Code Management Flashcards
Why are hospital color codes used?
- notify staff of various emergency situations
- convey essential info quickly with minimum misunderstandings
- minimize stress/ prevent panic among pts/ visitors
are the code colours used in hospitals the same around the world?
yes
What does code pink mean?
pediatric emergency
what does code blue mean?
cardiac arrest
what does code yellow mean?
missing resident/ patient
what does code amber mean?
miss/ abducted child/ infant
what does code white mean?
aggression/ violence
what does code red mean?
fire
what does code grey mean?
system failure
what does code green mean?
evacuation
what does code brown mean?
hazardous spills
what does code black mean?
bomb threat
what does code orange mean?
mass casualty/ disaster
what does code purple mean?
- over capacity
- no longer used
What does code silver mean?
- new code
- active attacker
what does active attacker mean?
1 or more people actively engaged in seriously harming, killing, or attempting to kill people in populated area using weapon
what does code silver refer to?
mass-harm incident where the goal of perpetrator(s) is to cause as many casualties as possible
what does code silver outline?
- run
- hide
- fight
What does CPR stand for?
cardio-pulomanry resuscitation
how many compressions should you perform per minute of CPR?
100-120
what is the depth you need to compress to for CPR for adults and children/ infants?
adults - 2 inches
children - 1/3 of the diameter of the chest
do you allow full recoil after each compression ?
yes
How many breaths do you give after 30 compressions?
2
if there is an advanced airway in place how many breaths should you give over much time?
1 breath every 6 seconds (10 breaths/ min)
define code blue
emergency situation > pt in cardio-pulmonary arrest, requiring code team to rush to specific location/ begin immediate resuscitative efforts
When do you call a code blue?
- pt has a respiratory or cardiac arrest
- assessment deems necessary (warning signs)
- when directed to do so
true or false
ideally we want to call a CODE prior to our patients experiencing a full respiratory or cardiac arrest?
true
What is the purpose of the 5 rights of clinical reasoning?
ability to collect right cues/ take right action for right patient at right time for right reason
what are the 5 rights of clinical reasoning?
- right cues
- right patient
- right time
- right action
- right reason
in regards to the 5 rights of clinical reasoning, describe the right cues
- physiological/ psychosocial changes
in regards to the 5 rights of clinical reasoning, describe the right patient
risk of critical illness/ serious adverse events
in regards to the 5 rights of clinical reasoning, describe the right action
- understanding the priority/ who should perform action
- policy/ procedure involved
- who should be notified and when
define failure to rescue
inability of clinicians to save pt’s life by timely diagnosis/ treatment when complication develops
research has shown that patients display S&S of impending arrest as early as what?
72hrs prior to arrest
when does failure to rescue occur?
when health care providers don’t recognize S&S/ fail to take appropriate action to stabilize pt
what is a major cause of mortality in acute care settings?
failure to rescue
what are 4 activities to prevent failure to rescue (FTR)?
- surveillance/ assessment
- timely identification of complications
- taking action
- activating a team response
in regards to the 4 activities to prevent failure to rescue, describe surveillance/ assessment
- be ablate identify progression/ trends of assessment changes as benign or pathological
in regards to the 4 activities to prevent failure to rescue, describe timely identification of complications
be vigilant to detect trends in assessment changes that can signify critical even
in regards to the 4 activities to prevent failure to rescue, describe taking action
take action regarding assessment findings
in regards to the 4 activities to prevent failure to rescue, describe activating a team response
need to notify physician/ team appropriately and in timely manner
out of the 4 activities to prevent failure to rescue, which is the most important?
surveillance/ assessment
in regards to the neurological bell curve, what are the things you need to watch for from lowest to highest risk
- restless
- anxious
- irritable
- agitated
- confused
- combative
- lethargic
- inresponsive
in regards to the respiratory bell curve, what are the things you need to watch for from lowest to highest risk
respirations/ min in the following order:
- 20
- 24
- 30
- increasing 40s
- 4-10
- apnea
in regards to the cardiac bell curve, what are the things you need to watch for from lowest to highest risk
- > 100bpm
- PVC
- shapes
- couplets
- patterns
- runs V tach
- V tach
- V fib
- asystole
if these 3 electrolytes go high or low together they could indicate a potential cardiac arrest. What are they?
- potassium
- sodium
- calcium
What are the major causes of instability?
compensation for:
- hypoxia
- hypo-perfusion
what systems could cue you to a pathological change?
- neuro
- respiratory
- cardiac
what are an exceptionally accurate and timely predictor of clinical instability or impending adverse outcome?
ventricles
the cardiac system requires 4 main elements that maintain stability and function efficiently. What are they?
- oxygenation
- perfusion
- electrolytes
- acid/ base imbalance
What are the stages of hypoxia?
- early
- intermediate
- late
describe the early stage of hypoxia
- restlessness
- change in metal status
- anxiety
- headache
- fatigue
- tachycardia
- dysthymia
describe the intermediate stage of hypoxia
- increased confusion
- agitation
- increased oxygen requirements
- decreased oxygen saturation
- lethargy
describe the late stage of hypoxia
- cyanosis
- diaphoresis
- unresponsive
- respiratory arrest
what are different things you can do to manage acute respiratory failure?
