Resuscitation Guidelines and Team Roles

The assignment discusses various aspects of resuscitation, including the European Resuscitation Council Guidelines for Resuscitation 2015, which provide detailed protocols for adult basic life support and automated external defibrillation. It also explores family presence during trauma resuscitation, highlighting attitudes, behaviors, and experiences of family members. Additionally, it examines the evaluation of six different airway devices regarding regurgitation and pulmonary aspiration during cardiopulmonary resuscitation. Furthermore, it touches on emergency resuscitation team roles and the importance of assessing and improving code team function.

Running head: NURSING
Nursing
Name of student:
Name of university:
Author note:

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Code Blue is the term used by medical institutions across the globe for indicating that a
patient has suffered a cardiopulmonary arrest and is in immediate need of resuscitation. The
resuscitation is carried out by the ‘code team’ present at the healthcare unit. However, the initial
efforts for resuscitation are to be carried out by the nurses on duty. It is therefore crucial for
nursing professionals to have a thorough knowledge regarding resuscitation process and the
essential skills in this regard. Communication between the nurse and the code team is also of
crucial importance to ensure that the desired patient outcomes are achieved. An amalgamation of
technical and non-technical skills ensures that nurses deliver optimal quality care through safe
approaches in resuscitation. The present paper is a media annotation that is based on the review
of a video titled “Code Blue”. The video is on an arrest scenario associated with resuscitation,
and the analysis is done for quality of identified practice and performance. Preference to
Australian Resuscitation council guidelines and other scholarly papers is done for identifying the
strengths and weaknesses of the performance. Recommendations for practice change are outlined
thereafter.
A deep insight into the video brings into notice that after the nurse entered the patient’s
room and understood the need of emergency care to the provided she called out to the fellow
nurse for contacting the Code Blue. It would have been desirable if she had pressed the
emergency button instead. According to Massey et al., (2014) medical emergency situations are
to be addressed by pressing the emergency button as an acute illness might pose a threat to the
patient’s life. Any response in the emergency situation would depend strongly on the situation,
the condition of the patient and the availability of resources. As highlighted by Ebert et al.,
(2017) the role of the health professionals acting as the first responders is critical as resuscitation
efforts are to be started at the earliest. The second issue that arose was that the nurses did not

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consider assessing the airway of the patient. As per the Australian Resuscitation Council
guidelines (2016) the initial steps of resuscitation involves the initial steps of DRS ABCD
(dangers, responsiveness, send, airway, breathing, CPR, defibrillation). Assessment of the
patient’s airway along with unresponsiveness is required for identification of the need of
resuscitation. In case of an unconscious patient, care of airway takes precedence over any poor
outcomes (Maconochie et aal., 2015). Further into the video, the nurses did not take the pillow
out for enabling the patient in a proper position. In addition, the nurses checked the breathing
pattern of the patient from distant height. Patients who are breathing in an abnormal manner or
are unresponsive require assessment of breathing (Piegeler et al., 2016). Australian Resuscitation
Council Guidelines (2016) outline that while assessing the breathing pattern of the patient
needing resuscitation, professionals must look for movement of the lower chest or upper
abdomen, listen for the escape of air from the mouth and nose, and feel for the movement of air
at the nose and mouth. This process of breathing assessment was not followed by the nurse as the
height of the bed was too low to carry out the assessment in an appropriate manner.
Coming to the section of the video where compressions were provided to the patient, a
number of key weaknesses were identified. Firstly, the nurse stood and stressed on the back of
the patient while giving compressions. The compressions were also not rhythmic. The Code
captain asked to stop the compressions for a second for checking the heart rhythm of the patient.
Further, the nurses did not count appropriately for understanding the point of time in which
airway management was required. Moreover, no professional engaged in carrying out the
compressions, and the same had to be stopped while delivering the shock to the patient. A look
into the Australian Resuscitation Council guidelines (2016) reveals that all professionals must
carry out chest compressions for patients with minimal interruptions. The professional delivering

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the compression must do so in a rhythmic manner with the focus on equal time for compression
and relaxation. Further, attention is to be given to the aspect that the chest of the patient is
completely recoiled after every compression. The professional is also supposed to avoid using
thumps or rocking back and forth while compressing. In this regard, the depth of compression
delivered is to be analyzed which was in appropriate. As per the Australian Resuscitation
Council guidelines (2016), the lower portion of the sternum must be depressed to at least one
third of the depth of the chest in case of each compression. This is equal to more than 5 cm in
adults. Idris et al., (2015) placed focus on the utmost need of sufficient compression depth.
Inadequacy in compression depth has a strong relation with poor patient outcomes (Perkins et al.,
2015).
The Code Captain was found to prescribe medication that is epinephrine, prior to
checking for any allergic reactions that the patient might have had. There was a possibility that
the condition of the patient would have deteriorated if the patient was allergic to epinephrine.
According to Belkin et al., (2017) epinephrine is a strong adrenaline medication that acts a
cardiac stimulant. The adverse effects of epinephrine include hypertension, palpitation, tremor,
respiratory difficulty. Another concern regarding the practice of the Code Captain was that he
requested for a briefing of the situation much later into the care process of the patient. It would
have been appropriate if the nurse had engaged in a proper handover at the initial stage in a
proactive manner. The need of safe and timely handover has been mentioned by a number of
researchers (Barry et al., 2018). Continuity of information is crucial for safety of patients.
Relevant and sufficient information is to be exchanged between care professionals at the initial
stage when teams work in collaboration so that approaches taken fit the needs of the patient.

