2. You find yourself going
through a typical day in
your shift, when suddenly
you hear the hospital
operator announce…

3. “YOUR ATTENTION PLEASE,
YOUR ATTENTION PLEASE…
CODE 82! CODE 82!
WARD 3B!”

4. Few seconds later, the sound
of the rolling E-Kart fills the
hallway and you see the
hospital code team; clad in
face masks, rapidly take off
running to the scene.

5. As a new nurse, you are aware
that a medical emergency is
being unfolded right at that
moment. You dream to be in that
scene, taking part of the
resuscitative measures and
helping to direct the many
interventions that will be
employed during the event.

6. This course gives you an
overview of your functions as
a nurse in an emergency
situation and an outline of the
nursing skills, detrimental in
the management of a CODE.

7. CODE MANAGEMENT
BASIC SKILLS TRAINING FOR NURSES
LUNG CENTER OF THE PHILIPPINES
Copyright © 2007

8. What is a CODE?

9. THE CODE TEAM
• Physician
• Critical Care Nurse
• Respiratory Therapist
• Nurse Supervisor
• Nursing Aide
• Security Officer

10. The Code Team shall be responsible for:
•Responding immediately to all Code alerts.
•Conducting the code according to current
Advanced Cardiac Life Support (ACLS)
protocols.
•Recording any pertinent data on the patient’s
record.

11. The nursing unit, clinic, and/or
department on which the Code occurs,
shall be responsible for initiating Basic
Life Support (BLS) until the Code
Team can respond.

12. Responsibilities of the Physician
1. Informing the patient’s family of the situation.
2. Making arrangements for an ICU bed if needed.
3. Completing the medical record if the patient expires,
documenting the events leading up to the patient’s
death, cause of death, date and time of death,
coroner’s case, autopsy requested, and physician
signature.

13. Responsibilities of the
Code Team Nurse
• Managing the E-Kart
• Administration of medications
• Assisting in Endotracheal Intubations
• Defibrillation
• Reviewing documentations post code and follow up to
ensure complete documentation

14. Responsibilities of the Charge Nurse
1. Overseeing traffic control on the unit.
2. Ensuring that emergency equipment is brought to the
bedside.
3. Delegating duties to appropriate personnel to ensure the
unit’s continued function.
4. Serving as the recorder for the resuscitation efforts or
delegating an appropriate person to do so.
5. Carrying out orders by physician.
6. Documenting and completing the chart.
7. Contacting the admitting office if the patient needs to be
transferred to a critical care bed.
8. Evaluating the situation to see if additional personnel are
needed to ensure that the Patient Care Area continues to
function.

15. CODE 82
Responds to
Medical
Emergencies
at the
Speed of Life…
Because every
second counts.

16. THE CHAIN OF SURVIVAL
1. Early Access to Care.
2. Early Cardiopulmonary Resuscitation (CPR)
3. Early Defibrillation.
4. Early Advanced Care.
These 4 steps can increase survival as much as
90% if initiated within the first minutes after
sudden cardiac arrest. Survival decreases by
about 10% each minute longer.

17. WHEN TO CALL A CODE?
• Primary Survey
•Assess for RESPONSIVENESS
•Assess for BREATHING
•Assess for CIRCULATION
• Secondary Survey
•Pre and Post RESUSCITATION
MEASURES

18. Assess Responsiveness
Responsive Not Responsive
> vital sign > call for help fast
> assess/inform AP > position
> document > open airway

19. Assess Breathlessness
BREATHING NOT BREATHING
> recovery position > Rescue Breath
> vital sign ( facemask/
> assess/inform AP resuscitation bag)
> Document
> Continously Monitor

20. Assess Circulation
(+) Pulse (-) Pulse
> continue pressure > Activate the
ventilation Code Team
support > Perform cardiac
compression

21. Primary Survey Activate Code 82
Start CPR Prepare for
Intubation
Post
Assist Code 82
Team Resuscitation
Activities

22. BASIC CODE 82 PHYSICAL SETUP
NURSE
SUCTION
CPR
SUPERVISOR
NURSE
CODE TEAM
LEADER

23. BASIC CODE 82 PHYSICAL SETUP
BST
NURSE
SUCTION
CPR
SUPERVISOR
NURSE
BST
CODE TEAM
LEADER
BST BST

24. What happens if a Code 82 is going on
and another call for a code team is
needed in another area?
1st call 2nd call 3rd call
MICU ER PACU