- provide supplemental oxygen
- improve ventilation/ promote adequate gas exchange
- give medication
in regards to the different things you can do to manage acute respiratory failure, describe improving ventilation
- put pt on positive end-expiratory pressure (BiPaP)
- endotracheal intubation
how much oxygen can be administered in L/min and what % can be delivered through nasal prongs?
- can administer 1-6L/min
- deliver 24-44% oxygen
how much oxygen can be administered in L/min and what % can be delivered through a simple mask?
- can administer 6-10L/min
- deliver 35-55% oxygen
how much oxygen can be administered in L/min and what % can be delivered through a non-rebreathing mask?
- can administer 10-15L/min
- deliver 60-80% oxygen
in regards to the different things you can do to manage acute respiratory failure, what medications would you give?
- bronchodilators
- steroids
- analgesics
- sedatives
- antibiotics
when someone goes into cardiac arrest how do you determine cardiac instability ?
change in heart rhythm plus one of the following:
- hypotension
- dizziness
- chest pain
- shortness of breath
- new or worsening heart failure
What can cause an arrhythmia?
- MI
- fluid/ electrolyte imbalance
- drug/ medication induced
- genetics
- diseases
what is an arrhythmia?
irregular heart rhythm > can be life threatening
What is pulseless electrical activity (PEA)?
- there is an ECG rhythm but heart not pumping
how do you know if someone is experiencing a PEA?
ECG monitor shows rhythm, but there is NO PULSE on palpation
what can cause a PEA?
reversible cause
What are S&S of arrhythmias?
- palpations
- anxiety
- lethargy
- fatigue
- weak pulse
- diaphoresis
- cyanosis
- chest discomfort
- nausea
- dizziness
- lightheadedness
- SOB
- unresponsiveness
How do you diagnose if someone has an arrhythmia?
- ECG
- troponin
what are the treatments for an arrhythmia?
- pacemaker
- ICD
- rhythm control medication
- shock
- cardio version
What does CCOT stand for?
rapid response team
who can activate the CCOT team if there are concerns that their client is deteriorating?
primary nurse
What are early warning signs of a PRE-CODE?
- RR
- systolic BP
- HR
- change in LOC
- SpO2
- urine output
- skin
- bleeding
- seizures
- chest pain
- failure to respond to treatment
- signs of sepsis
in regards to the early warning signs of PRE-CODE, describe RR
> 25 or < 8 breaths/ min or increased WOB
in regards to the early warning signs of PRE-CODE, describe systolic BP
< 90mmHg or drop of more than 30mmHg
in regards to the early warning signs of PRE-CODE, describe HR
> 120 or < 50 bpm
in regards to the early warning signs of PRE-CODE, describe change in LOC
GCS < 10
in regards to the early warning signs of PRE-CODE, describe oxygen saturation
< 90% c supplemental O2 > 50%
in regards to the early warning signs of PRE-CODE, describe urine output
< 80mL over the last 4 hours
in regards to the early warning signs of PRE-CODE, describe skin
- pale
- diaphoretic
- mottling on trunk of body
in regards to the early warning signs of PRE-CODE, describe significant bleeding
unexpected significant bleeding
in regards to the early warning signs of PRE-CODE, describe seizures
new, repeated or prolonged seizures
in regards to the early warning signs of PRE-CODE, describe chest pain
unrelieved by nitro spray ordered
in regards to the early warning signs of PRE-CODE, describe failure to respond to treatment
not responding to acute problem/ symptom
When would you call MRP/ CCOT/ RRT instead of code blue?
- client still responsive but sudden deterioration in patient status
- respiratory distress
- oxygen sat, BP, HR, dropping or bellow normal
when would you call a code blue instead of MRP/ CCOT/ RRT?
- client unresponsive
- no respiration
- no pulse
during the process before calling a code blue, what valuable information do you need to know first?
- perform assessment/ know whats going on c pt
- know pts code status
- use SBAR to communicate situation to MRP
during the process before calling a code blue, would you notify the MRP?
yes, if pt condition and time allows
during the process before calling a code blue, would you notify the CCOT?
yes, if appropariate
during the process before calling a code blue, if the client deteriorates before/ during interventions what do you do?
call code blue
What can be found in the ward emergency cart?
- back board
- bag valve mask with bag
- oral airways
- intubation supplies
- suction supplies
- IV solution/ tubing
- check lists
- resuscitation records
- orange cone
- code charing
how often should the emergency ward cart be checked/ ensure all supplies is in it?
weekly
who should be familiar with the contents/ equipment of the emergency ward cart?
all RNs
when do you cancel a code blue ?
cannot cancel code button until all members of code team arrive
What is the role/ responsibility of ward nurse 1?
responsible for patient including:
- assessment
- call for help
- initiate CPR
What is the role/ responsibility of ward nurse 2?
role is to assist by
- calling code
- bring emergency equipment to scene
- assist with CPR
What is the role/ responsibility of ward nurse 3?
responsible for environment including:
- bring pt chart to bedside
- start IV
- remove headboard
who is in a code team?
