Code Blue

  1. Develop a systematic approach to running a Code Blue (cardiac arrest)
  2. Practice three brief scenarios


Relax. Take a breath.  The patient has already died. All you can do is help.

Speak loudly, clearly and calmly. Point to a person and look them in the eye when you want them to do something.  Request they confirm that they heard you and will notify you when the task is complete (closed loop communication).


Establish you are the code leader – “I am Dr. Smith with Medicine, and I am running this code.”
Q: “Does the patient have a pulse?” If yes – are they breathing?
Q: “Do we have access?

1 – “Start compressions. Deep and fast (2 inches at 100bpm). Minimize interruptions.”
2 – “Get the defibrillator pads in place and let me know when we are ready to evaluate a rhythm.” – this is key to determining which algorithm you are on.
3 – “Give one breath every 10sec. Anesthesia – intubate through compressions when they are ready.”
4 – Assign jobs
– time keeper – “let me know every time we approach 2min of CPR and 3min since last epinephrine.”
– RN – “obtain access (intra-osseous is a fast and reliable option), if not already done. collect CMP/CBC/coags/trop.”
– Stat RN – “get an ABG.”
– Intern/med student – “chart biopsy and let me know when you are ready to report.”
– Charge/Stat RN – “control the volume and flow of the room.”
– back up for chest compression – “stand next to the person doing chest compressions and make a smooth transition at the next rhythm check.”

Scenario one

50 year old man with DM admitted three days ago for tib/fib fracture.

1st ECG image 1
2nd ECG image 2
3rd ECG image 3


Scenario two

40 year old woman POD 1 for open cholecystectomy

1st ECG image 4
2nd ECG image 5

Scenario three

55 year old man admitted two days ago with an acute MI.

1st ECG image 6
2nd ECG image 2
3rd ECG image 5

2015 ACLS algorithm

  1. There two reliable ways to improve mortality: good CPR and early time to defibrillation.
  2. Be calm. The room should feel quiet and controlled.

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