Code Blue Experiences


  1. Taylor Kragness says

    Registered nurse at operating room (circulator). Had an experience in 2017, where a 34 year old female patient was in for a routine vaginal hysterectomy due to heavy bleeding with menstruation and other hormonal issues. When I went to interview her, I felt like something was off, as if I somehow knew something was going to happen. Perhaps if was because we were of the same age, and I simply thought that it would be devastating if something were to happen due to her young age. The surgeon was maneuvering the uterus through the vaginal canal, about ready to make cuts to the uterine arteries, when the anesthesiologist said that the patient was in asystole. I quickly called a code blue over the intercom per facility policy and began CPR. Anesthesiologist administered epinephrine immediately, after already trying glycopyrrolate due to her bradycardia before the asystole happened. His best guess was that the bradycardia happened due to the vagal nerve being connected to the uterus. When the surgeon moved the uterus around, due to the patients young age and excellent vagal tone, her heart rate dropped fast. She came back to normal sinus rhythm after the first round of CPR and epinephrine administration, luckily. Later I vowed never to let my ACLS lapse. As an OR nurse we are not required to have it, but that day I was happy I did.


    Thank you for this comprehensive course.
    I have encountered an adult patient brought to ER, in asystole. CPR is performed immediatley, ETT in place , we encountered difficulties ensuring an IV access for the first 10 minutes. Couldn’t we administer epinephrine per ETT tube ( in place from the first 2 minutes)instead delaying the administration of epi ? Does epinephrine via ETT tube has the same action as if administrated via IV? Additionaly, the physician has ordered to administer epi 2 mg IV push once the IV access in place (to compensate the delay as he said) and he has administrated heparin 5000 UI, as he suspected that the cause of arrest was an MI . Are the beforementionned practices evidence based?
    Thank you for your reply

  3. Tod Tolan MD says

    Anesthesiologist at eye surgery center. We occasionally see vaso-vagal responses in the operating room or more commonly in the adjacent recovery room.
    A 65 year old slender caucasian male with afib and a bundle branch block completed successful cataract with implantation surgery under local with minimal sedation.
    He walked to the adjacent recovery room and sat down in the recliner chair. He suddenly became light headed and nauseous. Placement of oxygen cannula and AED pads followed. I stood at his recliner chairside and felt a pulse. The nurse stated that the AED called for a “shock.” I objected saying that i could feel a pulse. The AED did not have a display. She repeated the AED command, so we charged the device and gave him a jolt. He came off the chair and clutched his chest in agony. Once attached to our 6 lead monitor, we could see the persistent afib with aberrancy. He was transferred to our nearest hospital with suitable vital signs. Decoding of the AED demonstrated that he had ALWAYS been in afib with a wide complex. I was correct when I detected a pulse. The AED had misinterpreted his “stable daily” rhythm. Referring this to the AED manufacturer, they claimed that the AED had performed as “programmed.” We replaced that unit with one which shows the EKG pattern in real time. Live and learn.

    • ACLS says

      Wow! I’m glad you switched out that AED for one with a real time monitor. Worth it. Thanks for sharing your experience!

      Kind regards,

  4. Robert Finch says

    I became a Paramedic back in 1992. I worked the streets of Albuquerque NM for the Fire Service for 21 years. I had an absolute wonderful career and yes had hundreds of Code Blues. One particular call absolutely made be thankful to be a Paramedic. I responded to a 72-year-old male patient with heart problems. Upon arrival, he informed me that he was having major chest pain and said please Help…(me) but he collapsed in front of me. Back in those days we were taught to perform a pre-cordial thump to the chest. I did so as my partner readied the cardiac monitor (no ROSC with the thump). I placed the paddles on his chest to see the rhythm of V-Fib. I immediately shocked at 200 joules and rhythm changed to a junctional heart rate of 40-50 bpm with multifocal PVC’s. Airway was protected by using an NPA with bag valve mask and high flow O2. We did not stay on scene to intubate the patient; we rapidly transported the patient to the cardiac catheter center (Heart Hospital). We established a brachial IV with NS and pushed Lidocaine (1mg/kg) and noted that his rhythm changed to a trigeminal sinus rhythm. The patient was transferred to the cardiac care team with a report given. A couple of weeks later, I received a phone call from the patient himself thanking me for saving his life. He informed me that he underwent a triple-by-pass procedure and was at home recovering. He was so elated to be able to see his grandchildren once again.
    Sadly, I retired in 2011 and let my Paramedic license lapse in 2013. I have many certifications in various fields now and run a successful income tax and financial planning business with my wife. Recently on a trip back home from Hawaii, on the plane two hours over the ocean, there was a medical emergency with a female having a grand mal seizure. The flight attendants called for help, and I sprang up into action. That now has led me to taking this ACLS class and going forth with my re-certification of my National Registry EMTP status. Once I achieve this, I can apply for reciprocity here in New Mexico and challenge the state exam for a current license. I am very excited about coming back into the medical community to help others again. BOY A LOT has changed during my absence!


