Rapid Response / Code Blue Training with Michael Truxillo, MD, CPPS

Ochsner Health

25 Sept 201906:33

Summary

TLDRThis video script from the Ochsner Simulation Center illustrates the critical role of a well-organized team in performing effective CPR. It demonstrates the transition from a Rapid Response to a Code Blue scenario, emphasizing the importance of clear communication using the SBAR format. The script highlights the roles and responsibilities of nurses, respiratory therapists, and physicians in managing a patient's clinical deterioration, with a focus on early intervention and goal-directed resuscitation to save lives.

Takeaways

💡 Effective CPR requires a highly organized team with clear roles and responsibilities.
🏥 The patient's condition can transition from a Rapid Response to a Code Blue based on clinical deterioration.
🩺 The Bedside Nurse is the first to assess the patient and calls for support when signs of deterioration are observed.
📞 Clear communication using SBAR (Situation, Background, Assessment, Request) is essential when escalating the situation to the Charge Nurse and Rapid Response team.
🚨 Rapid Response and Respiratory teams arrive quickly to provide primary care and assess the patient's condition.
⚠️ CPR should be initiated within one minute of the patient becoming unresponsive, with a focus on continuous compressions.
💻 Technology such as end-tidal CO2 monitoring and defibrillator feedback improves the accuracy of compressions and reduces interruptions.
⚡ Defibrillation must occur within two minutes if a shockable rhythm is identified, while the team continues CPR.
👥 Roles shift during a Code Blue, with designated responders managing crowd control, documentation, and providing additional resources.
🎯 Closed-loop communication is crucial during resuscitation, ensuring everyone knows their tasks and the patient receives timely care.

Q & A

What is the primary role of the Bedside Nurse in the video?
-The primary role of the Bedside Nurse is to assess the patient's condition, identify any signs of clinical deterioration, and call for support from the Charge Nurse when necessary.
What does the Charge Nurse do upon receiving a call from the Bedside Nurse?
-The Charge Nurse immediately responds to support the Bedside Nurse, provides a secondary assessment of the patient's condition, and initiates a Rapid Response if the patient's condition is deteriorating.
What is the SBAR format mentioned in the script, and how is it used?
-The SBAR format stands for Situation, Background, Assessment, and Request. It is a standardized communication tool used by the Bedside Nurse and Charge Nurse to convey concerns about the patient's clinical deterioration clearly and concisely.
What is the significance of activating a Rapid Response?
-Activating a Rapid Response is crucial for early intervention in cases of clinical deterioration. It ensures that additional medical personnel, such as the Rapid Response Nurse and Respiratory Therapist, arrive quickly to provide necessary care.
What is the role of the Rapid Response Nurse in the patient's care?
-The Rapid Response Nurse conducts a primary survey of the patient, assesses the situation, and takes immediate action, such as initiating CPR if the patient becomes unresponsive.
What is the correct sequence of priorities during CPR as mentioned in the script?
-The correct sequence of priorities during CPR is compressions first, followed by airway, and then breathing. This order ensures that chest compressions, which are critical for maintaining blood circulation, are not delayed.
Why is it important to not halt compressions for more than 10 seconds during CPR?
-Halting compressions for more than 10 seconds can significantly reduce the effectiveness of CPR, as it interrupts the blood flow to the heart and brain, which are critical for resuscitation.
What is the purpose of using end-tidal CO2 monitoring during CPR?
-End-tidal CO2 monitoring is used to guide resuscitation efforts by providing real-time feedback on the effectiveness of chest compressions and ventilation, helping to avoid interruptions in compressions for pulse checks.
What happens when a Code Blue is called, and what does it signify?
-A Code Blue is called when a patient's condition deteriorates to the point where immediate resuscitation is required. It signifies an emergency situation where the Code Team is activated to perform CPR and other life-saving measures.
How does the transition from a Rapid Response to a Code affect the roles and responsibilities of the medical team?
-When the transition from a Rapid Response to a Code occurs, the roles and responsibilities of the medical team shift to a more specialized and coordinated approach. The Rapid Response Nurse leads the Code, while the Charge Nurse coordinates local responders, and the Code Physician takes over the patient's care.
What is the importance of closed-loop communication during a Code?
-Closed-loop communication is critical during a Code to ensure that all team members are aware of the patient's status, the actions being taken, and any changes in the plan. It helps maintain clear and effective communication, which is vital for successful resuscitation.

Outlines

00:00

🚑 CPR Team Dynamics and Rapid Response Activation

The video script from the Ochsner Simulation Center illustrates the critical nature of CPR and the importance of a well-organized team with clear roles. It begins with the bedside nurse, Kiara, who assesses Mr. Jones and notices his deteriorating condition, prompting her to call the Charge Nurse, Raenell, for support. The script emphasizes the use of the SBAR format (Situation, Background, Assessment, and Request) for effective communication. As Mr. Jones' condition worsens, a Rapid Response is called, and additional healthcare professionals, including a Rapid Response Nurse and a Respiratory Therapist, arrive to conduct a primary survey. The situation escalates to a Code Blue, and the Code Team is activated, highlighting the need for immediate CPR initiation and the importance of compressions, airway management, and defibrillation within the critical timeframes. The video script underscores the shift in roles and responsibilities as the situation transitions from a Rapid Response to a full Code Blue scenario.

