CODE BLUE


Adult

Adult Cardiac Arrest


 

NOTE: If after 20 min of CPR, the ETCO2 is still < 10, there is virtually ZERO possibility of pt surviving the code, go ahead and call the code at this point.
 

ORDERS:
  • IV Fluids (30cc/kg)
  • Intubate (15 L/min O2)
  • Central Line (IJ, Subclavian or Femoral)
  • Finger-stick Glucose, CXR, ABG, CBC, BMP, ProBNP, Lactic Acid, Cardiac Enzymes, EKG.
  • Bedside 2D-Echo.
  • Give: Ca Gluconate , NaHCO3  
  • Arterial pH between 6.90 - 7.00:
    • Drip: 50 mEq of NaHCO3 plus 10 mEq of KCL in 200 mL of sterile water over 2hr.

    - Arterial pH < 6.90:

    • Drip: 100 mEq of NaHCO3 plus 20 mEq of KCL in 400 mL sterile water over 2 hr.

     

 

Condition Common associated clinical settings Management
Acidosis Diabetes, diarrhea, drug overdose, renal dysfunction, sepsis, shock Amp HCO3 IV Push (may give multiple doses during a code)
Anemia Gastrointestinal bleeding, nutritional deficiencies, recent trauma TTranscfuse O (-) Blood while waiting for type/screen
Cardiac tamponade Post-cardiac surgery, malignancy, post-myocardial infarction, pericarditis, trauma  
Hyperkalemia Drug overdose, renal dysfunction, hemolysis, excessive potassium intake, rhabdomyolysis, major soft tissue injury, tumor lysis syndrome Amp CaCl IV (10% sol is 100 mg/ml in 10 mL)
- 5-10 ml of 10% solu IV, May repeat as needed
NaHCO3 1 AMP IV
Albuterol NEB 10 mg over 15 min
Lasix 40mg IV
 
Hypokalemia* Alcohol abuse, diabetes mellitus, diuretics, drug overdose, profound gastrointestinal losses Initial infusion of 10 mEq/L IV over 5 min.
- Must document that the infusion is intentional and done for life-threatening hypokalemia
Max IV rate: is 10-20 mEq/hr
Hypothermia (Im too cold) Alcohol intoxication, significant burns, drowning, drug overdose, elder patient, endocrine disease, environmental exposure, spinal cord disease, trauma Rapid Re-warming:
 -  Warm O2, Bear hugger, warm blankets, Warm Saline gastric lavage
Hypovolemia Significant burns, diabetes, gastrointestinal losses, hemorrhage, malignancy, sepsis, trauma  
Hypoxia Upper airway obstruction, hypoventilation (CNS dysfunction, neuromuscular disease), pulmonary disease  
Myocardial infarction Cardiac arrest
 
TNKase:
< 60 kg:  30 mg IV x1
60-69 kg: 35 mg IV x1
70-79 kg: 40 mg IV x1
80-89 kg: 45 mg IV x1
> 90 kg:  50 mg IV x1
Poisoning History of alcohol or drug abuse, altered mental status, classic toxidrome (eg, sympathomimetic), occupational exposure, psychiatric disease  
Pulmonary embolism Immobilized patient, recent surgical procedure (eg, orthopedic), peripartum, risk factors for thromboembolic disease, recent trauma, presentation consistent with acute pulmonary embolism tPA (Alteplase): 100 mg IV over 2 hours
Tension pneumothorax Central venous catheter, mechanical ventilation, pulmonary disease (eg, asthma, chronic obstructive pulmonary disease), thoracentesis, thoracic trauma  

V-Fib


V-Tach

 

Bardycardia

Tachycardia

Post-Cardiac Arrest



 
  • Theraputic Hypothermia: 32-34 C
  • Lactic Acid q6h
  • MAP > 65,
  • CVP = 8-12
Meds:
  • Midazolam 2-10 mg/hr
  • Fentanyl 0.1 mcg/kg bolus or as a continuous infusion starting @ 0.5 mcg/kg/hr
  • Levaphed or Dobutamine Drip
Mechanical Vent:
  • Mode = AC
  • FiO2 = 100%
  • TV = 6-8 cc/kg (450 cc)
  • RR = 16-20
  • PEEP = 5
  •  I/E Ratio = 1:2 (initial), 1:4 or 1:5 in COPD/Asthma
     

 

Condition Common associated clinical settings
Acidosis Diabetes, diarrhea, drug overdose, renal dysfunction, sepsis, shock
Anemia Gastrointestinal bleeding, nutritional deficiencies, recent trauma
Cardiac tamponade Post-cardiac surgery, malignancy, post-myocardial infarction, pericarditis, trauma
Hyperkalemia Drug overdose, renal dysfunction, hemolysis, excessive potassium intake, rhabdomyolysis, major soft tissue injury, tumor lysis syndrome
Hypokalemia* Alcohol abuse, diabetes mellitus, diuretics, drug overdose, profound gastrointestinal losses
Hypothermia Alcohol intoxication, significant burns, drowning, drug overdose, elder patient, endocrine disease, environmental exposure, spinal cord disease, trauma
Hypovolemia Significant burns, diabetes, gastrointestinal losses, hemorrhage, malignancy, sepsis, trauma
Hypoxia Upper airway obstruction, hypoventilation (CNS dysfunction, neuromuscular disease), pulmonary disease
Myocardial infarction Cardiac arrest
Poisoning History of alcohol or drug abuse, altered mental status, classic toxidrome (eg, sympathomimetic), occupational exposure, psychiatric disease
Pulmonary embolism Immobilized patient, recent surgical procedure (eg, orthopedic), peripartum, risk factors for thromboembolic disease, recent trauma, presentation consistent with acute pulmonary embolism
Tension pneumothorax Central venous catheter, mechanical ventilation, pulmonary disease (eg, asthma, chronic obstructive pulmonary disease), thoracentesis, thoracic trauma

Pediatric

Cardiac Arrest

Bradycardia

Tachycardia