CODE BLUE

PROCEDURES
CODE BLUE TEAM
Merupakan suatu tim yang melakukan
resusitasi pada setiap orang yang
mengalami :
Cardiopulmonary arrest
Respiratory arrest
Airway problem

Dalam tim terdapat :

Doctor
Nurse
Support Personnel
CODE BLUE ACTIVATION
Semua karyawan harus dilatih untuk
mengaktifkan respon Code Blue jika terjadi
Cardiac arrest
Respiratory arrest
Mengaktifkan respon Code Blue Response
dengan
Memanggil tim emergensi rumah sakit
Hal yang harus dijelaskan : Lokasi pasien, merupakan
pasien anak/dewasa
CODE BLUE MEMBERS
Dokter unit gawat darurat
Dokter spesialis anak
Dokter Penyakit Dalam
Dokter Bedah umum
Unit Perawatan Intensif / Perawat Darurat
Teknisi EKG (Elektrokardiogram)
Perawat
Los Angeles County + USC
Medical Center
Code Blue Protocol
ROLE OF THE TEAM MEMBERS
Ketua tim : Perawatan pasien langsung secara keseluruhan
Mengelola Code
Obat-obatan
Defibrilator
Prosedur lainnya :intubasi, melakukan kompresi
Mengevaluasi Prosedur Code Blue
Efektivitas dari kompresi dada
Efektivitas dari manajemen respirasi
Mengecek pulse dan ritme jantung
Mendokumentasikan dalam medical record
CODE BLUE SKILLS
Identifikasi cardiac / respiratory arrest
Mengaktifkan Code Blue
Pemberian Oxygen : Nasal cannula, mask
Resusitasi dengan Bag-Valve-Mask 100% O2
Dapat menggunakan Cardiac Monitor/defibrillator
Intra Venous access
Pemberian Medication
Defibrillation (ACLS trained)
Dokumentasi CPR
ROLE OF THE TEAM MEMBERS
SUPPORT PERSONNEL
Teknisi EKG : mengoprasikan 12-lead
EKG
Farmasi :menyediakan obat
BASIC LIFE SUPPORT
SURVEY
1- Cek kesadaran
2- mengaktifkan respon Emergency
Response
3- Circulation
4- Defibrillation
 Simplified adult BLS algorithm.

Berg R A et al. Circulation 2010;122:S685-S705

Copyright American Heart Association

ESTABLISH
UNRESPONSIVENESS
Tepuk dan tanyakan pak/bu apakah
anda tidak apa2?
Cek apakah ada nafas yang tidak
normal dilihat dari gerakan dada
ACTIVATE THE EMERGENCY
RESPONSE SYSTEM
Minta bantuan atau minta orang untuk
membantu

Cari Automatic External Defibrillator

CIRCULATION
Cek carotid pulse selama 5-10 detik
Jika tidak ada nadi mulai lakukan kompresi dada
Tekan ditengah dada ( of sternum)
Ratio: 30:2 compressions to breaths
Depth: at least 2 inches
Rate: at least 100 compressions per minute
Allow complete chest recoil
Minimize interruptions
Switch providers every 2 minutes
Avoid excessive ventilation
If pulse present start rescue breathing
1breath every 5-6 seconds (10-12 breaths per min.)
Check pulse every 2 minutes
DEFIBRILLATION

Ifno pulse check for shockable

rhythm as soon as AED arrives
Provide shocks as indicated
Follow each shock immediately with
CPR compressions
Advance Cardiac
Life Support Survey
Airway
Breathing
Circulation
Differential Diagnosis
AIRWAY
Maintain patent airway in unconscious Pts
Head tilt chin lift
Simple airway adjuncts:

Use advance airway if needed:

Confirm proper placement
Physical exam
Quantitative waveform Capnography

Secure Device to prevent dislodgement

Monitor airway placement with continuous
quantitative waveform Capnography
BREATHING
Supplemental O2 when indicated
O2 to oxygen sat 94% non arrest Pts
Titrate
100% O2 for Pts in cardiac arrest

Monitor adequacy of ventilation and

oxygenation
Clinicalcriteria: chest rise and cyanosis
Quantitative waveform capnography
Oxygen saturation

Avoid excessive ventilation

CIRCULATION
Monitor CPR quality
Attach monitor/Defibrillator
Monitor for arrhythmias or arrest rhythms
Provide defibrillation/Cardioversion
Obtain IV/IO access
Give appropriate drugs
Give fluids if needed
DIFFERENTIAL DIAGNOSIS
search for and treat reversible causes

Hs AND Ts
Hypoxia Tension pneumothorax
Hypovolemia Tamponade cardiac
Hydrogen ion (acidosis) Toxins
Hypo/hyper kalemia Thrombosis Pulmonary
Hypothermia Thrombosis Coronary
ACLS
Cardiac
Arrest
Algorithm .

Copyright American Heart Association

 ACLS Cardiac Arrest Circular Algorithm.

Neumar R W et al. Circulation 2010;122:S729-S767

Copyright American Heart Association

 Bradycardia Algorithm.

Neumar R W et al. Circulation 2010;122:S729-S767

Copyright American Heart Association

 Tachycardia Algorithm.

Neumar R W et al. Circulation 2010;122:S729-S767

Copyright American Heart Association

NSR with Ectopy > VT>VF>NSR
A 48 year old iron worker is brought to the
Emergency Department by co-workers following an
onset of sudden sever pressure-type chest pain
radiating to his neck, jaw and left arm.
He is pale slightly diaphoretic, and very anxious.
Wide-complex tachycardia >VF>NSR
A 63-Year-old woman alcoholic with a history of
CHF is brought to the hospital by her daughters
becouse of worsening symptoms of dyspnea, cough
and wheezing.
She looks moderately ill but denies chest pain.