Describe what happened in this Code Blue

[premed21]

I need help in understanding what happened in this code blue in medical terminology. Specifically, can someone please describe what the doctors/nurses/other people were doing using the medical terminology in this code blue?

Here is what happened: Siren goes on in ICU signaling code blue. All of a sudden, all the nurses and the doctors rush to the room where the patient is. His heart stopped beating, and the nurses begin doing CPR by using (insert medical terminology things here). The doctor comes and says to do (insert medical terms here). The nurses continue to do CPR and rotate because one nurse will get tired. The secretary is printing the (EKG type of monitor readings, pulmonary readings?) for file.

Other key notes: The patient had 2-3 of these code blues where his heart stopped over a few hours.

Basically, what is the standard procedure that the doctor/nurses will do to the patient if his heart stops? Which drugs are usually administered, etc? I know you cannot tell me exactly what happened in this code blue, but can you tell me in general what they do when the patient's heart stops?

**EDIT: Can anyone please tell me what kind of disease or problems that a patient will have that will make them suffer multiple cardiac arrests in a short amount of time?

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[Dr Roboto]

1. Do CPR
2. Give drugs (epinephrine, atropine, etc)
3. Shock if rhythm is shockable
4. Keep doing CPR until tired
5. Call time of death
6. Pass go and collect 200

 

[JRJ26]

http://en.wikipedia.org/wiki/Advanced_cardiac_life_support

code blue's vary depending on the type of rhythm the patient's heart is in. ACLS (advanced cardiac life support) is basically an algorithm you can follow that says what to do depending on what rhythm the patient has. So if the heart is asystole (the flat line you see on tv), you won't defibrillate (shock the patient), but if they're in pulseless ventricular tachycardia or in ventricular fibrillation, shocking is advised.

so the first thing you do is check for a pulse. if there's no pulse, you start CPR (chest compressions). they'll hook them up to the heart monitor and the defibrillator if they aren't already. While this is happening, they'll intubate the patient (put the tube down the throat), and use a bag valve mask to assist the patient's ventilation (breathe for them). There are various drugs that can be given depending on the situation, such as epinephrine, atropine, bicarbonate, amiodarone, etc. Once they're up on the monitor, they'll decide if it's a shockable rhythm. If it is, the doc (or whoever that's running the code) will ask the nurse to charge the defibrillator. Many/most places don't use the paddles you always see on TV, but these pads you just stick on the patient. Once it's charged, everyone stands clear of the bed, and they shock the patient. They then check for a pulse again and check the heart rhythm. Then everything happens again: more drugs, shocks, etc. This goes on until they go back into a perfusing rhythm (have a pulse), or everything was done and that's that.

That's a really general overview of what happens in a code.

 

[DrWookie]

1. Do CPR
2. Give drugs (epinephrine, atropine, etc)
3. Shock if rhythm is shockable
4. Keep doing CPR until tired
5. Call time of death
6. Pass go and collect 200

Damnit, I always forget to collect the 200 dollars!

 

[premed21]

Thanks for the responses. I don't recall them using the defibrillator on the patient, however I do remember them putting something under the patient to make the CPR more easy (don't know what it was though). They also used the breathing pump thing on the face to help them breathe more easily (manually pump the air).

 

[JRJ26]

Thanks for the responses. I don't recall them using the defibrillator on the patient, however I do remember them putting something under the patient to make the CPR more easy (don't know what it was though). They also used the breathing pump thing on the face to help them breathe more easily (manually pump the air).

they put a CPR board under the patient. it's just a hard surface that makes the CPR more effective than doing it on the soft mattress. the breathing pump thing is the bag valve mask/ambu bag.

 

[NotAndrew]

Did this guy in question end up dying?

 

[Ibn Rushd]

6. Pass go and collect 200

Can you explain what this last bit means, please?

 

[JackInTheBox]

Can you explain what this last bit means, please?

