Nurse's Station

Hospital: Code Blue! Everything You Need To Know


Shutterstock | Tyler Olson

Code blue is a hospital emergency code used in hospitals around the world when a patient is in need of immediate medical attention due to cardiac or respiratory arrest. Code-blue situations can be quite scary for everyone involved, especially those who have limited experience with these types of medical emergencies. If you haven’t had much experience with code blues and want to learn more about how they’re handled, this is the post for you!

When to Call a Code Blue

When you have a patient who isn’t pumping the oxygenated blood they need to survive due to cardiac or respiratory arrest, you need to call a code blue. Of course, before you call a code, you need to do a quick assessment; check for pulses, and check to see if your patient is breathing.  When your patient doesn’t seem to have a pulse or isn’t breathing, or if you feel this is where your patient’s condition is headed, go ahead and call the code. Honestly, even when you’re wrong in these situations, it’s always better to be safe than sorry. However, there is one important exception to this rule: patients with DNR orders.

Patients with DNR Orders

When it comes to potential code-blue situations, patients with do-not-resuscitate (DNR) orders are a different story. These patients have legal orders stating they do not wish to receive cardiopulmonary resuscitation (CPR) or advanced cardiac life support (ACLS). When you encounter a DNR patient in cardiac or respiratory arrest, you don’t perform these measures, and you shouldn’t call code blue. In addition to keeping DNR orders in patients’ charts, hospitals typically have DNR patients wear DNR-marked wristbands to ensure that nurses and other medical professionals know to respect their wishes.

What Happens During a Code Blue

When code blue is called, the situation quickly becomes chaotic. Other medical professionals will rush into the room to begin the resuscitation effort. The code should include the person’s specific location, so their colleagues can find them in the building. Typically, the person who called the code, who is usually the patient’s nurse, will begin CPR.

When the code team arrives, which usually consists of at least one physician, two or more critical-care nurses, and a variety of other medical specialists, the doctor will usually “run” the code, meaning that they’re in charge. The other members of the code team will assist with CPR and may intubate the patient to establish an effective airway if necessary. If the patient’s heart is in a shockable rhythm, everyone will stand clear of the patient as an automated external defibrillator (AED) is used to shock the patient, hopefully allowing their heart to reestablish an effective rhythm.

Sometimes, though, shocking the patient isn’t going to help. In these cases, there are certain medications that might be able to. Epinephrine, for instance, is often used for patients suffering from cardiac arrest. Naloxone can be used to help patients suffering from respiratory depression due to opiate intoxication. Another common crash-cart medication is atropine, which is used in cases of symptomatic sinus bradycardia. In most hospital settings, there are standing orders for these and other medications designed for use in emergency situations.  This makes it possible for nurses to administer medications in emergency situations without having to wait on a new medication order to arrive.

In-Hospital Outcomes for CPR

Even with everything that goes into trying to save a patient suffering from cardiac or respiratory arrest, the average code doesn’t last long. It ends when the patient is successfully resuscitated or when the physicians present declare the patient dead. Unfortunately, despite the best efforts of everyone involved, most resuscitation attempts are unsuccessful. For instance, this study on survival following in-hospital CPR found that approximately 30% of patients were successfully resuscitated. However, at the time of discharge, only 12% of patients were still alive. Obviously, these results show that CPR isn’t nearly as successful as popular television shows would have you believe. However, for many patients, it’s simply the only thing left to do, and while most patients who require CPR won’t make it back, it’s still important (and necessary) to do everything in our power to make it work.

Remember Your Codes

Code blue is just one of many codes that you may run into in the hospital. While these codes are less common, keep them in mind in case of emergency:

Code Red: This indicates there is a fire in the building. Follow the appropriate evacuation procedures.

Code Amber: This indicates a potential child abduction case. Report it your supervisor or the proper authorities right away.

Code Yellow: This indicates a bomb threat. An explosive device may be in the building.

Code Black: This indicates a personal threat of violance. A person may be attempting to harm themselves or commit suicide.

Have you ever had to call code blue for one of your patients or participated in a code-blue situation? If so, what did you do and how did you feel about the experience? If you’re comfortable sharing some of your experience with our readers, please do so by posting a comment in the section below.


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