Inpatient Rapid Response/Code Blue Event Note

Date/Time of Event: [Date and clock time of initial activation (HH:MM)]

Patient: [Patient full name and MRN]

Location: [Unit/bed or procedural area]

Event Type: [Rapid Response / Code Blue / Peri-arrest]

Code Status at Event Onset: [Full Code / DNR / DNI / Other (specify)]

Note Author/Role: [Name, credentials, team role]

Attending of Record: [Name and service]

Event Summary

[Concise narrative of trigger, identifier, and immediate clinical context] (2–6 sentences. Identify what prompted activation and by whom; include relevant pre-event context such as admitting diagnosis, active issues, baseline respiratory/circulatory support pertinent to deterioration. If the trigger is unclear, explicitly state that.)

Timeline

(Include only timepoints that occurred. Use exact times when known; label approximate times; document "Unknown" if unavailable.)

• Activation/Call Time: [HH:MM / approx HH:MM (source) / Unknown]
• Team Arrival: [HH:MM / approx HH:MM (source) / Unknown]
• CPR Started: [HH:MM / Not applicable / Unknown]
• First Rhythm Check/Defibrillation: [HH:MM and energy / Not applicable / Unknown]
• Airway Secured: [HH:MM and method / Not applicable / Unknown]
• ROSC Achieved: [HH:MM / Not achieved / Unknown]
• Event Stabilized/Ended: [HH:MM / Unknown]
• Transfer Initiated: [HH:MM and destination / Not applicable / Unknown]

Assessment at Arrival

Vitals: [BP, HR, RR, SpO2, Temp, O2 device and settings]

Focused Exam (ABCDE):

• Airway: [Patency and protective reflexes]
• Breathing: [Work of breathing, breath sounds, symmetry]
• Circulation: [Pulses, perfusion, skin, cap refill, rhythm on monitor]
• Disability: [Mental status, GCS, pupils, focal deficits]
• Exposure/Other: [Pertinent additional findings relevant to event]

Key Data: [POC tests, ABG/VBG, ECG/telemetry findings, imaging results—include times when relevant]

Interventions

(Document all interventions with drug, dose, route, and time. For procedures, include operator, method, confirmation, and complications. Reference code record or procedure note for detailed record if available.)

• Airway/Respiratory: [Airway maneuvers, oxygen changes, intubation details (method, tube size/depth, confirmation, operator, time), ventilator settings if initiated]
• Circulation/Access: [IV/IO access (site, gauge, time), arterial line, external pacing]
• Medications: [Medication, dose, route, time for each] (If none given, state: No medications administered.)
• Fluids/Blood Products: [Type, volume/rate, start time]
• Vasopressors/Inotropes: [Agent, dose/rate, route, time started]
• Electrical Therapy: [Defibrillation/cardioversion energies and times]
• CPR Summary: [Witnessed vs unwitnessed; initial rhythm and rhythm changes; total CPR duration; ROSC status and time] (If CPR not performed, omit this line.)
• Other Procedures/Consults: [Procedure details or teams engaged with times]

Assessment

[Working diagnosis or differential driving actions during the event] (Link objective findings to impression using terms such as "suspected," "likely," or "cannot exclude." If cardiac arrest occurred, document presumed cause category.)

Disposition and Communications

• Disposition: [Remain on unit / Stepdown / ICU / OR / Deceased]
• Accepting Team/Handoff: [Name, role, and time of handoff]
• Monitoring Plan: [Vital frequency, telemetry, parameters to monitor]
• Pending/Follow-up: [Labs, imaging, recheck intervals, contingency triggers for re-escalation]
• Notifications: [Primary team (who, when); consultants (who, when); family/surrogate (time, who spoke, key content, capacity status); code status changes if any]

(This is an event-focused note—omit unrelated history and ROS. Use exact times and doses when known; do not fabricate specifics. When information is unavailable for a critical field, document "Unknown" rather than omitting. Separate objective findings from clinical interpretation.)