Resources

Slides by Alex Ryden, Brian Locke

Do you have what you need?

Learners will:

  • Know when a situation should be a rapid vs. a code

  • Know when unique personnel or resources are needed

  • Be able to organize responding personnel

Analyze the Emergency

Stable or Unstable?

  • ABCs

  • What help do you have?

  • What help will you need?

Resources vary across site

Who comes? U of U IMED VA
RRT/MET House Sup, IM Res, SICU RN, Pharm IM, CICU RN, Nurse Sup, Pharm, RT, EKG, ABG, Lab IM, MICU, CNO, RNs, RT Pharmacy (7a-7p)
Code Blue add: Anesth, EMT, MICU res, Pharm, ICU Fellow add: ICU attgs add: Anesth (day)/ ED(night)

Paged to RRT at the VA

  • Elderly male who is hypoxemic immediately after a blood transfusion

  • RR 24, SpO2 82% on 2L

Sick or not sick? Stable or Unstable? What else do you need?

The patient worsens…

XR Chest Obtained During RRT

  • Begins to tripod with accessory muscle use.

  • Placed on 100% fio2 via face mask

  • O2 remains in the upper 80s

How has the situation changed?

Situations to Escalate

Rapid Response

Will this be a code in 5 min? Airway, In Extremis RRT → Code early
Brain attack? Focal Deficit Call Brain Attack (transfer after hours at VA)

Situations to Escalate

Code Blue

STEMI, or suspicion Activate Cath Lab All sites capable, 24/7
Shock Team HF, few comorbidities. VT Storm. High Suspicion for PE Shock Team (U of U). PERT Team or TICU attg (IMC)

Resources vary across site

U of U IMED VA
Shock Team, Cath, Brain Attack, VAD: 1-2222 Shock Team: Vocera TICU attg, Brain Attack: Operator/x33333 Cath: Page Cardiology, Code: x6666, Brain attack: Page Neuro Senior

You call a code blue.

Shortly after, the patient loses their pulse.

  • Anesthesia at head of bed preparing to intubate

  • Single compressor starting to tire

  • Pharmacist trying to hand epi to RN on far end of the room

How can we improve things?

Room Management

  • Bed out from wall (for airway), rotate bed (for compressor space)
  • Drop the bed (for CPR)
  • “Everyone clear out unless I’ve given you a role”

Bed Management

Summary

  • Is this rapid actually a code situation? Can’t breathe, in extremis

  • Situations where you need other people? Airway, Cath/Shock Team, Neuro

  • Room control: move the bed out and lower it, manage crowds

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