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In terms of patient assessment, some inappropriate practices were highlighted. Firstly,
there nurses did not consider carrying out an assessment of the patient to record the oxygen
saturation, blood pressure, pulse and blood glucose level. Oxygen saturation was checked at a
later stage and blood pressure was recorded after recording blood glucose level which was a poor
practice. The initial assessment of the vital signs of the patient prior to resuscitation is
elementary for understanding the exact needs of the patient and the consecutive improvement in
the condition of the patient (Monsieurs et al., 2015). The initial recording of the vital signs
requires a systematic and rapid approach. A systematic approach is needed for increasing the
speed of the resuscitation process as a demonstration of good clinical judgment.
Absence of delegation of roles is crucial weakness of the practice as evident from the
video. The professionals did not have clarity in understanding the exact roles they had to fulfill
in a code blue scenario. They also lacked knowledge of the tasks they had to carry out. It is also
worth mentioning that the professionals did not have a proactive approach in taking part in the
process as they did not decide among themselves about giving compressions in queue. A poor
non-technical skill was evident from the fact that the nurse demonstrated indistinct speaking.
From the research of Porter et al., (2013), effective resuscitation team is one where there is a
delegation of roles among the members and there is concise leadership. Members of such teams,
more importantly the nurses must have a clear knowledge of the tasks that are to be performed
independently for achieving a common goal. Important clinical decisions can only be taken when
there is a proactive approach demonstrated by the team members (Ford et al., 2016).
There was room for improvement regarding the debriefing at the end of the code. The
code captain briefly appreciated the efforts of the team members without any detailed discussion
of the same. The records were noted down and the scribe requested to members of the team to

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sign the document before any discussion among the professionals was done regarding the
outcome. Research suggests that debriefing is an effective strategy for improving the quality of
cardiopulmonary resuscitation (Couper & Perkins, 2013). Debriefing can take be in two different
formats. Hot briefing involves individuals providing debriefing immediately after the code. Cold
debriefing involves individuals providing debriefing at later stage after the completion of the
code. Objective performance data is to be discussed in such debriefing (Risaliti et al., 2018).
At this juncture of the analysis it would be beneficial to highlight the strengths of the
practice as evident from the video. The code captain demonstrated professionalism as an
assessment of the ECG rhythm was done prior to the delivery of the shock. As highlighted by
Guana et al., (2014) the chances of survival of the patient after resuscitation depends on a
number of factors including early ECG assessment. Reliable rhythm analysis prior to
compression is of great value (Australian Resuscitation Council Guidelines 2016). The nurse
announced saying all clear before delivering the shock. This reflects responsible and professional
behavior and technical skills since delivery of shock to patients entails minimal interference
(Soholm et al., 2014). The code captain had requested the scribe to inform at the end of two
minutes after delivery of the shock and the scribe showed professionalism in abiding by this
order. The scribe checked the time accurately after the code was complete and requested the
nurses to verify the records before signing. The nurse acknowledged that the strip of sinus
rhythm was printed with ten minutes time difference which she ensured to mention in the code
blue record. Accurate information documentation is critical for successive care plan in a care
environment. The need of proper documentation in resuscitation process has been mentioned by
(Karam et al., 2018).

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From the video it is noted that the social worker had a positive approach to inform the
family members of the patient. As per the Australian Resuscitation Council guidelines (2016),
family members of patients undergoing resuscitation are to be given the option of being present
at the time of resuscitation. Study by O’Connell et al., (2017) argue that presence of family
members at the time of recitation, if possible, leads to improved measures of positive emotional
and health outcomes, and coping. Some other strengths of the practice were that the head rail was
removed for giving breaths to the patient. The rail would have acted a barrier in this process.
A critical analysis of the video brings into limelight that certain practice of the
professionals seemed to be inappropriate though the outcomes of the same were desirable.
Firstly, the scribe nurse responsible for documenting the code was not efficient enough as
processes that were being undertaken on more than one instance. On one instance she clarified
the medication name that the nurse had administered to the patient. Secondly, the scribe
confirmed whether it was cardioversion or defibrillation that was given. However, it is worth
mentioning that it was a good practice of clarifying concerns in order to work for the safety of
the patient. Since the scribe clarified the doubts raised, there was minimization of risks
associated with wrong documentation (Cooper et al., 2016). Further, though there was no proper
seal while undertaking airway management, the fact that the nurse asked for help and assistance
reflected high level of communication. Communication and team work has been praised for
enabling care professionals to act in the best interest of the patients (Calder et al., 2017).
It is recommended that better personal resource skills and technical skills would have
improved the performance of the team members. It would have been appropriate if the nurses
had more situational awareness prior to the resuscitation process (McLaughlin et al., 2017).
Further, since many activities are to be carried out in a simultaneous manner in such a process it

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is pivotal that relevant information is communicated at the initial stage (Martin & Ciurzynski,
2015). It is also recommended that the supervisor in the code blue team is accountable for the
actions and participants in providing feedback (Calder et al., 2016). Nurses taking part in code
blue are to accept leadership. Delegate appropriately, show assertiveness, and demonstrate
credibility (Clarke et al., 2016). Coordination among the members was more in need in case of
the present scenario, along with open communication.
Coming to the end of the paper it can be concluded that the video presents some notable
weaknesses and strengths of the practice aiming to address code blue situation. The analysis has
been done on the basis of existing literature and guidelines of Australian Resuscitation Council.
The annotation was a good opportunity for professional development in nursing practice. Key
insights from the annotation would be applied in future in relevant scenarios.

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