Code Blue Generally is used to indicate a patient requiring immediate resuscitation, most often as the result of a cardiac arrest.

May also be used as a radio call to indicate that a patient en route to the hospital requires resuscitation. * Team leader. First, one person is designated as the code team leader. Usually a physician directs and coordinates the resuscitation efforts, but in some institutions, a nurse who's trained in ACLS may direct the code until a physician arrives. The team leader usually stands at the foot or head of the bed: She needs a clear view of the patient to ensure that procedures and patient assessments are performed rapidly and correctly. * Defibrillator operator: A physician or specially prepared nurse actually delivers the shock. Most victims of cardiac arrest die from lethal arrhythmias. Rapid defibrillation is the key to survival from ventricular fibrillation, so the team must be prepared to defibrillate immediately. Many hospitals have AEDs in each unit. With an AED, someone who's inexperienced at interpreting cardiac rhythms can prepare and deliver defibrillatory shocks based on information provided by the AED. If you don't have an AED in your unit now, you may soon. The 1992 National Emergency Cardiac Care Conference strongly endorsed the principle of early defibrillation, stating that everyone whose job requires performing basic CPR be trained to operate and be permitted to use defibrillators, especially AEDs. If you've been prepared to operate an AED and hospital policy allows you to do so, you can use an AED before the code team arrives. Make sure no one is touching the patient, bed, or any equipment connected to the patient when it delivers an electrical shock. * Recorder. At the start of the code, one nurse should begin recording the events and interventions on the official resuscitation record kept on the crash cart. She'll document all events and interventions, including the type and time of arrest, respiratory management, procedures, medication administration, I.V. fluids and medications, vital signs, cardiac rhythms, defibrillations, patient response to treatment, patient outcome, and termination of code. The role of recorder is vital. She shouldn't be asked to participate in any other way (for example, administering medications) that distracts her from this responsibility. An important duty of the recorder is to announce when a medication may be due--for example, "It's been 3 minutes since the last dose of epinephrine So she must know emergency cardiac drugs and their dosing schedules. As the patient's nurse, you may fill this role. If so, you should be familiar with your hospital's resuscitation record and know how and what to document. Identify yourself as the recorder to other team members and position yourself so you can see everything that's happening. Identify which clock will be the official code clock. If the patient's room has a clock, use it. If not, you may have to use your wristwatch to time events. Be precise about the timing on the resuscitation record.

Check that the time automatically recorded on the electrocardiogram (ECG) strips by the monitor corresponds to the code-clock time. Mark the correct time on the code strips periodically if the time differs. The resuscitation record is a legal document that's recognized as the official order sheet and must be signed by the code team leader or physician and co-signed by an RN. At the conclusion of the code, review the record with the team leader for accuracy and completeness. List all team members, even though they don't all need to sign the document. * Intubationist. A physician (for example, an anesthesiologist) usually performs intubation, but in some hospitals a respiratory therapist, nurse-anesthetist, or other specially prepared nurse may do so. Know where the intubation equipment is located on the crash cart and have it ready. Assemble the laryngoscope blade and handle. Both curved and straight laryngoscope blades will be on the crash cart. The type of blade used is up to the person who's intubating the patient: Ask which he prefers. * I.V. nurse. Two I.V. lines are usually placed early in the resuscitation effort. Try to access large veins, such as those found in the antecubital fossa, for quick insertion and easy infusion of large volumes of fluid. In some instances, vascular collapse will prevent you from using a peripheral vein, so make sure that you have the equipment needed for central-line insertion. It's usually packaged together in the crash cart's I.V. drawer so that everything the physician needs for central-line insertion is immediately available. After establishing I.V. access, start the I.V. fluid at the rate ordered by the team leader. The rate depends on the suspected cause of the arrest. Solutions typically used during resuscitation efforts include 0.9% sodium chloride and lactated Ringer's solution. * Medication nurse. The patient will need emergency drugs almost immediately, so make sure you know where they're located on the crash cart. Also familiarize yourself with the drugs used during a code (see Understanding Code Drugs) and learn to open packages and assemble syringes quickly. The three most frequently used medications during the initial stages of a code are epinephrine, lidocaine, and atropine. If vascular access is delayed and an ET tube has been inserted, these three drugs can be administered through the ET tube. Make sure you know the proper dilutions, which differ from the dilutions for I.V. administration. As you prepare a drug, repeat the drug name and dosage order out loud, so no one's confused about what you're drawing up. Again announce the drug and dosage when you hand the drug to the team member nearest I.V. access or just before you administer the drug, and announce it again when the drug is completely injected. Accurately documenting the time of administration is critical because many drugs must be repeated at 3- to 5-minute intervals. If you're using peripheral venous access, administer I.V.

medications rapidly. Follow them with a 20-ml bolus of I.V. fluid while elevating the patient's arm to encourage rapid drug distribution into the central circulation. Because drugs should be distributed to the central circulation before another defibrillatory shock is administered, be sure that CPR is continued during the period between administration of a drug and the next defibrillation. * Floor nurse. The family and primary physician must be informed of resuscitation efforts. If the family is in a hospital waiting area during the code, someone must keep them informed of what's happening. * Crowd controller. Crowd control may be needed when too many people in the room obstruct the team leader's view and unnecessarily increase the noise level and room temperature.