Complex Care Nursing: A Code Blue Simulation and ARC Guideline Review

This report analyzes a code blue simulation video, assessing the actions of medical professionals against the Australian Resuscitation Council (ARC) and ANZCOR guidelines. It identifies both correct actions and deviations from the guidelines, highlighting errors such as delays in chest compressions, failure to change compressors, and incorrect medication administration. The analysis emphasizes the importance of adhering to ARC guidelines to improve patient survival chances during resuscitation events. The report also points out the failure to follow guidelines regarding family presence during resuscitation and discusses deviations from advanced life support protocols, including the timing and dosage of medications. Ultimately, the report underscores the need for strict adherence to established protocols to ensure effective and safe resuscitation efforts.

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

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The given video titled “Code Blue Simulation - Virtual Education and Simulation
Training Centre” is about a hospital code blue scene, involving an unresponsive patient
(Youtube.com, 2018). Described below is the analysis of the video, to identify the actions
performed by the medical professionals, and to what extent do they adhere to the
recommendations of the Australian Resuscitation Council (ARC) and ANZCOR
(resus.org.au, 2018). From the video, it was seen that several errors were made by the present
medical team, which deviated from the ARC and ANZCOR guidelines, which will be
discussed below along with the actions which were taken correctly by. This can help to
understand the best practice of care, as well as understand the National Guidelines on
nursing, especially in reference to the guidelines on the resuscitation of patients.
The video begins with the nurse walking in on an unresponsive patient (at 0:15), in a
hospital room, during a regular nursing visit. The nurse was very prompt to check if the
patient had a pulse and so see if he responded to call or touch (audio and tactile stimuli).
When the nurse understands that that patient has no pulse and is completely unresponsive she
calls for help (0:23), and immediately checks the air passage of the patient, and starts giving
her artificial ventilation (as mouth to mouth resuscitation). The medical team also reaches in
less than 10 seconds, and quickly assesses the situation to understand CPR was required. The
patient was then administered artificial ventilation with air bag (0:40) and pads for
defibrillation was placed (0:59) (youtube.com, 2018).
These actions show a significant deviation from the ARC guideline 2 (managing an
emergency), which recommends that the patient should be placed in a lateral position if the
patient is not breathing, before providing ventilation. Also, the guideline recommends that the
patient should be on a flat surface, for which a board can be placed below the patient, which
was not done in this case (Considine & Nation, 23018). However, the present nurse did take a
very prompt action to call for medical assistance, and at the same time checking the airways

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for obstruction and providing mouth to mouth resuscitation. The prompt actions are
recommended by the ARC guideline 2; as such promptness can greatly improve the survival
changes of the patient. Also, checking the response to the verbal and tactile stimuli was also
an important aspect of the guideline 2, which was followed by the nurse (Sunamak et al.,
2015).
The Guideline 3 (Recognition and First Aid Management of the Unconscious Person)
of the ARC and ANZCOR mentions that the saturation of oxygen in the blood should be
checked when providing ventilation to the patient, which was not done by the medical
professionals in the video (Zideman et al., 2015). At 0:47, the patient was provided
ventilation using an air bag, and by 0:53, it was identified that the patient was in defib, for
which shock is needed. At this stage it was recommended that the patient was given
compressions, which were not commenced till after the first shock was given. The guideline
also suggests that both the patient and the rescuer’s safety should be ensured, for which it is
important for two medical professionals to be present, and the most experienced rescuer
should be present with the patient, all of which was addressed by the medical team (Catangui
et al., 2015).
The team also followed the guideline 4 of the ARC and ANZCOR (Airway), as the
nurses were able to assess the breathing of the patient before giving ventilation. The patient
did not seem to have anything choking the airway, due to which it was not necessary to
follow the Chocking Algorithm (Simpson, 2016). Also the patient was given rescue breathing
on time, which was an effective strategy taken by the present nurse. However there was a
significant deviation from the guideline 2 of the ARC ANZCOR (Breathing), which suggests
that before resuscitation, it is important to assess the breathing of the patient properly, by 1)
looking for movement of the upper abdomen, 2) listening for escape air from nose and 3)
feeling for the movement of air at the nose or mouth (Douglas et al., 2016). It also

