04/19/23 1

Responding to a Code

Keith Rischer RN, MA, CEN

04/19/23 2

Today’s Objectives…

Identify clinical situations in which a code would be called. Differentiate a code for respiratory arrest versus cardiac arrest. State emergency measures when initiating a code before the

code team arrives. Identify dysrhythmias and interventions experienced in a code

situation. Discuss the specific roles of each of the emergency team

members. Discuss the role of the patient’s assigned nurse in a code

situation. Practice responding to a code including recording on a code

record. State actions for using a portable defibrillator.

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Today’s Schedule…

Past experiences with codes Discussion of legal and ethical issues Code team membership Responsibility of each member Equipment and safety issues Brief review CPR protocols/defibrillation Implementation of code scenarios/debriefing Post code issues

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Legal & Ethical Issues

DNR order No DNR order Advanced directives Organ donation Code review Ethic Committee

Code Team Responsibilities

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Primary nurse caring for patient Second nurse (possibly from code team/defibrillator certified) Rapid response nurse Medication nurse Scribe (nurse/manager/supervisor) Respiratory/Anesthesia Team leader Ancillary departments (EKG, I.V. Team) Patient representative and/or clergy Runner Security

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Basic Life Support: Primary Survey

Airway • Open airway, look, listen, and feel for breathing.

Breathing • If not breathing, slowly give 2 rescue breaths.

Circulation • Check pulse. If pulseless, begin chest compressions at 100/min

30:2 ratio. • Consider precordial thump with witnessed arrest and no

defibrillator nearby• Attach monitor, determine rhythm. If VF or pulseless VT: shock 1

time Defibrillate

• YouTube -• YouTube – • YouTube -

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Primary Survey continued priorities

Airway • Establish and secure an airway device (ETT, LMA, COPA,

Combitube, etc.). Breathing

• Ventilate with 100% O2. Confirm airway placement (exam, ETCO2, and SpO2). Remember, no metabolism/circulation = no blue blood to lungs = no ETCO2.

Circulation • Evaluate rhythm, pulse. If pulseless continue CPR, obtain IV

access, give rhythm-appropriate medications (see specific algorithms). PIV preferred initially vs. central line.

Differential Diagnosis • Identify and treat reversible causes.

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ACLS Medications

Adenosine Atropine sulfate Amiodarone Cardizem (diltiazem) Dopamine HCL Dobutamine hydrochloride Epinephrine HCL (Adrenalin)

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ACLS Medications

Levophed (Norepinephrine) Lidocaine HCL Magnesium Nitroglycerine (NTG) Oxygen Sodium Bicarbonaate Vasopressin

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Defibrillation

Patho Bi-phasic Nursing Responsibilities

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ACLS Rhythms: Most Common

VT-VF Asystole Tachycardia

• AFib w/RVR (symptomatic)• SVT

Bradycardia (symptomatic)

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Ventricular Tachycardia

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Ventricular Fibrillation/AsytoleVentricular Fibrillation/Asytole

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Post Code Concerns

Autopsy Family presence

• SurvivalSaving life is priority regardlessSeen in less experienced nurses, MD’s

• HolisticSave lifeAddressing needs of the familySeen in more experienced providers and those

who were sensitive to their own spirituality