    Robert C. Finch

  5. Brandy says

    I have participated in codes as a pharmacist for 20 years but was never expected to be ACLS certified by my previous employer. My new job requires it for all Code Team participants so I just took ACLS for the first time. Have had 2 codes since and it is amazing how this has changed my experience and participation. I now automatically pay attention to things other than medications and feel able to more fully participate and assist beyond medications preparation and handoff.

  6. Mark Hill says

    I used to teach BCLS & ACLS from when it started, working in ICU,CCU, ER i have done CPR & Coded patients hundreds of times. One of the worst was in ICU we had a 3 bed room and a PT codes , the the other Pt seen whats going on and codes, then the 3rd PT codes we we were running 3 codes at once. Luckily they were all in the same room. In 20 yrs of working Critical Care it was a night to be remembered.

  7. Rehema Mutaki says

    I last took ACLS class 2 years back though i have kept my self updated as well as training fellow nurses at the hospital. I must say the information provided is very guiding and helpful.
    Its however absurd that despite the efforts we inccur in training and continuous drills, we never achieve the expected good team dynamics. Hope some one here can guide me on how and what best can be done to achieve. Regards.

  8. Cooper says


    I currently on a task force that is trying to make a code blue standard of work when only one nurse is being staffed. The situation would be at a rural small hospital where only one nurse is staffing at night and needed to preform a code blue. Does anyone know of any technology or advise on how to handle this situation?

    • Alan Mclean says

      It is very difficult to do everything single handed: calling for help before starting resuscitation is important, clearing the airway, Bag mask ventilation and applying the automated defibrillator may be the priorities. [If you are on your own, you cannot do cardiac comprssions and apply the pads at the same time…]It could be that in collapse which can not be helped by airway management and ventilation, getting the defibrillator on as soon as possible may be the intervention most likely to safe life [that will depend on whether it is a shockable rhythm, but you won’t know this until you put the defibrillator on. A few years ago we bought a mechanical cardiac commpression device but I don’t think it has ever been used. In kids, airway management and breathing take priority but youll still come to this issue of needing to commence compressions and getting the monitor on.
      Getting somebody else, even a family member to do compressions may help.
      Community first aid education may be lifesaving!
      There are some web guidlines on single operator resuscitation which you could search for.
      Dr Alan Mclean [wiluna Western Australia]

      • ACLS says

        Hi Dr. McLean,
        Thanks so much for leaving a comment and sharing your experiences! Kind regards, Jeff

  9. Doug Kahn, RPH says

    The last time I took CPR training was 30 years ago. It is so much more detailed today. These guys make review a breeze and help you to get ready and have to confidence in class to do the right thing right away, without it being boring. The guy has a sense of humor and gets you to think what is next..
    That is half the battle…do what is next quickly, and without hesitation.
    This set of videos helps you with this and any hesitation you may have..they give you confidence.

  10. James a ward says

    In a hospital environment when I suspect a pt might code I will be prepping the room for it , do your self a favor and get some of the furniture out of the way,! nobody is teaching this , in addition it helps if your lines tubes and other attachments are set up neatly and not braided,… just saying

  11. Seedy Danso says

    My first time ACLS certification and your site was invaluable in this effort. It has fully prepared me in just 2 weeks and I would be sure to recommend this site to my colleagues. I will subscribe again sometime in the near future to retain my skills since I don’t use them on the floor as often. Many thanks Jeff, I am most grateful.

    • ACLS says

      Hi Seedy,
      Thank you so much for the encouraging words and the feedback. I’m so glad that the site has been helpful. Thank you for telling others about the site! Kind regards, Jeff

  12. Margaret Moore says

    Thoroughly enjoying the way all of the information has been presented!
    Committing to reviewing this critical information frequently to be as best prepared as can be for any unfortunate circumstance.

    Thank You!

    • ACLS says

      Hi Margaret,
      Thanks so much for leaving a comment. I’m so glad that the site has been helpful for you and that’s great that you’re committing to keeping this stuff fresh in your mind as a healthcare provider. Kind regards, Jeff

  13. Kris Gray says

    Here is my recent experience with codes: With everyone wearing N-95s or ENVOs, surgical mask over that and a face shield, people are yelling during codes and you still can’t understand anyone! ACLS should now include hand signals.

  14. Lisa Strickland says

    I have nothing but praise for this course. The information is presented in such a way that learning (or reviewing) is made easy. The quizzes are excellent; the presentation of material via text, video and scenario is outstanding. I won’t hesitate to recommend this website.

    Great work!

  15. Mari says

    Hi. So I’m an experienced nurse but not so much with codes and I feel I panic when there is a coffee recently I had a code and I feel I did poorly with it and now I feel like a failure

    • ACLS says

      I totally understand how you feel. We all have had experiences like this. The best way to overcome these types of negative experiences is to be fully prepared for all of the most common emergency circumstances.

      When I first started building this website the content was for me. I did not perform well in code blue situations and I felt like I could not perform under the pressure.

      I started taking ACLS seriously and this website is the result of that change. I can guarantee that if you use this website on a quarterly basis you will definitely be prepared for whatever code blue situation you are faced with and you never feel unprepared again.

      We all make mistakes and we all at times are not fully prepared, so learn from that lesson and be ready for the next time.
      Kind regards, Jeff

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