1. A team approach to performing the first 5 minutes of CPR
Code Blue
A team approach to performing the first 5 minutes of CPR

2. Objectives
Perform CPR for the 1st 5 minutes of a code blue following the team format demonstrated in this presentation.
The RN will be able to assign or self-assign roles necessary to perform team-based CPR.
The CPR team member will use closed loop communication when being assigned a role or self-assigning a role during CPR.

3. 1st Responder to the Patient in Cardiac Arrest
Assess patient for unresponsiveness
Call for help
Begin chest compressions

4. 1st Responder to the Patient in Cardiac Arrest
As people enter the room, if possible, assign roles:
Crash cart
Airway/breathing
Defibrillator/monitor
Backboard
Medication/IV nurse
Recorder
Compressions – minimum two person team
Team leader
Primary RN - provides patient report to Code Blue Team.

5. First person to respond to “Call for help”
Delegate or retrieve the crash cart and assign a person to dial “18” and activate “Code Blue, Room number ____”.
If 2nd person enters the room and the crash cart is being retrieved but is not available , the 2nd person will begin to prepare the bed for optimal access to patient for CPR and insertion of crash cart into room.

6. Airway/Breathing Role
Person assigned to airway/breathing role states “I’ve got airway/breathing”.
Obtains bag-valve-mask (BVM) from crash cart if not already on bed.
Assembles BVM and attaches to oxygen source at 15 Lpm.
Begin ventilation at 2 breaths to 30 compressions.
Assist with log-rolling patient by maintaining head/neck alignment.
Insert airway adjunct such as an oral pharyngeal airway as soon as possible.

7. Defibrillator/Monitor Role
Person assigned to defibrillator/monitor role states “I’ve got defibrillator and monitor”.
Turn on the monitor and attach defibrillator pads to monitor.
Attach the anterior defibrillator pad to the patient.
Says, “on the count of three, log roll the patient away from me and I’ll attach the defibrillator pad to the back and place the backboard under the patient”. Continue compressions.
If rhythm is shockable, charge defibrillator and state “all clear”, and deliver shock. If rhythm is not shockable, “rhythm not shockable; continue CPR”.

8. Backboard Role
Person assigned to backboard role states “I’ve got the backboard”.
Retrieve backboard from the crash cart.
Place backboard on the side of the bed nearest the defibrillator/monitor.
Go to the opposite side of the bed and prepare to assist with log- rolling the patient for placement of posterior defibrillation pad and backboard by defib/monitor RN.
Relieve 1st person performing compressions after log-rolling patient if position not already assigned.

9. Medication/IV RN
Person assigned as medication nurse states “I’ve got medications and IV”.
Assess IV patency and/or start large bore IV.
Prepare for administration of IV ACLS medications by discontinuing IV medications such as antibiotics and having IV NaCl (0.9%) 10 ml flushes available or an IV infusion bag of NaCl (0.9%).
If appropriate, prepare first IV epinephrine dose for administration.

10. Recorder
Person assigned as recorder states “ I will record (or document)”.
Retrieve the work-station-on-wheels to document in Code Narrator.
Access Code Narrator and state “when did the code start?”
Continue documentation of code.

11. Primary Nurse
If doing compressions, assign roles to team members as they enter the patient’s room.
Be relieved of any assigned roles as soon as possible during the code to be available for report to the Code Blue Team.
Assist with accessing the patient’s chart in Epic.
Provide patient report to the Code Blue Team.

12. Code Blue Team Leader
This role is assigned to the most competent ACLS provider available.