From the Guidelines
When documenting general findings for a person in a code blue situation, it is crucial to record clear, chronological, and comprehensive information, as emphasized by the 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care 1.
Key Components of Documentation
The documentation should include:
- Time the code was called and who discovered the patient
- Patient's initial condition, including vital signs, level of consciousness, and presenting symptoms
- Specific rhythm identified, such as asystole, ventricular fibrillation, or pulseless electrical activity
- All interventions performed with precise timing, including:
- CPR initiation and duration
- Defibrillation attempts with energy levels
- Medication administration with doses and routes
- Patient's response to each intervention
- Airway management details, including method of intubation, tube size, confirmation methods, and ventilation parameters
- Medications administered during the code, such as epinephrine, amiodarone, and sodium bicarbonate
- Laboratory values obtained and point-of-care testing results
- Duration of the resuscitation effort and outcome, including return of spontaneous circulation or time of death pronouncement
- Post-resuscitation care initiated
Importance of Documentation
This detailed documentation is essential for continuity of care, quality improvement, and medicolegal purposes, as it provides a complete picture of the emergency response and clinical decision-making during this critical event, as highlighted in the 2020 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations 1.
Recent Guidelines
The most recent guidelines from the American Heart Association, as outlined in the 2020 guidelines for cardiopulmonary resuscitation and emergency cardiovascular care 1, emphasize the importance of high-quality CPR and prompt defibrillation in cardiac arrest management.
Clinical Decision-Making
The documentation should reflect the clinical decision-making process during the code blue situation, including the rationale for interventions and the patient's response to treatment, as discussed in the context of adult advanced life support 1 and pediatric life support 1.
Quality Improvement
Accurate and comprehensive documentation is also crucial for quality improvement initiatives, allowing healthcare providers to review and refine their resuscitation practices, as noted in the context of cardiac arrest in pregnancy 1.
From the FDA Drug Label
Management of local anesthetic emergencies: The first consideration is prevention, best accomplished by careful and constant monitoring of cardiovascular and respiratory vital signs and the patient's state of consciousness after each local anesthetic injection. At the first sign of change, oxygen should be administered The first step in the management of convulsions consists of immediate attention to the maintenance of a patent airway and assisted or controlled ventilation with oxygen and a delivery system capable of permitting immediate positive airway pressure by mask Immediately after the institution of these ventilatory measures, the adequacy of the circulation should be evaluated, keeping in mind that drugs used to treat convulsions sometimes depress the circulation when administered intravenously If cardiac arrest should occur, standard cardiopulmonary resuscitative measures should be instituted
The general findings documentation for a person in code blue may include:
- Monitoring of cardiovascular and respiratory vital signs
- Oxygen administration at the first sign of change
- Maintenance of a patent airway and assisted or controlled ventilation with oxygen
- Evaluation of circulation and potential administration of intravenous fluids and vasopressors as needed
- Standard cardiopulmonary resuscitative measures if cardiac arrest occurs 2
From the Research
General Findings Documentation for Person in Code Blue
- The American Heart Association (AHA) published guidelines in 2010 that emphasize 5 major areas of therapy in patients with cardiac arrest, including immediate recognition and activation of the emergency response team, effective chest compressions, rapid defibrillation, effective advanced life support (ALS), and integrated postresuscitation care 3.
- Advanced life support encompasses only 1 of these 5 major areas of cardiac arrest intervention, and recent research and the AHA guidelines note that ALS therapy is less important than previously thought 3.
- The use of cardioactive medications, such as epinephrine, vasopressin, atropine, lidocaine, and amiodarone, is a key component of advanced cardiac life support cardiac arrest algorithm 3.
- Epinephrine is the primary drug administered during cardiopulmonary resuscitation (CPR) to reverse cardiac arrest, but its use is based on limited animal data and recent studies question its overall benefit for patients 4.
- The administration of epinephrine before defibrillation in patients with shockable in-hospital cardiac arrest is associated with worse survival outcomes, including lower odds of survival to discharge, favorable neurological survival, and survival after acute resuscitation 5.
Documentation During Code Blue
- Documentation during a code blue is an important aspect of patient care, and it is essential to accurately record the events surrounding the cardiac arrest, including the time of the arrest, the interventions performed, and the patient's response to treatment 6.
- The roles of perioperative personnel during a code blue are critical, and it is essential to have a clear understanding of each person's responsibilities to ensure effective management of the cardiac arrest 6.
Medications Used in Code Blue
- Epinephrine, vasopressin, atropine, lidocaine, and amiodarone are commonly used medications in advanced cardiac life support cardiac arrest algorithm 3, 7.
- The effectiveness of these medications is widely debated, and recent studies have begun to clarify their role in cardiac arrest care 7.
- The use of epinephrine, in particular, has been associated with both beneficial and harmful effects, and its use should be carefully considered in the context of each individual patient's needs 4, 5.