What Happens When a "Code Blue" is Called in a Hospital

"Code Blue Intensive Care Unit" "Code Blue Intensive Care Unit"


When these words are announced over head, my heart always skips a beat. I am one of the people who is usually on the Code Blue Team. I am a Registered Respiratory Therapist. Here is what goes on in a Code Blue situation. It may differ slightly from hospital, but in the big scheme of things, there are certain steps that are followed.


A nurse, doctor, x-ray technician, Respiratory Therapist, or whoever enters a room. When they look at the patient, they can see that he is not breathing. They go over to feel for a pulse, they cannot feel one. In every single hospital I have worked in, there is an emergency phone number to get this message out, someone is actively dying or has died. "Code Blue and the location is announced overhead several times. It also comes across the Code Team Pagers. Immediately, people and actions are set into motion.

(I would love for it to be as pretty as it is on TV where the patient comes out in better condition than what they went in. I would love if performing CPR on a patient could heal all of their illnesses. This is NEVER the case.

1. The person who found the Patient initiates CPR or cardiopulmonary resuscitation. This includes giving the patient breaths and pumping on their chest to imitate the hearts pumping action. This is done until the Code Team arrives.

2. The Code Blue Team consists of several people including but not limited to the following: Physician, 2 or 3Intensive Care Trained RN, 3 Respiratory Therapists, lab, and even Pharmacy. Also showing up are students who need the experience of dealing with CPR. Of course, there are the gawkers. Those who do nothing but think they should be there for support. That is why there is a person assigned for crowd control. The Physician is the one who is supposed to run the Code, The ICU Nurses are the ones supposed to start new IV sites and push the medications. They are also the ones that shock the patient when the patient's heart is in a rhythm that can be shocked. They also sometimes take turns with the compressions. The Respiratory Therapists are in charge of getting an airway by intubation (also can be done by physician), setting up the life support (ventilator), getting arterial blood gases, and doing chest compressions.

3. The first thing that happens to the patient in a Code Blue situation when the code team arrives is that every stitch of clothing on the person is stripped off. The person is totally naked. This enables the code team to start lines, check for pulses, locate the proper place to do chest compressions and assess breathing. The patient is quickly assessed for pulse, heart rhythm, and breathing.

The second thing that happens to the patient is that they are hooked up to monitors to determine what rhythm there heart is in. In the mean time, The doctor or the respiratory therapist is putting a tube in their mouth, down their throat, and into their lungs. When this tube is in place and it is determined that it is indeed in the lungs and not in the stomach, the Respiratory team will then start giving the patient oxygen via a bag. The most common name for this bag is Ambu bag. By this time, the cardiac monitor leads will have been placed on the patient, IV's started, labs drawn-all of this with in just a couple of minutes.

4. What is the heart doing? Is it beating wildly, but not effectively. Is it in a life threatening arrhythmia? Is it in a rhythm that can be shocked or not? If the heart is in a shockable rhythm the pads have already been applied to the patient.





The days of putting gel on these two big old hand paddles and rubbing them together are over. The thing that is not over is the yelling of the word, "CLEAR" and believe me...you want to not be touching the patient or any part of the bed. They will put electricity through the chest into the heart to try to get it to (believe it or not) calm down. They have the option to shock at different electrical strengths to get the job done.




If the heart is not in a shockable rhythm, is it in a rhythm that is fixable? Can we give fluids to help. Can we give drugs that will speed up the heart, slow down the heart, stop the heart for a brief shinning moment?

Is the patient asystole? There is no heart rhythm at all....only a flat line.
This is probably the most ominous rhythm that there is. It means that there is no life in this patient. More than likely, their soul has left the body.

During all of the above things that are going on, someone is right up on top of that patient pushing hard on their chest, doing chest compressions. Someone is breathing for that patient, someone is putting a tube in the patients nose and down to their stomach to keep too much air from going into the stomach causing the patient to vomit, someone is putting a Foley catheter into the patient's bladder, and someone is probably praying for the patient.

More than likely, the patient has had a bowel movement all over themselves and they have blood coming from different orifices because everything is done in an emergent situation.
If we get the patient back...if we get their heart beating, they are immediately taken to a Critical Care Unit where they are placed on life support. Most patients do not "come back". A lot of patient's who do come back, insist on dying a little bit later. Some actually get well and go home.
Do I sound discouraging. I don't mean to, it is just that on TV so many things are made to be nice and easy...and getting a person back from death's door is not easy at all. Some people no matter what you do will insist on dying. Some people should be allowed to die without the indignity of being put through a code blue situation.

It is a really difficult situation and decision that has to be made. Ideally, the decision should have been made long before it is needed, and family members should have been made aware of the Patient's wishes. This is what should happen. However, death is sometimes hard to speak of, but it is one of those necessary things that needs to be done.

People who should be allowed to die with dignity without having to go through a code blue situation:

1. People who do not wish to be placed on life support
2. People who are elderly who do not wish to be placed on life support
3. People with cancer who do not wish to be placed on life support
4. People who have illnesses that they are never going to recover from and do not wish to be placed on life support.

So you see, it is my opinion that people, families, care givers and loved ones need to sit down and talk about end of life issues. Do they want to go through everything that I just explained up there.

We had a woman in the hospital. She was not brain dead but she had very little brain function left in her. She had already been placed on life support. The family wanted everything done. What I was finally able to get across to the family was this: What they see is what they were going to get. If we do all of the work on her and save her life, her brain is still not going to function. She will never breath again on her own, she will never speak to them again. When we were able to impress upon the family that their loved one, the person that they knew and loved was gone, we were able to move on ... and more importantly, so was that family. They all said their loving good byes and we let her go on to heaven.

It is my hope that someone who reads this will learn just a few things from it and with this information be able to make a good, educated, and loving decision when these end of life issues come about.