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Code Blue Meds

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5K views35 pages

Code Blue Meds

Thank you for the overview. Let me know if you need any clarification or have additional questions.

Uploaded by

sbjon984924
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Code Blue Procedures

Updated Mar 2006: D. Tucker, RPh, BCPS


with K. Wahby, PharmD and R. Simpson, PharmD
Objectives

Š To acquaint the pharmacist with the activities


of a code blue emergency
Š To identify the procedures followed during a
code blue emergency by the pharmacist
Š To elucidate the appropriate conduct to
follow during a code blue emergency by the
pharmacist
Why Pharmacist Participation

Š Use of medications is an inherent part of


most code blue emergencies
Š Preparation of intravenous medications
comes under the purview of pharmacists
Š It is a dynamic and interactive process of
pharmaceutical care
Crash Cart Locations

Š Determine location of crash cart on any


unit(s) covering
Š Replacement medication trays are kept in the
central pharmacy manufacturing area
„ Replaced to ICU Pyxis machines
„ Replaced to CPD post-code when cart is cleaned
and medications and instruments replaced
HUH/HWH Crash Cart
Components
Drawer 1:
Medications Drawer 3:
Syringes
Needles

Drawer 6:
Drawer 5: Gloves
IV Fluids Face masks
Angiocaths
RIM Crash Cart Components

Drawer 3:
IV Fluids
Drawer 4:
Medications

Drawer 5:
Gloves Drawer 6
Syringes Gloves
Needles Stethoscope
Attending a Code Blue

Š Notification
„ Overhead PA system
„ Code blue pager
Š Reach site of code
„ Take stairs when possible
„ Enter room/area and identify yourself to staff
already in attendance
Pharmacist Procedures

Š If the medication tray is still in the cart,


remove it at an opportune time when the
other drawers are not in use
Š If medication tray is already being attended
by a physician or nurse, offer to work with
them or to handle the medications
Remove the Medication Tray

RIM Crash Cart

Medication
Tray

HUH/HWH Crash Cart


Place Tray on Solid Surface
Medication Tray

Remove the
plastic from
the tray
Pharmacist Procedures

Š Identify the physician calling the code


Š Identify the nurse recording the events
Š Stand by the medication tray in sight of the
physician running the code
Š If possible, be in view of the ECG monitor
Pharmacist Procedures

Š Identify yourself to the recording nurse


Š If events allow, identify yourself to the
physician calling the code
Š Locate the nurse or physician administering
the medications
Syringe Preparation

Š At the start of the code open and assemble an


epinephrine and an atropine syringe

Š Replace each assembled syringed in its box to make


quick identification easier
Š Draw up 2-3 syringes with 20ml NS for flushing
between doses of medications
To Assemble a Syringe

Open the syringe box


from the side indicated
To Assemble a Syringe

So that the two parts


fall out into your hand,
then
To Assemble a Syringe

Flip off the plastic end-


caps and
To Assemble a Syringe

Attach the medication


half to the plunger half
with a push
To Assemble a Syringe

And a twist until


resistance is met
Pharmacist Procedures

Š Obtain IV solutions, syringes, and needles


from the cart as necessary for requested
medications
Š Determine if IV medications will be
administered by needle or blunt tip system;
may need to exchange needles on syringes
Š Stay focused on physician calling the code
Dispensing Medications

Š Select correct medication requested by the


physician calling the code
Š Assemble the syringe (if not done in earlier
step) or draw up medication requested;
change to blunt tip system if required
Š Step to bedside and loudly read name of
medication and dose from syringe or vial as
you hand it to the administering MD or RN
Dispensing Medications

Š Reading name of dose of medication from


syringe or vial
„ Ensures that the correct medication is being
dispensed
„ Is a double check that the correct medication is
handed to the administering physician or nurse
Dispensing Medications

Š Return to stand by the medication tray


Š Check with recording nurse that the correct
time and medication were recorded
„ Try and use overhead clock in room to write
administration times so everyone can follow the
medication timing
Š Draw up another syringe/vial/ampule of
medication just used
Dispensing Medications

Š Helpful hints
„ Back of the medication list found in the
medication tray contains dosing basics
„ Keep track of empty boxes/vials/ampules as
physician calling the code often asks how much
of various medications were already used
z Line up empty containers next to the medication tray
as used
z Keep track of timing between doses of epinephrine
z The recording nurse can corroborate counts and timing
Dispensing Medications

Š More helpful hints


„ Wearing gloves is not mandatory
„ Be aware that other code blue attendees may
encounter blood then hand you a syringe to
dispose of in the needle box,
„ Therefore, know where to find gloves and try to
keep some nearby in case they are needed
Preparing Medications

Š Helpful hints
„ If possible, check patient’s chart for allergies,
age, height, and weight
„ Correct patient demographics make for more
accurate calculation of doses or infusion rates if
needed
Preparing Medications
Amiodarone
Š Initial dose: 300 mg IVP qs to 20
ml with NS or D5W; may repeat
with 150 mg qs to 20 ml prn
„ Infuse each dose over 10 minutes
Š Infusion dose: 150 mg in 150 ml
D5W; stable for 2 hours only
„ Infuse at 1 mg/minute = 60 ml/hour
Š Kit with drug, label, and IV fluid
in medication tray
Preparing Medications
Norepinephrine
Š Dilute 4 mg in 250 ml D5W or
D5NS (16 mcg/min)
Š Avoid dilution with plain NS
Š Infuse at 0.5-1 mcg/min and
titrate up to 30 mcg/min to
improve blood pressure
Š Avoid giving in same line as
alkaline solutions
Preparing Medications
Isoproterenol
Š Dilute 1 mg in 250 ml D5W, LR,
or NS (4 mcg/ml)
Š Infuse at 2-10 mcg/min titrated
to an adequate heart rate
Preparing Medications
Epinephrine
Š For cardiac arrest, dilute 30
mg epinephrine (30 ml of
1:1000 solution) in 250 ml
NS or D5W to infuse at 100
ml/hr and titrate to response
Š For bradycardia, dilute 1 mg
of 1:1000 epinephrine in 500
ml NS and infuse at 1-5
ml/min (2-10 mcg/min)
Preparing Medications
Procainamide
Š Dilute 1 grams in 250 ml D5W
or NS (4 mg/ml)
Š Maximum concentration 20
mg/ml
Š Recurrent VF/VT: 20 mg/min
up to 50 mg/min with maximum
dose of 17 mg/kg
Š Maintenance: 1-4 mg/min
Professional Conduct

Š Always remain focused on the physician


calling the code
Š Watch and be aware of events going on
around you
Š Never leave a code that is underway without
arranging for someone to handle medications
and, if possible, letting the physician calling
the code know
Professional Conduct

Š Sometimes additional medications are


needed; options to obtain them include:
„ Calling from room to have tubed or delivered to
nursing unit, i.e., phenytoin IVPB; send RN,
MD, or other pharmacist to pick up from tube
„ Having RN, MD, or other pharmacist go to front
desk and call pharmacy
„ Having RN or other pharmacist obtain
medication from Pyxis, i.e., flumazenil
Professional Conduct

Š End of Code
„ Always ask permission to leave even though the
code has ended as further drips and their
calculated rates may be needed
„ Clean up your area and dispose of syringes and
waste paper in the appropriate containers
Conclusion

Š Always remain calm and in control


Š Note that each code you attend will be a
different scenario; be alert and pay attention
Š Remember that participation in code blue
emergencies becomes easier with each time
you do it

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