Complex Nursing Care

This article discusses the guidelines for performing resuscitation of a patient in a code blue scenario. It also highlights the flaws in the actions of the nurses and the importance of following the guidelines to ensure the best outcomes.

Running head: Complex Nursing
Complex Nursing Care
Name of the Student
Name of the University
Author Note

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The given video “Mock Code Training Video” involved a scenario of ‘code blue’
where an elderly patient who have undergone abdominal surgery complained of pain, and
then became unresponsive, as his pulse went missing, and he stopped breathing
(youtube.com, 2018). The code blue team appeared in the scene and defibrillation and CPR
was given to the patient, and it was recognized that the patient needed a cathlab for further
analysis of the reason for the code blue. According to the Australian Resuscitation Council
(ARC), specific guidelines are supposed to be followed to perform resuscitation of the
patient, which will be related to the actions taken by the medical professionals in the video
(resus.org.au., 2018)
The video begins with the patient, in a conscious state, but complaining of a lot of
pain. The patient’s family (presumably his wife) was there in the patient’s ward. Equipments
were immediately brought to monitor the blood pressure of the patient. It was also seen that
the family member became increasingly worried and seemed agitated with the delay of the
nursing team, to evaluate the patient. The nurse who was present wasn’t able to say for sure
why the patient was feeling unwell. At 1:14 min, the nurse called for the RRT, and the team
arrived by 1:41 (within 30 sec). When the patient was asked how he was feeling, he said that
he felt as if he was going to die, and soon after lost consciousness and became completely
unresponsive (2:50). Before he lost consciousness, he mentioned that the pain medication did
not alleviate his pain, and the blood pressure monitor showed an elevated blood pressure but
very fast heart rate. The attending nurse showed a quick action, and promptly assessed the
patient and raised an emergency code ‘code blue’ as soon as the patient lost consciousness.
However there was a significant delay in giving the patient shock and compressions.
According to the Guideline 2 of ARC, the nurses should respond promptly to the emergency,
and the blood saturation of oxygen should be assessed before the patient is given oxygen.
However, the patient was not placed in a lateral recovery position at the initial stage to help

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him breathe (Zideman et al., 2015; Keller et al., 2015). This was an overlook on the part of
the attending nurse, which could have been avoided. It is suggestible that a patient facing
breathing difficulties be placed in a lateral position to aid his breathing better (youtube.com,
2018).
After the patient became unconscious, the nurses checked the responsiveness of the
patient to verbal and tactile stimuli (by calling the patient and touching him), which was in
accordance to the guideline 3 of ARC (Recognition and First Aid management of
unconscious person). This step allowed the nurses to assess the unresponsive state of the
patient, and understand the criticality of the condition (Keller et al., 2015). However the
guideline 2 recommends prompt response, by the medical team, which could have been
affected by the late arrival of the RRT nurse. The patient’s family member (wife) was also
present when the patient drifted out of consciousness, which made her quite worried, and the
nurses told her to leave the room, to that they can start the resuscitation process of the patient.
This was also in violation of the guideline 10.6 of the ARC (Family Presence during
resuscitation) according to which the patient’s family should have a choice in deciding if they
want to be present during the resuscitation of the patient (resus.org.au, 2018). Instead of
telling the family member to move out of the room, the nurses should have informed why it
was recommended, but still given her the opportunity to decide if she still wants to be present
in the process (De Stefano et al., 2016).
At 2:58 minutes of the video, the patient lost consciousness, and chest compressions
were started immediately. However there as a delay in placing a board underneath the patient
while giving chest compressions. Moreover, the number of compressions, and the effective
depth of the compressions was not informed by the nurse. According to the Guideline 4 of the
ARC, the patient’s airways should be checked before resuscitation is given, to ensure that
there is nothing in the air passage that can prevent normal breathing (Simpson, 2016). The