05:01

🔧 Post-Code Blue Team Coordination and Patient Management

In this paragraph, the focus shifts to the post-Code Blue scenario where the Code Team, led by the Rapid Response Nurse, coordinates the resuscitation efforts according to the patient's clinical condition. The Code Physician, Dr. Kahn, arrives and takes charge, inquiring about the administration of medications and the status of IV access. The team follows a closed-loop communication protocol, which is essential for clear and effective communication during high-stress situations like a code. The script details the administration of Epinephrine (Epi) and the continuation of CPR, including the process of defibrillation. The team works together to secure the patient's airway and prepare for the patient's transfer to the ICU. The video concludes with a call to action for healthcare professionals to familiarize themselves and their teams with their roles and responsibilities to improve patient outcomes in emergency situations.

Mindmap

Keywords

💡CPR

CPR, or cardiopulmonary resuscitation, is an emergency procedure performed when someone's breathing or heartbeat has stopped. In the video, it is highlighted as a critical intervention that can save lives, especially when performed effectively by a coordinated team. The script describes the transition from a Rapid Response to a Code Blue situation, emphasizing the importance of timely CPR initiation within one minute of the patient becoming unresponsive.

💡Rapid Response

A rapid response system is a hospital protocol designed to quickly address clinical deterioration in patients. In the script, the Bedside Nurse calls for a Rapid Response when she notices signs of deterioration in Mr. Jones. The Charge Nurse then activates the Rapid, bringing in additional healthcare professionals to assess and stabilize the patient's condition.

💡Code Blue

A 'Code Blue' is a hospital emergency code that indicates a patient requires immediate resuscitation. The script illustrates the activation of a Code Blue when Mr. Jones' condition deteriorates further, necessitating the involvement of the Code Team for CPR and potential defibrillation.

💡Bedside Nurse

The Bedside Nurse is a healthcare professional who provides direct patient care at the bedside. In the video, Kiara, the Bedside Nurse, is the first to recognize Mr. Jones' clinical deterioration, initiating the chain of events that lead to a Rapid Response and eventually a Code Blue.

💡Charge Nurse

The Charge Nurse is responsible for coordinating patient care and supervising other nursing staff. In the script, Raenell, the Charge Nurse, responds to Kiara's call for support, providing a secondary assessment and activating the Rapid Response protocol.

💡SBAR Format

SBAR is a structured communication format used in healthcare to convey critical information quickly and clearly. It stands for Situation, Background, Assessment, and Request. The script shows how both the Bedside Nurse and Charge Nurse use SBAR to communicate Mr. Jones' deteriorating condition effectively.

💡Primary Team

The Primary Team in a hospital setting typically consists of healthcare professionals who are responsible for the initial assessment and management of a patient's condition. In the video, the Bedside Nurse calls the Primary Team for assistance when she detects clinical deterioration in Mr. Jones.

💡Respiratory Therapist

A Respiratory Therapist is a healthcare provider who specializes in respiratory care, often involved in the treatment of patients with respiratory conditions. In the script, Jamie, the Respiratory Therapist, arrives with the Rapid Response Nurse to conduct a primary survey on Mr. Jones.

💡Defibrillation

Defibrillation is the medical procedure of applying electrical shock to the heart to restore a normal rhythm in cases of certain life-threatening cardiac arrhythmias. The script mentions defibrillation as a critical step in the resuscitation process during a Code Blue, with the goal of delivering the shock within two minutes of identifying a shockable rhythm.

💡End-tidal CO2 Monitoring

End-tidal CO2 monitoring is a method used to measure the partial pressure of carbon dioxide at the end of an exhalation. It is used to assess the effectiveness of ventilation during CPR. In the video, the addition of end-tidal CO2 monitoring to the ambu bag is highlighted as a tool for goal-directed resuscitation.

💡Closed-loop Communication

Closed-loop communication is a communication technique where a message is confirmed as understood by the recipient, ensuring clear and effective information exchange. The script emphasizes the importance of this technique during a Code Blue, where clear and confirmed communication is vital for coordinating the resuscitation efforts.

Highlights

CPR requires a highly organized team with clear roles and responsibilities for effective performance.

Clinical deterioration can occur at any time, necessitating early intervention.

The Bedside Nurse initiates assessment and calls for support from the Charge Nurse if needed.

The Charge Nurse provides a secondary assessment and calls a Rapid Response when necessary.

The SBAR format (Situation, Background, Assessment, Request) is used for standardized communication.

Rapid Response Nurse and Respiratory Therapist conduct a primary survey upon arrival.

CPR should be initiated within one minute of the patient becoming unresponsive.

Compressions are prioritized in CPR, followed by airway and breathing.

Compressions should not be halted for more than 10 seconds during resuscitation.

End-tidal CO2 monitoring is used for goal-directed resuscitation.

See-through CPR and end-tidal CO2 monitoring avoid pulse check interruptions.

Enhanced defibrillator feedback technology assesses rate, depth, and recoil with compressions.

Defibrillation should occur within two minutes of identifying a shockable rhythm.

Roles and responsibilities shift when transitioning from Rapid Response to a Code Blue.

The Rapid Response Nurse leads the Code and coordinates critical care personnel.

The Charge Nurse coordinates local responders, including the Recorder, Security, Runners, and Chaplain.

Bed management during a Code is handled outside the room by designated personnel.

The Code Physician assumes leadership once they arrive, with a SBAR report provided by the Rapid Response Nurse.

Closed-loop communication is critical during a Code for effective teamwork.

Securing the airway and calling the ICU are part of the post-CPR procedures.

Familiarity with roles and responsibilities is essential for all unit staff to save more lives.