- team lead > ICU/ ER physicians
- critical care RN
- primary/ unit RN
- respiratory therapist
- other RN’s/ LPN’s
- social worker
- PCC or charge nurse
what in the role of a team (ICU/ ER physician) during a code?
led and direct the code
what in the role of a critical care RN during a code?
- attach/ interpret monitor
- defibrillate/ initiate IV
- administer medications
- documentation on cardiac arrest record
what in the role of a primary/ unit RN during a code?
- provide pt info to code team
- notify MRP/ airway if no RT
- document on pt progress notes
what in the role of a respiratory therapist during a code?
- airway/ ventilation
what in the role of other RN’s/ LPNs during a code?
perform cardiac compressions
what in the role of a social worker during a code?
provide support to family members
what in the role of the PCC or charge nurse during a code?
coordinate possible transfer to ICU/ communication
What is the role of the ward 1 nurse during a code?
remain on scene and document
What is the role of the ward 2 nurse during a code?
remain on scene and run errands
what is the role of the ward 3 nurse during a code?
- direct traffic
- resume ward duties
- care for nurse 1 and 2’s patients
what is included in a primary survey during a code?
- rapid assessment of pt/ environment
- ABCD’s
in regard to a primary survey during a code, describe the D in ABCD’s.
A = alert
V = respond to verbal stimuli
P = responds to painful stimuli
U = unresponsive
every minute without CPR and defibrillation reduces survival rates up to what?
10%
survival rate is highest if someone is defibrillated within what?
3 minutes of collapse
during cardiopulmonary resuscitation it is important to search for reversible causes of the arrest and then treat the possible causes. What are the 5 H’s?
- hypovolemia
- hypoxia
- hydrogen ions (acidosis)
- hypokalemia/ hyperkalemia
- hypothermia
during cardiopulmonary resuscitation it is important to search for reversible causes of the arrest and then treat the possible causes. What are the 5 T’s?
- tension pneumothorax
- cardiac tamponade
- toxins
- pulmonary thrombosis
- coronary thrombosis
during CPR what other things do you need to rely on besides an ECG?
- patient and their pulse
during a code, what are the on-going ABC assessment and reassessment things you are completing?
- monitor VS and pulse
- recognize oxygen desaturation
- position pt that promotes best ventilation for them
- have emergency respiratory equipment accessible
the post-resuscitation period is the time between what?
between return of spontaneous circulation and the transfer to intensive care
during post-resuscitation care the emphasis if this care period is to what?
- maintain optimal tissue oxygenation and perfusion
- identify cause of arrest/ initiate treatment
after a code is done what is the role of the ward nurse 1?
- complete charting
- ensure family notified
- transfer pt
after a code is done what is the role of the ward nurse 2?
assist nurse 1
after a code is done what is the role of the ward nurse 3?
continue to care for nurse 1 and 2’s patients
what makes a resuscitation team function well?
- identifiable leadership
- clear communication of roles
what is a primary cause of inadvertent patient harm in the hospital?
communication failure
what are areas that could be improved in a resuscitation team?
- decreasing # of people attending code with no specific role
- increasing access to most code blue training
- debriefing after crisis
what are elements of an effective resuscitation team dynamic?
- effective communication
- clear message
- clear roles/ responsibilities
- know one’s limitations
- share knowledge
- constructive intervention
- re-evaluate/ summarize
- mutual respect
in regards to elements of an effective resuscitation team dynamic, describe effective communication
acknowledging the message was heard and give clear response back
in regards to elements of an effective resuscitation team dynamic, describe clear message
clear distinctive speech in a calm direct manner with confirmation repeated back
in regards to elements of an effective resuscitation team dynamic, describe share knowledge
communicate changes in the patient’s condition
in regards to elements of an effective resuscitation team dynamic, describe constructive intervention
intervene if action is contraindicated
families can be present during resuscitation. What can this provide to them?
- helpful/ comforting
- helps family comprehend seriousness of pt’s condition
- may ease grieving
how can you support a family during a code?
- ask if they want to stay or leave
- provide them with a support person before, during and after
- follow up with family/ give them opportunity to share experience
- follow policies/ procedures in place
what else are you going to do when you start CPR?
- give oxygen
- attach defibrillator/ AED
after you start CPR, you check and find that your patient does not have a shockable Rhythm, what are you going to do? What are they in?
- asystole/ PEA
- administer epinephrine Q3-5 mins and continue CPR for 2 more minutes
- consider advanced airway
- assess for shockable rhythm
- continue CPR/ shock
after you start CPR, you check and find that your patient has a shockable Rhythm, what are you going to do? What are they in?
- VF/pVT
- shock
- CPR 2 mins
- ensure IV access
- if rhythm is shockable administer epinephrine Q3-5 minutes
- consider advanced airway
- continue shock/ CPR
what are the different types of lethal rhythms?
- 3rd degree atrial ventricular (AV) block
- ventricular tachycardia
- ventricular fibrillation
