Healthcare institutions usually

conduct mock codes especially for new nurses so they will be
oriented with the hospital’s policies during Code Blue

3. After your first Code Blue, debrief with the team afterwards –
Talk with the team about the things that went well and what
areas need improvement. Debriefing after the code will help you
improve your skills and knowledge in responding to codes.
Don’ts

1. Leaving the code right away – Once the Code Team has arrived, don’t
leave the scene right away. You know your patient well and the team
might need some information from you as the patient’s charge nurse.

2. Switching roles without proper communication – If you feel the need

to switch roles, communicate with the team to ensure someone will
take place of your role.

3. Shouting – Be calm and communicate clearly. Do not shout or yell as

it adds up to the tension of the team during a code. Speaking calmly
also maintains your presence of mind throughout the event.
 National Cenetr for Biotechnology Information
(NCBI)
Analysis of functioning and efficiency of a code blue system in a tertiary care
hospital: Saudi J Anaesth. 2018 Apr-Jun; 12(2): 245–249.

694 (code blue) calls were studied and analyzed. 620 were true calls
and 74 were falls alarm.
422 were cardiac arrests
and 198 were medical emergencies.
Overall survival was 26%.
Survival in patients with cardiac arrests was 11.13%.
Factors such as age, presenting rhythm, and duration of CPR were
found to have a significant effect on survival.
“The key to running an effective code blue is the quality and timeliness of
the interventions. Early, high-quality CPR and rapid defibrillation, if
indicated, before advanced cardiovascular life support (ACLS)
interventions are two essential principles in beginning the resuscitation
phase.” (Cr:2018)

Cirebon City, West Java Indonesia

March 2 2019

Donald S. Escano. BSN, RN, MANc

International Nurse Speaker

Terima kasih!