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choking algorhythm outlined in guideline 4 could have been followed in this scenario (Hood
& Considine, 2015). Not specifying the effective rate of compression (which should be 30:2)
was also in violation of the guideline 5 of ARC, which suggests rescue breathing, if the
patient is unable to breathe normally.
While administering the chest compressions, it is vital that the number of
compressions, the depth of the compression and the duration of the compression be clarified
to the compressors/ventilators. According to the guideline 6 (Compressions) of ARC, it is
recommended that effective chest compressions should be 5cm deep and the rate of
compression should be 100 to 120 compressions per minute. The guidelines also recommend
minimal interruptions of the compressions. However in the video, it was seen that there were
several interruptions in the chest compressions, and the compressors also got fatigued, which
could have affected the quality of the compressions. It is vital that to prevent fatigue, the
compressors should be changed every 2 minutes, which was partially followed by the nurses.
This was also in violation of the guideline 6 of ARC. The team however constantly kept
monitoring the pulse of the patient with each cycle of compression to see any progress, which
was a good practice, and adhered to the ANC guidelines (guideline 6).
The defibrillation shocks were given twice in the video, the first before the arrival of
the code blue team (2:43) and then later by the code blue team (6:14), each at 150 joules. The
pads were placed correctly in accordance to the ARC guideline 7 (Automatic External
Defibrillation in Basic Life Support). However, it is also recommended that the defibrillation
should have minimal delays, as that can reduce the survival chances of the patient, with delay
of every minute (Idris et al., 2015; Perkins et al., 2015; Travers et al., 2015). The CPR Code
Blue team also arrived at 4:45, which was a significant delay, from the initiation of the code
blue by the nurse. This could have significantly affected the survival chances if the patient
and thus a serious overlook by the medical practitioners.

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The code blue team captain assigned the specific tasks to the different medical
professionals in her team (5:13), and was also provided a history of the patient leading up to
the code blue. It was informed that the patient recently lost his pulse, which as 2 hours post
abdominal surgery, and after he complained of pain. It was informed that he was given
medication but still became unresponsive and a defibrillation shock was given. However, the
structure of the report did not follow the AMPLE method (which provides information in the
order of: Allergies, Medications, Past Medical History, Last Meal and Event leading to Code
Blue) (Lawrence et al., 2013). The nurses should have informed before the treatment of any
allergies of the patient, which might have affected the outcome of the treatment.
Both the fibrillation shocks were given at 150 joules, followed by chest compressions.
However according to the guideline ARC 11.4 (Electrical Therapy for Adult Advanced Life
Support) mentions that monophasic defibrillation shocks should be given at 360 joules, or
biphasic shock starting at 200 joules for the first shock and then higher power for the
subsequent shocks. Thus the defibrillation was provided at less than optimum standards. The
safety precautions were however adhered to before giving the shocks. It should be noted that
the standard practice mentioned in guideline 11.4 should have been followed to provide the
shocks (Soar et al., 2015).
According to the guideline 11.5 related to Medications in Adult Cardiac Arrest, the
patient was mostly given intravenous doses of medicine: 1mg of 1:10,000th of Epinephrine
(6:22) after the second shock and 300 mg of Amidarone, and 40 units of vasopressin was also
given. However the patient was also given a direct injection to the heart, which is not
recommended by ARC, as it increases the risks of infections. Additionally, the ARC
Guideline 11.5 also recommends against the usage if vasopressin, which was also not
followed and the patient was injected with Vasopressin (even after Epinephrine was
administered to the patient). The Amidarone was administered at the recommended dosage of

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300 mg, but was done only one, in contrast to the ARC guidelines that recommends a second
dosage of 150 mg, which was not administered to the patient. The medications therefore
showed a significant deviation from the recommended standards. It was also noted that the
additional (visiting) physicians suggested that the patient be given sodium bicarbonate and
calcium fluoride, both of which was promptly dismissed by the code blue captain, on the
grounds that the patient was not acidotic and did not need additional calcium. However the
administration of calcium is recommended by ARC guideline 11.5.
Overall, the video showed that the present medical practitioners gave their best efforts
to ensure the recovery of the patient, and to identify the reason for the cardiac arrest, post
which the patient was transferred to the cath lab. However, considering the ARC guidelines,
several flaws have also been found in the actions of the nurses, which could have reduced the
survival chances of the patient in the given scenario. It is therefore of highest importance that
the guidelines should be stringently followed to ensure the best outcomes, and also ensure
compliance to the standards set by ARC.

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