Code Blue, BLS & ACLS

Unresponsive patient

Nurse 2 (who answers

Nurse 1 (who finds the
the call for help) to CCA informs MO in ER, Intensivist and
patient) presses call bell
initiate and activate code blue by Consultant in charge of patient for Confirmation
and calls for help – Nurse
dialing 8888 and to announce code
will not leave the patient.
blue with location
Code Blue Team on hearing
announcement will proceed to site
Check for the response Push crash cart to immediately
patient’s bedside
First doctor who arrives will assess patients’
Patient not responding condition and function as team leader.
Connect patient to cardiac monitor

Check for carotid pulse Dr will do/request intubation

Monitor BP and O2
and/or defibrillate if required
saturation

Pulse Pulse Nurse 3 gets ETT, laryngoscope Nurses to prepare and

Present Absent gel, syringe, tape ready for administer drugs as
intubation required If patient does not
respond, consultant
Start takes the decision to
CPR Sets up IV line Continue vigorous CPR
stop CPR and
for 30 minutes
determines
the cause of death
Prepare Emergency Drugs
Put patient in left lateral If patient stabilizes shift
position and clear airway. to ICU
END
Maintain airway, tilt
head back.

Assess for breathing Put the

patient on recovery position.
BLS and ACLS SURVEY
Goal

Is to support and Restore spontaneous circulation, effective ventilation and oxygenation with return of intact
neurological functions.

Objectives

Recognize and initiate early management of periarrest conditions.

Improve proficiency in providing BLS and ACLS care.

Manage arrest till ROSC/termination of resuscitation.

Improve team dynamics as a leader/member of resuscitation team.

BLS PRIMARY SURVEY

ASSESS ACTION
CIRCULATION
Check Pulse - Present/Absent Perform high quality CPR until AED arrives.
 Carotid Pulse – Not more than 10 seconds. C:V -30:2, 5 cycles over 2 min.

AIRWAY
Check if Patent/Obstructed ? Head tilt- chin lift or Jaw thrust

BREATHING
Whether Adequate/Inadequate ? 2 Breaths using a barrier device,
Each over 1 sec, with visible chest rise.
C:V -30:2, 5 cycles over 2 min.

DEFIBRILLATION - AED
Whether rhythm is Shockable/not Shock as indicated.
Resume CPR with compressions.

Overview of BLS Primary survey

Stresses on early CPR and Early Defibrillation

Does not include advanced interventions.

Goal is to restore spontaneous circulation, effective ventilation and oxygenation till initiation of ACLS interventions.

Improves better neurological outcomes.

ACLS SECONDARY SURVEY

ASSESS ACTION
CIRCULATION
 Recognize Initial Cardiac Rhythm  Attach ECG leads and MONITOR.
 Establish access for Drugs and Fluids  Obtain IV/IO access.
administration  Give appropriate drugs to manage rhythm
and blood pressure.
 Give fluids if indicated.
 Chest compression at a rate of atleast
100/min.

AIRWAY
 Patent/Obstructed?  Maintain Airway patency by Head tilt-Chin
lift, Suctioning, OPA, NPA.
 Recognize need for advanced Airway  Use advanced Airway management if
needed[LMA, Combitube, ET tube].
 Confirm proper placement of Airway  By Phycial Examination,
device Measurement of exhaled Co2,
Use of Esophageal Device.
 Secure the tube and Reconfirm the  Secure and reconfirm to prevent
placement Dislodgement

BREATHING
 Assess Oxygenation and Ventilation  Give supplement Oxygen
 Give Bag-mask ventilation every 5-6
seconds or about 10-12 breaths/min(rescue
breaths without chest compression).
 Assess adequacy of Oxygenation and
Ventilation by Clinical criteria(chest rise)
Oxygen saturation
Capnometry/Capnography

DIFFENTIAL DIAGNOSIS
 Why did the Patient develop Cardiac  Search and treat reversible causes.
Arrest?  Consider 6H’s and 5T’s
 Identify reversible cause of Arrest. 1)Hypovolemia 1)Toxins
2)Hypoxia 2)Tamponade(cardiac)
3)Hydrogen Ion(acidosis) 3)Tension Pneumothorax
4)Hyper/Hypokalemia 4)Thrombosis
5)Hypoglycemia 5)Trauma
6)Hypothermia