For someone working in a hospital or any similar medical facility, it’s not a matter of if emergencies will happen but when. Since you are dealing with human life, any occurrence that will harm the welfare of any patient has to be intercepted immediately, depending on the severity. As a nurse, you will be kept on your feet as you anticipate such events.
Picture this: you are a neophyte nurse in your first few weeks in a hospital that just hired you, and there is a rush of fellow nurses and doctors with the words “code blue” being mentioned. You are then asked to assist them. What should you do then during a code blue?
Read on to get to know or refresh your memory on what to do in a code blue, and what it takes to successfully contribute as part of a rapid response team.
You may have encountered the term code blue in school or internships before. However, for the sake of discussion, let’s refresh on the definition and context of code blue.
Code blue is the common term used by medical institutions to signify that a patient is going through cardiopulmonary arrest and is in need of immediate resuscitation.1 In layman terms, a patient’s heart and respiratory functions are on a decline, and medical personnel, usually in the form of a rapid response team, will perform any procedure for them to be able to bring the patient back to a stable condition.
It is imperative for a rapid response team to have their roles and responsibilities laid out at the onset of a code blue. Usually, calling a code blue starts with signs that a patient is unresponsive and/or has no pulse.2 When this happens, the attending nurse must perform CPR on the patient until the members of the rapid response team have arrived.
The foremost rule you must follow as part of the rapid response team is to know your responsibility and stick to it. For each nurse assigned with a specific role within the team, they should call out that role as they enter the room, to alert everyone about what kind of help is available. If you are one of these assigned members of the rapid response team, take your role to heart when the time comes you will respond to the code:2
· Compressor. The first responder is in charge of delivering rhythmic chest compressions. As a first responder, nurses assigned to do compressions have to act right away and do the compressions before the patient runs out of air.
They don’t need to place a board under the patient; compressions should start right away, and the board can be placed when another available responder comes. While the compressions may not be enough to revive the patient, these are helpful in slowing the loss of air in the patient.
· Airway manager. As the first responder is doing compressions, the next response will attend to giving the patient further airways, or ventilation. Equipment like a bag-mask device will be used to provide the patient with further air. They may even assist the use of intubation in case the bag-mask device is not effective enough.
· Defibrillator manager. Providing “shockable rhythms” through a defibrillator has been proven as potent ways to revive a patient. Nurses who handle this responsibility must be trained in identifying dysrhythmia, or abnormal patterns in heart activity.
Once the abnormal pattern has been pinpointed, the defibrillator manager will provide the right amount of shock to the body and at the right time. A correct calculation may result in successful resuscitation of the patient.
· Crash cart manager. This particular nurse is in charge of a crash cart that has tools or medicine the rapid response team has for their use. Part of their responsibility is to keep the cart orderly so that the team knows where a specific resource is placed.
· Recorder. Documentation is key in an emergency like this so that the situation can be evaluated and reported properly. A recorder must take down the entire resuscitation process, and be keen on details such as patient health records, tracking downtime, and so on.
As a new nurse, your mastery of what to do during a cardiac or respiratory arrest will come as you’ve had numerous exposures to the said event. However, emergencies like the code blue may not come as often as possible, for you to practice your skills and eventually master your craft. For now, the best way for you to be ready is to stay informed.
While there are no code blues happening yet, participate in mock codes and related training. During mock emergencies, nurses and other hospital personnel practice with anatomically correct mannequins to at least be familiar with the necessary steps within a process.
If you see an opportunity to participate in a mock code blue, or even to get to know further the use of ventilators or defibrillators, grab the opportunity. While practicing through actual situations would be better, these mock instances keep your knowledge and skills fresh in your memory.
By the time you are to participate in your first code blue, keep the following in mind:
· Do not shout. Shouting will only add to the tension and panic. Take note as well that family and friends of the patient may be on the premises as well, and your loud voice will only aggravate them further. Do your best to be in a room speaking voice the entire time.
· Declare your designation as you enter the situation. As mentioned, it’s compulsory that members of the rapid response team announce to everyone in which station of the patient’s room they will attend to. Doing these alerts everyone that the particular resource you will provide for the code blue is available.
· Stay at your designation. It’s tempting to assist your fellow nurses with their tasks, especially in a situation that is life-threatening. However, leaving your post will be
detrimental to the entire process, and diving into another nurse’s tasks might result in confusion.
Final note: After the code blue, make sure to participate in post-code briefing, and listen to what transpired, what the team could have done, and what the individual rapid response team members could improve on in case the next code blue appears. Being part of this meeting allows you to look at your mistakes, and do a better job next time.
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