It's from the board game "Monopoly." Every time you pass the "GO" square, you collect $200. It was a joke by that poster (i.e. you don't actually collect $200 for every code you run).

 

[spicedmanna]

Person collapses:

Check responsiveness. No? Call the code, then:

A = Open Airway

B = Breathe for the patient --> BVM (bag-valve-mask) in a hospital setting

C = Circulation --> Check pulse.

*If pulse present --> Rescue Breathing w/ supplemental O2 (intubate if indicated), IV fluids, monitor EKG and vitals, establish etiology

*If no pulse --> Commence CPR, intubate/O2, IV access, consider defib (goto D)

D = Defib and/or meds, if indicated.

CPR until ready to defib, check rhythm--> VFIB (ventricular fibrillation), VTACH (ventricular tachycardia), PEA (pulseless electrical activity), asystole (no pulse, no electrical activity, aka "flatline")?.

Shockable?

Yes--> VFIB, VTACH: Deliver 360J shock; CPR; recheck rhythm; deliver 360J shock; CPR, 1 mg Epi, IV push; recheck rhythm; deliver 360J shock; CPR, 300 mg Amiodarone, IV push, etc.

No--> PEA, asystole: continue CPR. 1 mg Epi, IV push, q3-5 min; 1 mg atropine, IV push, q3-5 min (max total of 3 mg), etc.

 

[RnD4Lyf]

If memory serves from my EMT-B training (and without looking at the other posts)...

1) Assess ABC's (Airway, Breathing, and Circulation)..gotta make sure the bastard isn't faking it.
2) Start CPR/ Rescue breathing if there is no pulse and breathing. Compression ratio is 30 compressions:2 breathes. Rescue breathing can be a misnomer as you'll probably be using a bag to push oxygen in.
3) Get the good ol' AED (or EKG if you're dangerous with them) and assess the heart activity.
4) Heart arrhythmia = shock
Cardiac Arrest = Adrenaline (can't shock a flat line)
5) Rinse and repeat (?)

This was all from memory...how did I do?

 

[premed21]

Did this guy in question end up dying?

Yes.

Person collapses:

Check responsiveness. No? Call the code, then:

A = Open Airway

B = Breathe for the patient --> BVM (bag-valve-mask) in a hospital setting

C = Circulation --> Check pulse.

*If pulse present --> Rescue Breathing w/ supplemental O2 (intubate if indicated), IV fluids, monitor EKG and vitals, establish etiology

*If no pulse --> Commence CPR, intubate/O2, IV access, consider defib (goto D)

D = Defib and/or meds, if indicated.

CPR until ready to defib, check rhythm--> VFIB (ventricular fibrillation), VTACH (ventricular tachycardia), PEA (pulseless electrical activity), asystole (no pulse, no electrical activity, aka "flatline")?.

Shockable?

Yes--> VFIB, VTACH: Deliver 360J shock; CPR; recheck rhythm; deliver 360J shock; CPR, 1 mg Epi, IV push; recheck rhythm; deliver 360J shock; CPR, 300 mg Amiodarone, IV push, etc.

No--> PEA, asystole: continue CPR. 1 mg Epi, IV push, q3-5 min; 1 mg atropine, IV push, q3-5 min (max total of 3 mg), etc.

Thanks for the detailed response. You sound like an expert. 😎

 

[146233]

Thanks for the detailed response. You sound like an expert. 😎

spicy's the best. You'll learn all that stuff when you take ACLS (Advanced Cardiovascular Life Support) either in medical school or as an intern.

 

[LilHouse]

🙂

 

[MDman87]

Code Blue?! Code Blue! Let's vent

 

[Forbes]

Code Blue?! Code Blue! Let's vent

You know it's cold when the mountains are blue.

