Collaborative Discussion ACLS 2025

​In-Hospital Code Blue Documentation and Code Team Management

By Jonel Mallari

Multiple Choice

During a Code Blue, a patient achieves ROSC after 3 shocks and 2 doses of epinephrine. According to Utstein-style reporting, which variable is considered a core outcome variable?

• Time from collapse to initiation of CPR

• Return of spontaneous circulation sustained for at least 20 minutes

• Total number of IV/IO attempts during the code

• Specific brand of defibrillator used

Identifies learning needs, quality issues, and enables continuous improvement efforts.

Quality Improvement

Provides information to guide continuing care and helps answer family questions about the event.

Patient Care

Why Documentation Matters

Proper documentation also reduces medical litigation risk and enables comparison with similar institutions' outcomes.

Ensures standards are met, guides resource allocation and provides research data.

Compliance & Research

Why Documentation Matters

The Utstein Style Foundation

• The standardized approach to cardiac arrest documentation originated from the Utstein '95 Symposium at Norway's historic Utstein Abbey. This landmark event established the "Utstein Style" for reporting cardiac arrest and resuscitation data.

• The American Heart Association adopted these guidelines in 1997, with updates in 2004 and ongoing revisions through the International Liaison Committee on Resuscitation (ILCOR) between 2013 and 2018.

Three Categories of Data Elements

Multiple Choice

The scribe must document: “Time from collapse to first epinephrine administration.” Why is this data point critical?

• It evaluates medication stock availability.

• It reflects adherence to evidence-based guidelines for survival.

• It determines if the patient qualifies for advanced therapies.

• It verifies whether the family was informed promptly.

Critical Time Elements

Multiple Choice

The team leader notices the compressor showing fatigue and a decreased compression depth. Which immediate action demonstrates effective leadership?

• Tell the compressor to continue until the next rhythm check.

• Assign another team member to take over compressions immediately.

• Pause compressions and allow the compressor to rest briefly.

• Rotate compressors only after 5 minutes to avoid confusion.

Multiple Choice

Which task is the primary responsibility of the Timer/Recorder during resuscitation?

• Administering epinephrine every 3–5 minutes

• Monitoring pulse and rhythm during CPR

• Tracking interventions and announcing when the next drug/defib is due

• Directing compressor changes

Multiple Choice

The Airway/Respiratory Specialist inserts an advanced airway. Which action best ensures quality ACLS care?

• Delaying CPR until capnography confirms placement

• Rotating airway managers every 2 minutes

• Deferring ventilation until after 5 minutes of CPR

• Minimizing chest compression interruptions during insertion

Multiple Choice

A nurse reports: “The patient’s rhythm is pulseless VT. We’ve defibrillated once, CPR ongoing, and epinephrine is prepared for administration.” Which SBAR component is primarily demonstrated?

• Situation

• Background

• Assessment

• Recommendation

Multiple Choice

Which statement best reflects effective call-out communication during ACLS?

• “Heart rate is now 90, sinus rhythm restored.”

• “Someone give epinephrine please.”

• “Who’s available to ventilate the patient?”

• “Can anyone confirm if ROSC occurred?”

Multiple Choice

The team leader orders: “Give 300 mg amiodarone IV now.” Which response best demonstrates closed-loop communication?

• “Okay, I’ll give amiodarone.” [gives drug silently]

• “300 mg amiodarone IV now, correct?” Leader: “Yes.” Nurse: “Drug given at 10:22.”

• [Prepares drug without verbal confirmation]

• [Prepares drug without verbal confirmation]

  “Amiodarone given.” [no repeat-back]

Multiple Choice

Which leadership behavior best improves team performance during ACLS?

• Assigning roles only when gaps are noticed

• Monitoring overall progress while stepping in when needed

• Avoiding interruptions by handling all roles independently

• Delegating all tasks without monitoring

Multiple Choice

In a simulation, a student leader repeatedly fails to update the team about CPR cycle times. Which intervention best reinforces ACLS team dynamics?

• Assign the scribe to quietly record without interruptions.

• Allow the error to continue for realism.

• Have the compressor keep time instead.

• Provide a mid-simulation huddle to re-establish shared awareness.

Multiple Choice

After 25 minutes of high-quality CPR, multiple shocks, advanced airway placement, and epinephrine, there is no ROSC. Which next step is most appropriate?

• Continue ACLS for 10 more minutes

• Stop resuscitation and discuss redirection of care with the family

• Transfer the patient to ICU for post-resuscitation care

• Administer additional vasopressin before deciding on termination

Multiple Choice

During a megacode simulation, a student pauses chest compressions to ask what dose of epinephrine to give. What is the best instructor feedback?

• “Ask after compressions, because maintaining CPR is a priority.”

• “Pause compressions if you’re unsure, safety comes first.”

• “Let the compressor decide whether to continue or pause.”

• “Epinephrine dosing is less important than minimizing interruptions.”

Adapted from AHA 2020 Guidelines for CPR and ECC.

“High-quality ACLS is non-negotiable: early recognition, rapid defibrillation, effective chest compressions, and ongoing quality monitoring are what determine survival.”

“Quality ACLS isn’t optional — it’s lifesaving.”