Ending the Code/RRT

Rapid Response: Unresponsive

12h post laminectomy

HR and SpO2 ok. Pinpoint pupils, bradypneic. You give doses of naloxone without response. You..

1. Continue administering naloxone until they respond

2. Advocate for a move to the ICU

3. Defer to primary team

Rapid Response: Possible Outcomes

• Turn into a code blue ([Do You Have Who/What You Need?])
• Go to ICU
  • Instability, too much nursing care, needs titratable drip
  • Don’t delay - faster & safer to get things done in ICU if dispo known
• Stay on floor

  • Prompt stabilization and workup

  • Always hand off to the primary team assuming care

Code Blue:

Young patient. Seems like a PE.

She has been in PEA at each pulse check.

Resuscitation has been going on for 40 minutes.

When do you stop?

How long is too long?

That’s average, but consider:

• Pre-arrest state? more ill (esp. if chronic) → shorter
• Is the likely cause reversible? yes → longer
• What’s the rhythm?

  • Shockable → good (longer).

  • Asystole → bad (shorter).

  • PEA can be a transition state

The Family

Use judgement, Delegate attention, but try to include

How to actually end an (unsuccessful) attempted resuscitation?

• “Does anyone have ideas we haven’t tried?”
• “We’re going to stop CPR at next check unless rhythm changes”
• Thank team members
• Set a time & location to debrief (5-15 mins)
  • feedback is the way to improve

Summary:

Rapid Response

• Consider what’s next and don’t delay.

Code blue

• Consider pre-arrest state, causes, and rhythms. 5-60 minutes, generally.
• Bring in family when possible
• Always debrief.

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