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recommends that compressions to rescue breaths be given in the ratio of 30:2 (Hunter, 2017).
However, it was seen that the nurse provided the rescue breaths without starting the
compressions. This was a critical error on the part of the nurse, which could lower the
survival chance of the patient. Instead, the nurse should have analysed patient’s breathing,
and immediately start the compressions, along with the rescuer breathing, till the medical
team arrived (at 0:27). This also showed the nurse deviated from the guideline 8
(Cardiopulmonary Resuscitation) of the ARC and ANZCOR, which outlines the
compression, ventilation ratio, compression rate and minimising interruptions, which were
not followed by the medical team. The nurse did not completely follow the DRS ABCD
process as the patient was not given 30 chest compressions followed by 2 breaths before the
defibrillation was given (Sana, 2015).
Significant deviations were also found from the recommendations of the guideline 6
of ARC and ANZCOR (Compressions), according to which interruptions to chest
compressions should be minimal. In the video, the compressions started very late (1:17), after
the delivery of the first defibrillator shock. The guidelines also recommends that the
compressions should be 5 cm deep for maximum effect and should be delivered at 100 to 120
compressions per minute, and the compressors should be replaced at frequent intervals to
prevent fatigue to the compressor (Inaba & Maeda, 2016). Changing the compressor is vital,
since fatigue of compressors can result in shallower compression, and hence can affect the
process of resuscitation (Meyer et al., 2016). In the video, it was seen that the depth and rate
of compressions were never identified, and the compressor was not changed, which could
have deteriorated the quality of the compression and the survival chance of the patient. Such
error therefore is quite serious, and should have been avoided.
The guideline 7 of the ARC ANZCOR (Automated External Defibrillation in Basic
Life Support) which informs about the placement of pads for defibrillation and the safety

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protocols while giving shock was properly followed by the nurse, and did not show any
deviation (Perkins et al., 2015). The guidelines 9.2.1 (Recognition and First Aid Management
of Heart Attack) could not be followed since the patient was unresponsive, due to which it
was not possible to administer aspirin to the patient (Singletary et al., 2015). However, the
patient could still have been given oxygen, which was not done in the video, and thus was
also an error on the part of the nurse.
The nurses also did not follow the Guideline 10.6 (Family Presence during
Resuscitation), which recommends that the family of the patient should be informed if the
patient is being resuscitated, which was not done in the video (Strasen et al., 2015).
According the guideline, the family members should have the option to be present along with
a support person. The medical professional in the video never made an attempt to contact the
patient’s family members, and there was a clear absence of a social support worker in the
scenario.
Deviations were also observed from the recommended Protocols for Advanced Life
Support, guideline 11.2 of the ARC and ANZCOR. The guideline mentions that the adult
ALS algorhithm should be used for adult needing advanced life support, and a good quality
CPR should be ensured, while focussing on the reduction in the time for defibrillation, and
interruptions in the CPR (Soar et al., 2015). However, it was evident that there were several
interruptions in the CPR and compressions, and it started a lot late in the video. Additionally,
there was also the possibility in the reduction in the quality of the CPR and compressions as
the compressor was not changed, and could have been fatigued. The defibrillation shocks
were given 3 times at 200 joules (1:15; 2:04; and 3:49). This also violates the guideline 11.2
as well as guideline 11.4 (Electrical Therapy for Adult Advanced Life Support), which states
CPR for 2 minutes should be given for 2 minutes between two shocks, and a maximum
energy level of 360 Joules be used (for monophasic) or a starting energy level of 200 joules,

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followed by higher energy levels. (For biphasic) (Link et al., 2015). The medical team
however followed the guideline in the administration of 1mg of Epinephrine and 300mg of
Amiodarone.
The medication given to the patient were 1mg Epinephrine IV at 1:10000 concentration
(1:17) and 300 mg Amiodarone IV (2:15) and 0.8 units of Narcan (3:31). The IV route for the
administration of medicine is also recommended under the guideline 11.5 (Medications in
Adult Cardiac Arrest) of ANZCOR and ARC, as it is the most effective delivery method.
However the guidelines also recommends that Epinephrine be given after the 2nd shock and
then after every second loop. Amiodarone should be administered between the third and the
fourth shock. Additionally, administration of Calcium, Lidocaine, Magnesium, Potassium and
Sodium Bicarbonate also could have been considered by the medical team (Kudenchuk et al.,
2016).
It was understood from the video, that the medical team made several serious errors
while working on the code blue. Delays in chest compression, not changing compressors, not
outlining the depth and rate of compressions, not placing a hard board under the patient and
delay in the defibrillation could have significantly reduced the survival chances of the patient.
Similarly, there were also errors in the administration of medicines, in regards to the
quali8tties given and the stage when they were administered. All such errors could have been
avoided by following the ARC and ANZCOR guidelines related to the resuscitation process.

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