| Code Blue Recording Flowsheet — Renal Care Unit | W.G.M. Rivero MD · FPCP · DPSN · · williamriveromd.com · 2026 |
Clinician Form · Resuscitation Code Blue Recording Flowsheet Real-time documentation of CPR, defibrillation, ACLS medications & events — Renal Care Unit, Rafael C. Lazatin Memorial Medical Center | ✚ W.G.M. Rivero MD FPCP · DPSN Nephrology williamriveromd.com |
| [ PATIENT LABEL ] NAME · AGE · MRUN | Date: | Room #: | Time code called: | Time team arrived: |
| CPR start time: | Team: | |||
| TIMEmilitary | BP | HR | RHYTHM | O₂ Sat | PULSEabs 0 / ✓ | CPR✓ /2min | SHOCKjoules | EPI1mg | AMIO300/150 | LIDOmg/kg | ADEN6/12 | ATRO1mg | Ca gluc1–2g | NaHCO₃50mEq | COMMENTSBVM · intubation · IV fluids · pacing · cardioversion · lines · labs · etc |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Use alongside your institution’s Code Blue policy and current AHA/ACLS guidelines. Verify all doses against local standing orders. Recording form for clinical documentation by trained personnel. | williamriveromd.com Page 1 of 4 · /guides/code-blue-acls-dialysis-unit.html |
Code Blue Recording Flowsheet — continued Recording grid · Event conclusion · Personnel on duty | Renal Care Unit |
| TIMEmilitary | BP | HR | RHYTHM | O₂ Sat | PULSEabs 0 / ✓ | CPR✓ /2min | SHOCKjoules | EPI1mg | AMIO300/150 | LIDOmg/kg | ADEN6/12 | ATRO1mg | Ca gluc1–2g | NaHCO₃50mEq | COMMENTSBVM · intubation · IV fluids · pacing · cardioversion · lines · labs · etc |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Code Blue Event Conclusion Time event ended: Patient outcome: ☐ROSC achieved ☐Expired / efforts terminated Reason resuscitation ended: ☐ROSC ☐No benefit to continue Family notification: ☐At bedside ☐By phone ☐Unable to reach ☐No family ☐Pending Name of person notified: Relationship to patient: | Personnel on Duty
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| Use alongside your institution’s Code Blue policy and current AHA/ACLS guidelines. Verify all doses against local standing orders. Recording form for clinical documentation by trained personnel. | williamriveromd.com Page 2 of 4 · /guides/code-blue-acls-dialysis-unit.html |
ACLS — Adult Cardiac Arrest High-quality CPR + the dialysis circuit in parallel · epinephrine + rhythm-based pathway · treat reversible causes | Renal Care Unit · ACLS reference |
Shockable — VF / pulseless VT SHOCK · biphasic 120–200 J (device-specific) · monophasic 360 J ▼ CPR 2 min · obtain IV / IO access ▼ Rhythm shockable? → SHOCK ▼ CPR 2 min · Epinephrine 1 mg IV/IO q3–5 min · consider advanced airway + capnography ▼ Rhythm shockable? → SHOCK ▼ CPR 2 min · Amiodarone 300 mg (then 150 mg) or Lidocaine 1–1.5 mg/kg · treat reversible causes ▼ ROSC? → post-cardiac-arrest care. If not, continue 2-min cycles. | Non-shockable — Asystole / PEA CPR 2 min · Epinephrine 1 mg IV/IO as soon as possible, q3–5 min · IV/IO access · advanced airway + capnography ▼ Rhythm shockable? → if YES, move to the shockable lane ▼ CPR 2 min · treat reversible causes (see below) ▼ ROSC? → post-cardiac-arrest care. If asystole persists despite treating reversible causes, consider termination per team decision. |
Reversible causes — H’s: HIGH-YIELD Hyper-/hypokalemia · Hypovolemia (over-UF → saline) · Hydrogen ion / acidosis · Hypoxia · Hypothermia · Hypocalcemia / hypomagnesemia | Reversible causes — T’s: Thrombosis (MI / PE) · AIR EMBOLISM clamp venous line, left-lateral Trendelenburg · Tamponade · Tension pneumothorax · Toxins |
| ACLS algorithms adapted from current AHA guidance for trained personnel. Verify every dose and step against your institution’s protocols and the responding physician’s judgment. Reference only — not a substitute for ACLS certification. | williamriveromd.com Page 3 of 4 · /guides/code-blue-acls-dialysis-unit.html |
ACLS — Peri-arrest Rhythms & Hyperkalemic Arrest Bradycardia · tachycardia (stability drives the path) · the dialysis-specific reversible cause | Renal Care Unit · ACLS reference |
Bradycardia w/ Pulse (HR < 50) Identify & treat cause · airway, O₂ if hypoxic · monitor BP/SpO₂, IV, 12-lead ECG ▼ Symptomatic? hypotension · altered mental status · shock · ischemic chest pain · acute HF ▼ NO → monitor & observe YES → Atropine 1 mg IV q3–5 min (max 3 mg) ▼ If ineffective: transcutaneous pacing AND/OR Dopamine 5–20 mcg/kg/min or Epinephrine 2–10 mcg/min IV ▼ Consider expert consult & transvenous pacing Dialysis pearl: hyperkalemia commonly causes bradycardia & AV block — give calcium gluconate, shift K⁺, arrange HD. | Tachycardia w/ Pulse (HR ≥ 150) Identify & treat cause · O₂ if hypoxic · monitor, IV, 12-lead ECG ▼ Symptomatic? hypotension · altered mental status · shock · ischemic chest pain · acute HF ▼ YES — UNSTABLE → synchronized cardioversion (sedate if able); if regular narrow, consider adenosine ▼ NO — STABLE → assess QRS width ▼ Wide QRS ≥ 0.12 s? WIDE: adenosine only if regular & monomorphic · antiarrhythmic (amiodarone / procainamide / sotalol) · expert consult NARROW: vagal · Adenosine 6 → 12 mg rapid push · β-blocker or CCB · expert consult | Hyperkalemic Arrest (dialysis) 1 · STABILIZE — Calcium gluconate 10% 1–2 g IV/IO (or CaCl₂ 1 g, central/IO). Onset 1–3 min · protects heart · does NOT lower K⁺. ▼ 2 · SHIFT — Insulin 10 U + D50 25 g · Salbutamol neb 10–20 mg · ± bicarbonate (separate line). Monitor glucose. ▼ 3 · REMOVE — Emergency HD, low-K bath (≈ 2.0 mEq/L) — the only definitive removal. Mobilize a machine early. ⚠ Calcium & bicarbonate must NOT share a line (precipitate). Suspect with missed sessions / peaked-T / wide-QRS / sine-wave / PEA. After ROSC: airway & BP · 12-lead ECG · treat cause · continue K⁺ mgmt / dialysis · ICU transfer with documentation. |
| ACLS algorithms adapted from current AHA guidance for trained personnel. Verify every dose and step against your institution’s protocols and the responding physician’s judgment. Reference only — not a substitute for ACLS certification. | williamriveromd.com Page 4 of 4 · /guides/code-blue-acls-dialysis-unit.html |