CODE BLUE

PROCEDURES
CODE BLUE TEAM
 Pasien yang memerlukan tindakan
resusitasi
 Serangan jantung
 Gangguan pernafasan
 Pasien tidak sadar

 Train providers:
 Doctor
 Nurse
 Support Personnel
CODE BLUE ACTIVATION
 Semua orang harus di didik bagaimana cara
mengh aktifkan code blue dan kapan code
blue di aktifkan ?
 Cardiac arrest
 Respiratory arrest
 Pasien tidak sadar

 Activate Code Blue Response by

 CallingHospital Emergency Operator
 Provide Information: Patient location, Adult/Pediatric
 Tekan tombol code blue yang ada di ruangan (king,
admisi/pendafataran, poli, multazam, gizi, ibnu sina)
Sistem respon terbagi dalam 2
tahap, yaitu:
 Respon awal (responder pertama) berasal
dari petugas rumah sakit baik medis
ataupun non medis yang berada di sekitar
korban (perawat primer/penolong
pertama)
 Respon kedua (responder kedua) berasal
dari tim code blue.
CODE BLUE MEMBERS
 Physician: Emergency Department
 Physician: Internal Medicine
 Physician: general Surgery
 General Physician
 Intensive Care Unit/Emergency Nurse
 EKG (Electrocardiogram) Technician
 Nursing Supervisor
ROLE OF THE TEAM MEMBERS
EMERGENCY PHYSICIAN
 Team Leader: direct overall patient care
 Manage the Code
 Medication
 Defibrillation
 Other procedures: Intubation, compressions
 Evaluate Code Blue procedures
 Effectiveness of Chest Compression
 Effectiveness of assisted respirations
 Rhythm/pulse check

 Document in the medical record

ROLE OF THE TEAM MEMBERS
EMERGENCY NURSE
 Maintains airway/oxygenation/ventilation
 Applies monitor leads/defibrillator pads
 Starts Intravenous access
 Administer medications
 Administers Electrical Shock (ACLS trained)
 Assist with intubation procedures
 Completes CPR record
ROLE OF THE TEAM MEMBERS
PRIMARY NURSE
 Activate code blue team
 Bring Emergency Resuscitation
 Place backboard under patient
 Initiate 2 man Cardio Pulmonary Resuscitation
 Administer ventilations with 100% O2 with Bag/valve/mask
 Attach Electro cardiogram leads
 Attach “hands off” defibrillator pads
 Ensure patient Intra Venous access
 Prepare suction
 Obtain supplies from CPR Cart/Ward Stock
 Record events on CPR record
CODE BLUE
NURSING SKILLS
 Identify respiratory/cardiac arrest
 Activate Code Blue
 Oxygen administration: Nasal cannula, mask
 Bag-Valve-Mask resuscitation with 100% O2
 Cardiac Monitor/defibrillator pads Application
 Intra Venous access
 Medication Administration
 Defibrillation (ACLS trained)
 CPR documentation
ROLE OF THE TEAM MEMBERS
SUPPORT PERSONNEL
 Respiratory Therapist
 Maintains airway and oxygenation/ventilation
 Assist with intubation procedures

 EKG Technician: Performs 12-lead EKG

 Pharmacist: Prepares medications
BASIC LIFE SUPPORT
SURVEY
1- Establish Unresponsiveness
2- Activate Emergency Response System
3- Circulation
4- Defibrillation
 Simplified adult BLS algorithm.

Berg R A et al. Circulation 2010;122:S685-S705

Copyright © American Heart Association

ESTABLISH
UNRESPONSIVENESS
 Tap and Shout “are you all right”
 Check for absent/abnormal breathing
by scanning the chest for movement
ACTIVATE THE EMERGENCY
RESPONSE SYSTEM
 Call for help or send someone for help
 Yell
for help
 Code Blue protocol

 Get the Automatic External Defibrillator

CIRCULATION
 Check corotid pulse for 5-10 seconds
 If no pulse Begin Cardio Pulmonary Resuscitation
 Compress center of chest (lower ½ of sternum)
 Ratio: 30:2 compressions to breaths
 Depth: at least 2 inches (4-6 cm)
 Rate: at least 100/120 compressions per minute
 Allow complete chest recoil
 Minimize interruptions
 Switch providers every 2 minutes
 Avoid excessive ventilation
 If pulse present start rescue breathing
 1breath every 5-6 seconds (10-12 breaths per min.)
 Check pulse every 2 minutes
DEFIBRILLATION

 Ifno pulse check for shockable

rhythm as soon as AED arrives
 Provide shocks as indicated
 Follow each shock immediately with
CPR compressions
Advance Cardiac
Life Support Survey
 Airway
 Breathing
 Circulation
 Differential Diagnosis
AIRWAY
 Maintain patent airway in unconscious Pt’s
 Head tilt chin lift
 Simple airway adjuncts:

 Use advance airway if needed:

 Confirm proper placement
 Physical exam
 Quantitative waveform Capnography

 Secure Device to prevent dislodgement

 Monitor airway placement with continuous
quantitative waveform Capnography
BREATHING
 Supplemental O2 when indicated
O2 to oxygen sat ≥ 94% non arrest Pt’s
 Titrate
 100% O2 for Pt’s in cardiac arrest

 Monitor adequacy of ventilation and

oxygenation
 Clinicalcriteria: chest rise and cyanosis
 Quantitative waveform capnography
 Oxygen saturation

 Avoid excessive ventilation

CIRCULATION
 Monitor CPR quality
 Attach monitor/Defibrillator
 Monitor for arrhythmias or arrest rhythms
 Provide defibrillation/Cardioversion
 Obtain IV/IO access
 Give appropriate drugs
 Give fluids if needed
DIFFERENTIAL DIAGNOSIS
search for and treat reversible causes

H’s AND T’s

 Hypoxia
 Hypovolemia
 Hydrogen ion (acidosis)
 Hypo/hyper kalemia
 Hypothermia
 Tension pneumothorax
 Tamponade cardiac
 Toxins
 Thrombosis Pulmonary
 Thrombosis Coronary
ACLS
Cardiac
Arrest
Algorithm .

Copyright © American Heart Association

 ACLS Cardiac Arrest Circular Algorithm.

Neumar R W et al. Circulation 2010;122:S729-S767

Copyright © American Heart Association

 Bradycardia Algorithm.

Neumar R W et al. Circulation 2010;122:S729-S767

Copyright © American Heart Association

 Tachycardia Algorithm.

Neumar R W et al. Circulation 2010;122:S729-S767

Copyright © American Heart Association

NSR with Ectopy > VT>VF>NSR
• A 48 year old iron worker is brought to the
Emergency Department by co-workers following an
onset of sudden sever “pressure-type” chest pain
radiating to his neck, jaw and left arm.
• He is pale slightly diaphoretic, and very anxious.
Wide-complex tachycardia >VF>NSR
• A 63-Year-old woman alcoholic with a history of
CHF is brought to the hospital by her daughters
becouse of worsening symptoms of dyspnea, cough
and wheezing.
• She looks moderately ill but denies chest pain.