Your Role During a Code Blue

Scenario

You enter your patient’s room and find them unresponsive, pulseless, and not breathing.
You immediately call for help and announce a Code Blue overhead.

Question: What are your responsibilities and actions in the first few minutes, and how do you function as part of the resuscitation team?

Best Practice Answer

1. Recognize the Arrest and Initiate Immediate Action:

   • Quickly assess unresponsiveness, absence of breathing, and no carotid pulse (within 10 seconds).
   • Shout for help, activate Code Blue, and request the crash cart and defibrillator.
   • If alone, start CPR immediately before leaving to activate the code.

2. Start High-Quality CPR (First Responder Role):

   • Begin chest compressions at 100–120/min, depth 2 inches (5 cm), allowing full recoil.
   • Maintain compression-to-ventilation ratio of 30:2 with a bag-valve mask if no advanced airway yet.
   • Switch compressors every 2 minutes to prevent fatigue and maintain quality.
   • Avoid interruptions longer than 10 seconds between cycles.

3. When the Code Team Arrives — Integrate Smoothly into the ACLS Sequence:

   • Continue compressions until relieved by another qualified provider.
   • Attach cardiac monitor/defibrillator leads and analyze rhythm (asystole, VF/VT, PEA).
   • If shockable rhythm → defibrillate immediately, then resume CPR without delay.
   • Establish IV/IO access, draw labs (including electrolytes, glucose), and assist with epinephrine/amiodarone administration per ACLS protocol.

4. Assign and Support Clear Team Roles:

   • Compressor: Performs compressions; alternates every 2 minutes.
   • Airway Manager: Manages bag-valve-mask or intubation; ensures adequate oxygen delivery.
   • Defibrillator Operator: Prepares defibrillator, announces “clear,” and performs shocks.
   • Recorder: Tracks times, medications, shocks, and interventions — vital for documentation and debrief.
   • Team Leader (MD/ACLS RN): Directs algorithm, delegates, and communicates clearly.
     As the responding nurse, be flexible and fill whatever role is most needed — competence and teamwork matter most.

5. After Return of Spontaneous Circulation (ROSC):

   • Assist with post-resuscitation care: airway management, hemodynamic stabilization, and blood work.
   • Prepare for ICU transfer and ensure all lines, monitors, and infusions are ready.
   • Communicate with family once leadership permits.

6. Documentation and Debrief:

   • Record:
     • Time of arrest and recognition
     • Initial rhythm, interventions, and response
     • Medications, doses, and times
     • ROSC or termination time
   • Participate in post-code debrief, discussing what went well and what could improve — this reflects clinical maturity and team accountability.

Real-World Application

This is one of the most critical and high-pressure scenarios tested in clinical interviews.
Interviewers assess whether you:

• Can act immediately rather than freeze or overanalyze
• Understand ACLS principles and team roles
• Demonstrate clear, confident communication under stress

Strong candidates emphasize both technical skill and teamwork — not just textbook knowledge.

Tip: In interviews, say —
“I’d start CPR immediately, call for help, ensure defibrillator setup, and communicate clearly using ACLS team roles. My focus would be high-quality compressions, rapid rhythm assessment, and calm coordination.”
That shows readiness, composure, and strong understanding of emergency protocol.