a. Sudden cardiac death and the ensuing hectic activity involved in code
management can be a frightening and anxiety producing experience for nursing
personnel who are unaccustomed to this type of event. A basic understanding of what
takes place during a code will do much to alleviate that anxiety.
b. When a cardiac arrest has been identified:
(1) The person who witnesses the event or discovers the patient will call for
help from his co-workers and immediately initiate CPR. The co-workers will respond by
initiating the procedures for "calling" a code. They will then obtain the emergency
equipment, take it to the location of the code, and relieve or assist the individual
performing CPR. As help arrives, several things begin to happen simultaneously:
(a) An IV "lifeline" will be initiated.
Blood pressure readings will be obtained.
The patient is connected to the cardiac monitor.
(d) Baseline blood work is drawn to assess the patient's status.
(e) An ambu bag and oxygen will replace mouth-to-mouth
(2) The physician in charge will make decisions based on his observations
of the patient's condition and the response to CPR. If there is no response to CPR, the
code continues, and again, several things happen simultaneously:
(a) The patient will be intubated.
(b) Appropriate emergency drugs will be administered.
(c) Cardiopulmonary resuscitation is continued while the electrical
activity of the heart is observed on the cardiac monitor. If appropriate to the patient's
condition, the patient will be defibrillated.
(d) Blood samples are drawn repeatedly to monitor the effectiveness of
the treatment. Acid-base balance and adequacy of oxygenation are of extreme
(3) These procedures continue until the patient is stabilized or the physician
makes the determination to declare the patient dead.