 

[premed21]

The breathing pump thing was a bag valve mask (big blue bag that somebody squeezes). They will usually place an endotracheal tube in the pt's airway when they get a chance. (If they have an ET tube, they can continuously breathe for them while doing compressions instead of taking breaks ever 30 compressions. If they give air w/o an ET tube during compressions, the pt often vomits which can compromise the airway)

As for the defibrillator, they only defibrillate if that patient is in a certain heart rhythm (Ventricular Fibrillation or Ventricular Tachycardia - basically the bottom of the heart has to be beating really fast or chaotically to the point where it isn't pumping blood)

They'll usually give epinephirne (adrenalin) immediately. That's pretty much the big code drug. It often restores BP and HR (all things relative) breifly, but it's very short acting. They give amiodarone later - it's an anti-dysrhythmic

While things can vary, the whole process is pretty scripted. There's not much deviation other than timing. If it's in the ER, there will usually be somebody standing around and writing everything that happens and the time it happened (the scribe). The nurses switch every 5 rounds of CPR (2 minutes). In reality, they usually switch when they get tired or remember to call for it. That strip was an EKG - it lets them see what rhythm their heart is producing in case a shockable one appears. Or a rhythm that will sustain life (e.g. normal sinus)

If you have CPR certification and they call a code, offer to switch out with one of the nurses so you can get in an practice. CPR's pretty mindless. Don't be afraid you'll mess up. Most of the pts die anyway at that point, so you really can't do anything but good. Besides, it's nice to have Dr and nurses to coach you.

So yeah, I know this is kinda late, but I wanted explain what the BVM was and add the part about jumping in and doing CPR.

Wow, thanks for the really, really great and in depth response. Much appreciated.

Also, does anyone know usually what kind of disease or what problem a patient will have that will cause their heart to stop beating like multiple times in a short amount of time?

 

[NicoDuval]

There could be many things that contribute to multiple cardiac arrests but often the things lead to CHF, COPD. Heart and lungs all the time. Just the other day we had a guy come into the ER by ambo. They wheeled him in in a wheelchair and it was a crazy day which means he was about to be sent to the waiting room. The only complaint was diarrhea and then he codes. He had previously had a heart attack and just went into a fib with no warning.

 

[smq123]

2. Give drugs (epinephrine, atropine, etc)

Right. And which drugs are given will depend on exactly what is wrong with the patient. If a patient doesn't have a good heart rate, epi might help. If a patient has an irregular heart beat, things like amiodarone/lidocaine might help.

Also, does anyone know usually what kind of disease or what problem a patient will have that will cause their heart to stop beating like multiple times in a short amount of time?

Sure, lots of things.

Being septic might cause this (i.e. having such a high bacterial load in your system that your body can't fight it off). A drug overdose can do this, too (including alcohol). Any metabolic derangement can overwhelm your system to the point that your heart and lungs can't work correctly. Heart attacks can also do this, because dead/dying heart muscle can interfere with the heart's ability to beat correctly.

The only complaint was diarrhea and then he codes. He had previously had a heart attack and just went into a fib with no warning.

Do you mean ventricular fib? Atrial fibrillation rarely causes people to become unresponsive, unless it's given them a stroke or something.

Diarrhea can also cause a metabolic derangement bad enough to overwhelm your system, although it would have to be pretty bad diarrhea.

Poor guy, though. 🙁 That does sound pretty crazy.

 

[rowerontheriver]

It's from the board game "Monopoly." Every time you pass the "GO" square, you collect $200. It was a joke by that poster (i.e. you don't actually collect $200 for every code you run).

Yeah, I was going to say, I haven't gotten anywhere close to $200 for the codes I have run... On the off chance it wasn't a joke, more information on where to collect would be appreciated. 😛

Diarrhea can also cause a metabolic derangement bad enough to overwhelm your system, although it would have to be pretty bad diarrhea.

I feel like the dehydration at the point would have to be really bad as well, blood volume goes down, stress on the heart increases.... would have been interesting to see his vitals/ekg