25. When NOT to call a CODE?
DNR CANCER ET / TRACH

26. The Medical Crash Cart
Other names:
E-Cart
E-Kart
Service Cart
Code Cart
Critical Care Cart

27. Basic Components of CODE 82 E-Cart
• Cardiac Monitor
• Defibrillator
• Emergency Meds
• Laryngoscope
• Ambubag
• Miscellaneous medical supplies
• Cardiac Board

29. Activities During a Code
CPR
Endotracheal Intubation
Defibrillation
Administration of
Medications

30. CPR
•When the heart stops, the absence of oxygenated
blood can cause irreparable brain damage in only a
few minutes. Death will occur within eight to 10
minutes. Time is critical when you're helping an
unconscious person who isn't breathing.
•CPR does not restart a heart that has
stopped, but it can keep a victim alive
until more aggressive treatment can
be administered.

31. ENDOTRACHEAL INTUBATION
Endotracheal intubation is performed to
establish and maintain a patent airway,
facilitate oxygenation and ventilation,
reduce the risk of aspiration, and assist
with the clearance of secretions.

32. Nursing Responsibilities in
Endotracheal Intubation
• Assembling materials needed
• Proper patient and bed positioning
• Ensuring O2 source and suction equipment
• Ensuring ET is secured
• Proper collection of ETA specimen and sending to
laboratory
• Chest X-ray post intubation

33. SECURING AN ENDOTRACHEAL TUBE

35. DEFIBRILLATION
It is the administration of electric shock
for a patient on cardiac arrest when the
presenting rhythm is pulseless VT or VF.

36. Ventricular Fibrillation
A turbulent, disorganised electrical activity of the heart in such a
way that the recorded electrocardiographic deflections
continuously change in shape, magnitude and direction.

37. VENTRICULAR TACHYCARDIA
A fast rhythm that originates in one of the ventricles of the heart.
This is a potentially life-threatening arrhythmia because it may lead
to ventricular fibrillation and sudden death.

38. DEFIBRILLATION METHOD
1. Verify cardiac arrest. Ensure ongoing &
effective BLS [CPR and airway management]
2. Ensure the ECG monitor is properly connected.
3. Identify VF or pulseless VT. Ensure all patient
and device movement is eliminated.
4. Gel the entire metal surface of both paddles.
5. Place the paddles on the chest wall. The
sternum pad is placed to the right of the
sternum just below the right clavicle (not on
the clavicle or sternum). The apex pad is
placed at the level of the apex of the heart in
the area of the anterior.
6. Charge the defibrillator or paddles to the
desired energy level.
7. “Verbally and visually clear the patient!” In
simple terms, make absolutely sure that no
one is in electrical contact with the patient.
1. Provide firm, downward pressure (25 pounds
of force) onto the chest
2. Discharge the selected energy by pressing 2
buttons simultaneously.

39. ADMINISTRATION OF MEDICATIONS

40. The administration of medications is a
chief responsibility of a nurse in an
event of a code.
• Anticipation of the drug to be
administered
• Dosage & Route of administration
•When to use an agent (indications)
•Why an agent is used (actions)
•How to use an agent (dosing)
•What to watch out for (precautions)
• Obtain a patent IV access
• Announce the drug and dosage
before and after administration

41. CESSATION OF CODE ACTIVITIES
Criteria for stopping the Code activities:
1 – When sinus rhythm is detected on the ECG, Vital Signs in
acceptable limits
2 – When code lasted for more than 30 minutes with no sign
of sinus activity on the ECG.
3 – When patient’s immediate and significant family member
verbally stops the activities and agreed to sign waiver / DNR.
4 – When flat ECG tracings are seen despite 15-20 minutes
of continued CPR and “maximum” dose of Epinephrine is
administered.

