Hey guys. I'm Siobhan, a second-year medical resident
You've seen me running to codes in previous videos
but today we are going through the details of what actually happens at a code blue and
I'll be telling you what the odds are of actually bringing somebody back to life
A code blue is a medical emergency. That could be someone's heart stops,
So they're having trouble breathing or they're about to stop breathing. Maybe they're having a seizure or they're completely unresponsive
The goal is to get people,
resources, equipment, all to the emergency
So a code blue can be initiated by anybody in the hospital
Usually though it's the bedside nurse because they're always in and out checking in on the patients
So if a nurse is at the patient's bed, and they want to call a code blue
There are two ways to get this started
One there can often be an axial button
Sometimes a blue button and you just push that to start the code blue process or if you can't reach that
The patient's call bell
so what the patient usually pushes to call the nurse they can rip that out of the wall and then that will also
Alert the business clerk at the front desk by the nursing station. When the business clerk hears about the emergency
They'll immediately pick up the phone and call paging.
There's a dedicated line so that it's always available for emergencies
Paging will pick up and then we'll ask what type of emergency it is. So what kind of code and where it's located?
Then they're gonna send a notification
Overhead in the hospital so we can all hear it
plus, they're gonna send a notification to our pagers and that'll say code blue and then the location. Next they'll go and
open up all the locked doors in the hospital and this is particularly
Important so that all the people who need to get to an emergency
Can get there as quickly as possible, and they're not locked in anywhere
This sends a whole bunch of people into action. You'll get doctors from internal medicine like me
Anesthesia or ICU, depending what hospital you're at and of course medical students come as well
Then you've got nurses coming from the ICU who are bringing a code blue cart and nurses from the ward and nursing students
respiratory therapists and respiratory therapy students may also show up and then on top of that you've got
Security to come help manage this whole situation and porters coming bringing a bed in case the patient needs to get transferred
Let me walk you through what would happen in a classic
Resuscitation when a patient's heart stopped and they stopped breathing and if we didn't do anything they would actually pass away
First you've got the team leader and as a senior internal medicine resident, that's my job. So it's a lot of responsibility
when I arrive at a code
I stand at the foot of the bed and
you're looking down at the patient then anyone who comes into the room knows who is in charge because they're standing at the foot of
the bed
The goal is to be giving instructions to everyone. There are so many people in the room that you are
Organizing this chaos
Then people are reporting back to you with any information
So you're gathering information to try to figure out
1. What caused this patient to get so sick and 2. how are you gonna treat them? And the key is that whatever's going on
I need to be alerted to it. So if I say push one milligram of epinephrine
Nurse will go push it
They're going to come back and say one milligram of epinephrine is in so all this closed loop communication
Always comes back to the team leader
next a line up forms to do CPR
So this is often medical students, junior residents, nursing students, nurses, all line up
usually I would say four to five people and CPR is
Exhausting, so you try to do two minutes at a time
but if someone is obviously getting
Exhausted it's my job as the team leader to say you need to switch out because CPR is the most
Important thing that you can do to bring somebody back so you need high quality CPR
Then there's someone at the head of the bed, so that's managing airway. And that's often anesthesia, respiratory therapy could be
Internal medicine or ICU but some kind of physician or respiratory therapist
bagging, so forcing air down into the lungs through a mask that's covering the mouth and the nose and
Then as the code goes on they often get intubated. So that's putting a tube down the patient's throat
Then you've got nurses who are dedicated to giving
medications, starting IVs if we need and then getting code bloodwork. All the supplies that you need come from the crash cart or
the code blue cart
You've got all the different medications
heart monitors
IV equipment and even oxygen
So this way the resuscitation can happen anywhere in the hospital, not just a patient's room
Then a resident is tasked to go and get the chart and find out information about the patient like their past medical history
What kind of medications are on, if anything's been changed today?
then somebody's in charge of going and calling the family to give them an update and let them know what's happening right away. If the
family's present or they show up while we're doing the code
Someone will step outside and take them aside to explain what's going on because it can be so incredibly overwhelming and scary
There's actually evidence
And studies that have been done showing that if family members are offered the opportunity to go in and watch the resuscitation
That there's less incidence of PTSD and stress
Afterwards, depression or anxiety and I think the reason for that is that they get to witness that we've done every single thing
possible for that patient
So when does the resuscitation end?
Best case scenario is that we're able to get a heartbeat back?
It's not like in the movies, you don't get it back and someone opens up their eyes and sits up
These people are very sick. There are still sort of touch-and-go and
They're often still unconscious with a breathing tube down their throat. And at that point we're transferring them to the ICU for more care
Unfortunately, this is often not the case and patients often don't make it and in that scenario
It's about a decision for when to stop CPR
So at that point, I usually make a summary of everything we've done up to that point
So I actually say it out loud to the room and I ask: ''does anybody else have any other suggestions?''
Because nobody should walk out of there thinking. I wish we had done that or why didn't we do this?
Everyone should voice their opinion and if no one has any other solutions or suggestions at that point
I usually say: ''let's finish this round of CPR''
We'll check for a pulse, you check for breathing, check their pupils and if there's still no sign of life
We call the end of the code and you call time of death
codes can last for
20 to 40 minutes depending on the scenario and it's uhm, it's always sad when they end and you don't get a patient back
So you're probably wondering how often do we actually bring somebody back to life and
Of course the answer is: it depends, so it depends on what caused them to have the arrest.
It depends how healthy they were in advance and also how quickly CPR was started
So studies have shown that if it's a witnessed arrest, meaning you actually watch the heart stop and you started CPR right away
then there's about
50% chance that you get the patient back
But there's only about a 20% chance, so one in five that a patient ever leaves the hospital, which gives you a sense of how
incredibly sick people are if they get to that point
Unfortunately, if it was an unwitnessed arrest meaning we don't know how long it was between the person's heart stopping and starting CPR
There's only about a 1% chance that that patient will ever leave the hospital
You can imagine this is a huge trauma to someone's body often breaking the sternum and ribs
They end up on a ventilator in the ICU and not everybody wants the end of their life to be like that
And so we ask everybody who comes into the hospital about their goals of care
What do they want us to do if their heart stops or if they stop breathing. Do they want to go through all of this?
Because if we don't hear otherwise our assumption is to do everything for everybody, of course
Anyway, I feel very passionate about this topic and about goals of care and end-of-life planning
So at some point, I would love to chat with you guys about that more
There just isn't really time now. So I know that was a ton of information
so if you have any questions about code blues what it's like
things I didn't mention, just let me know in the comments below and if you want to know about other color code emergencies like
Code white, code purple, code yellow, check out this video where I go through and explain all of it
Anyway, I'll be chatting with you guys next week. So bye for now