Rapid Response / Code Blue Training with Michael Truxillo, MD, CPPS
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
🚑 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.
🔧 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
💡Rapid Response
💡Code Blue
💡Bedside Nurse
💡Charge Nurse
💡SBAR Format
💡Primary Team
💡Respiratory Therapist
💡Defibrillation
💡End-tidal CO2 Monitoring
💡Closed-loop Communication
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.
Transcripts
We all know that CPR saves lives, but to perform effective CPR, it requires a
highly organized team with clear roles and responsibilities. As we watch this
video filmed at the Ochsner Simulation Center, pay attention to how the roles
shift as the patient's condition transitions from a Rapid Response into a
Code Blue.
Clinical deterioration can happen at any time.
Early intervention starts with the
Bedside Nurse who assesses the patient and calls for support from the Charge Nurse
if she feels something is just not right.
Hi Mr. Jones. This is your nurse, Kiara,
I came in to take you vital signs. How are you feeling today?
[groans]
I'm gonna go ahead and get your blood pressure.
Your blood pressure's a little low. I'm gonna go ahead and call my Charge Nurse for some support.
I feel like I could die.
Hi Raenell. This is Kiara. I'm in room 926 with Mr. Jones.
He doesn't look too good...
The Bedside Nurse provides a quick report to convey
any urgency or signs of clinical deterioration.
The Charge Nurse immediately responds to support the Bedside Nurse
and provide a secondary assessment of the situation.
Hey. What's going on?
Hey, this is Mr. Jones. He came in last night.
This morning he was feeling fine. I just took his blood pressure. His systolic was in the low 80's.
He said he feels like he's about to die and he said he's feeling a little...
short of breath right now.
I'm not liking the way he's looking. I'm gonna go ahead and call a Rapid.
And I'll go ahead and call the Primary Team.
Hey I'm in 26. I have a Rapid.
Hi this is Kiara. I'm calling about the patient in room 926, Mr. Jones.
Hey I have a Rapid. Can I get some help in here? Bring the monitor.
Can someone come in here and take a look at him? We're calling the Rapid Response right now.
Thank you.
They both use a standardized SBAR format:
Situation, Background, Assessment, and Request to communicate their concerns of clinical deterioration.
The Bedside Nurse calls the Primary Team while the Charge Nurse activates a Rapid.
The Charge Nurse also calls for help and a monitor.
As personnel respond, she will designate roles and responsibilities.
He's already on telemetry.
Alright.
Let's get his pulse...
The Rapid Response Nurse and Respiratory Therapist arrive within minutes to conduct a primary survey
while receiving an updated SBAR report.
Hi I'm Brittany, the Rapid Response Nurse. This is Jamie, the Respiratory Therapist.
Can you tell me what's going on?
Yes, this is Mr. Jones. He came in last night with COPD exacerbation.
I came in just this morning and checked him. His systolic was in low 80s which is a
significant change from this morning and his sats have now dropped to the 80s.
I'm gonna take a listen to him.
Mr. Jones, can you take a deep breath for me?
Mr. Jones?
Mr. Jones?
It doesn't look like he's responding.
His pulse is actually pretty thready.
Mr. Jones? Hey bud.
Mr. Jones.
Let's go ahead activate CPR.
You calling a code? Calling a code.
The patient's condition deteriorates and the Code Team is activated.
I have a Code Blue in 26.
CPR should be initiated within one minute of the patient becoming unresponsive
Remember your priorities: compressions come first, then airway, and breathing.
Compressions should not be halted for more than 10 seconds at any point during resuscitation,
such as when pads are placed in the anterior-posterior position.
Alright, on the count of three, we're gonna turn him towards you.
One, two, three.
Okay, lay him flat and resume compressions.
End-tidal CO2 monitoring is added to the ambu bag...
Alright, let's go ahead and add the end-tidal CO2.
...to allow for goal-directed resuscitation.
End-tidal CO2 and see-through CPR can be used to avoid pulse check interruptions.
Let's analyze the rhythm.
Rate, depth, and recoil with compressions can be assessed
using enhanced defibrillator feedback technology.
Hold compressions.
Analyzing.
The Rapid Response Nurse uses the analyze function...
Shock advised.
Stand clear.
...to determine if a shock is needed until the Code Physician arrives.
Shock delivered. Resume CPR.
Defibrillation needs to occur within two minutes of identification of a shockable rhythm.
Now that the Rapid has shifted to a Code, roles and responsibilities for those in the room also shift.
The Rapid Response Nurse leads the Code and coordinates the critical care personnel by name,
which include Anesthesia, Critical Care Physicians, and Critical Care Nurses.
The Charge Nurse coordinates local responders by name, which include the Recorder,
who uses a computer or portable device for documentation, Security for crowd control,
Runners for additional supplies, and the Chaplain, who is there for the family.
Bed management occurs outside the room by the ICU Charge Nurse, Patient Flow Coordinator,
and House Supervisor.
When the Code Team arrives, the Rapid Response Nurse gives a SBAR report to the Code Physician
and the Code is run according to the patient's clinical condition.
Hey Dr. Kahn. I'm the Code RN. We just shocked him at 150 for a V-Fib arrest.
He looks to still be in V-Fib. The last shock was delivered a minute and a half ago.
Thank you, Brittany.
Have we given any meds yet?
No meds yet. We do have IV access.
Let's give Epi.
Notice the closed-loop communication, which is critical during a Code.
Good compressions.
One milligram of Epi in.
Good. Looks like we have a good airway and you're ventilating.
At pulse check, we're gonna switch compressors.
Looks like it's V-Fib. Let's go ahead and shock.
Charging at 200 joules.
Everybody stand clear.
Shocking.
Shock delivered.
Resume CPR.
Resume compressions.
10 seconds till pulse check.
Pulse check.
He has a pulse with compressions.
Hold compressions.
We have a pulse.
Good job guys. Let's secure the airway and let's call the ICU.
If there were a code on your floor today, would you know what to do?
Work with your team until everyone on your unit knows their roles and responsibilities so that we can
change and save more lives.
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