42. POST RESUSCITATION ACTIVITIES
1. Obtaining 12-Lead ECG
2. Obtaining Chest X-Ray
3. Request for Laboratory workups
4. Inserting NGT
5. Inserting Foley Catheter
6. Coordinating with Admitting section for transfer to ICU
7. Coordinating with ICU Nurse for plan of transfer
8. Coordinating with Respiratory Services for VR parameters
9. Coordinating with Dietary Division
10.Patient preparation and coordination with relatives
11.Documentation
12.Transfer of patient
13.Pharmacy and CSSR reconciliations

43. DOCUMENTATION
Code Team Leader
-Written orders
-Code notes
-Transfer referrals
Charge Nurse
-All pertinent data pertaining to the event
-Medications administered
-Completing the Chart
-Nurse’s notes / Charting

44. NURSES’ NOTES
07/16/07 F -Cardiopulmonary Arrest
9:40am D -Patient’s relative rushed to station and reported of
patient’s unconsciousness, stating, “Patay na yata
ang tatay ko!”
-Seen on bed unresponsive, with hands cupped over
chest
-Breathing ( - ), Pulse ( - )
9:40am A -Activated Code 82 immediately.
-Positioned flat on bed immediately and initiated
CPR, ambubagging at 10L O2 flow.
9:41am -Code team arrived and assisted with intubation.
9:45am -Defibrillation administered by code team at three
episodes, noted sinus activity after third shock.

45. (cont.)
A -Emergency medications administered by member of
code team / MTR
-12-lead EKG done, tracings seen by AP
10:14am
-Chest X-Ray requested, plate seen by AP
-Laboratory specimen for ETA G/S, C/S sent
10:14am -Requested Lab for Trop-T, CPK-MB, Na, K, BUN, Crea
-Coordinated with relatives of MICU transfer, conveyed
support and gave reassurance
10:30 -NGT inserted, Consent Form duly signed by relatives
10:40 -Informed Dietary Dept of change in diet & MICU bed
-IFC inserted, Consent Form duly signed by relatives
10:40 -IV Fluids regulated accordingly
10:40 -Coordinated with Admitting Section for MICU transfer
-Coordinated with MICU NOD for transfer

46. (cont.)
A -Coordinated with SRS personnel of VR parameters
10:55am -Transfer Notes completed by AP
-Placed on stretcher and prepared patient for transfer
-Patient’s dentures and wristwatch endorsed to
relatives
11:00am R -Successful resuscitation lasting for about 20 min
11:10am -Wheeled to MICU accompanied by AP
-On ambubagging per ET @ 15 LPM, unconscious,
with latest VS; BP 160/90, CR 142/min, Temp 36.4ºC
O2 Sat 94%
-Endorsed to MICU receiving nurse accordingly
BC A. Co, RN

47. Managing the
Family
Members

48. Normally, the family is quickly escorted
away from the scene, presumably for the
following reasons:
1. The family’s outpouring emotions may be disruptive
2. The family interferes with the resuscitation efforts
3. The family tends to scrutinize the activities and
interventions for signs of incompetence
4. Code team considers to protect the family members
from irreparable psychological harm from
witnessing the event

49. Dispelling the Myths…
Terry L. Tucker’s study, (Critical Care Nurse) Baltimore, USA
•It has been observed that families are rarely disruptive
•Family members rarely interrupt code activities, don’t
really scrutinize the activities of the code team for signs
of incompetence
•Family members feel they provide an element of
emotional and psychological support for the patient.
•Families of patients who don’t survive the event feel a
level of comfort in knowing that everything that could be
done to save the patient was done, thereby facilitating
the grieving process.

50. Dispelling the Myths…
Terry L. Tucker’s study, Baltimore, USA
•No report of significant psychological damage from
witnessing the attempted resuscitation of a loved one.
•Most families believe it’s their right to be present and
that their presence is important to the patient.
•Provides the family member or significant other an
opportunity to say goodbye, relay their love, apologize
or reconcile their relationship, or simply give permission
before the patient takes leave.

51. Providing Guidelines…
Opening the doors?

52. CODE MANAGEMENT
BASIC SKILLS TRAINING FOR NURSES
LUNG CENTER OF THE PHILIPPINES
Copyright © 2007