Resuscitation (Code Blue/CPR) Event Note

Date of Event: [Date]

Location: [Unit/room/area]

Event Type: [Code Blue / CPR / Respiratory arrest / Peri-arrest]

Patient Status at Documentation: [Alive with ROSC / Deceased / Ongoing critical care]

Author Role in Event: [Team leader / Airway operator / Bedside responder / Compressor / Recorder / Consultant / Other]

Reference: See [code narrator record / resuscitation flowsheet / defibrillator record] for complete medication and shock logs.

(Use 24-hour time throughout. Synthesize key details rather than duplicating the granular code record. Label suspected or presumed causes explicitly. State unknown information explicitly rather than omitting. Omit sections that do not apply.)

Event Summary

[High-yield narrative synthesis of the event, approximately 6–10 lines: brief pre-arrest context including reason for hospitalization and immediate antecedent; arrest recognition and initial rhythm; core interventions including CPR, defibrillation, airway approach, and vascular access; ROSC status with sustained ROSC time if achieved; suspected or presumed cause with label; and disposition]

Pre-Arrest Context & Code Status

• Witnessed status: [Witnessed / Unwitnessed / Unclear]
• Monitored status: [Monitored / Unmonitored]
• Preceding symptoms or events: [Description]
• Recent vital sign trajectory: [Description] (Include only if relevant.)
• Pertinent risk factors: [Relevant conditions such as sepsis, myocardial ischemia, PE risk, electrolyte abnormalities, overdose, pregnancy]
• Code status prior to arrest: [Full code / DNR / POLST / Unknown]
• (If code status was unknown at arrest, state that resuscitation was initiated under emergency presumption.)
• (If a limitation was discovered during resuscitation, document who provided the information, what documentation was found, and how the plan changed.)

ACLS / CPR Timeline

(Chronological timestamped entries in 24-hour format. Note time source when ambiguous. Use approximate times with notation when exact times unavailable. If multiple arrest episodes occurred, clearly distinguish each. Reference code record for complete medication and shock logs.)

• [HH:MM] — Arrest recognized / Found pulseless ([Time source])
• [HH:MM] — CPR initiated ([Time source])
• [HH:MM] — Initial rhythm: [VF / Pulseless VT / PEA / Asystole] ([Time source])
• [HH:MM] — First defibrillation at [energy] J ([Time source]) (If performed.)
• [HH:MM] — First epinephrine [dose] ([Time source]) (If given.)
• [HH:MM] — Advanced airway placed: [Device/technique] ([Time source]) (If performed.)
• [HH:MM] — [Rhythm transitions, subsequent shocks with energy, key medications as applicable]
• [HH:MM] — ROSC achieved ([Time source]) (If applicable.)
• [HH:MM] — Sustained ROSC ([Time source]) (If applicable.)
• [HH:MM] — CPR stopped: [Reason] ([Time source])

Airway / Breathing

(Include if any airway or ventilation intervention was performed or if respiratory arrest occurred. If no airway intervention was required, note briefly in Event Summary and omit this section.)

• Initial airway approach: [BVM / Supraglottic airway / ETT / Existing tracheostomy / None required]
• Intubation details: [Number of attempts, technique, tube size, depth] (If performed.)
• Confirmation method: [Waveform capnography / Auscultation / Visualization / CXR]
• Post-ROSC ventilation: [Device/mode, FiO2, rate, settings] (If applicable.)
• Complications: [Aspiration / Esophageal intubation / Difficult airway / Trauma / None] (If any.)
• (Reference separate RT or anesthesia airway note if applicable.)

Circulation / Access

• Vascular access: [Peripheral IV / IO site / Central line site / Arterial line site]
• Access difficulties: [Description] (If encountered.)
• Fluids/blood products: [Type and volume administered]
• Vasopressors initiated: [Agents and doses or titration status]
• Post-ROSC hemodynamics: [BP range/trend, HR, lactate if known]
• Mechanical circulatory support: [ECMO / IABP consideration or initiation, consultation, decision] (If applicable.)
• (Reference separate procedure notes for central or arterial line placement if applicable.)

Suspected Etiology / Reversible Causes

• Suspected etiology: [Top suspected or presumed cause with brief clinical rationale] (Do not state as definitive without confirmation.)
• Reversible causes considered: [Hypoxia, hypovolemia, acidosis, electrolyte abnormality, toxins, tamponade, tension pneumothorax, coronary thrombosis, pulmonary thrombosis]
• Targeted treatments given: [Interventions addressing suspected causes]
• Diagnostics and consults: [Labs, ECG, imaging, POCUS, specialty consults initiated]

Post-ROSC Status & Plan

(Include only if ROSC was achieved.)

• ROSC timing: [Initial ROSC time] and [Sustained ROSC time]
• Neurologic status: [Ability to follow commands, pupillary findings, GCS if feasible]
• Hemodynamic status: [BP/HR trend, vasopressor support and targets]
• Airway/ventilation status: [Device, settings, oxygenation goals]
• Temperature control: [Strategy initiated or planned, target range] (Required if patient not following commands.)
• Seizure management: [EEG planned, antiseizure therapy] (If indicated.)
• Post-arrest plan: [Diagnostic plan and destination with rationale]
• (If ROSC was transient with re-arrest, briefly describe each episode.)

Termination of Resuscitation / Death

(Include only if resuscitation was terminated without sustained ROSC.)

• CPR stopped: [Time] for [Reason]
• Time of death: [Time] (If pronouncing clinician.)
• Pronouncement criteria: [Per local policy]
• Family notification: [Time and person notified]
• Disposition: [Morgue / Medical examiner referral / Organ donation referral per institutional workflow]
• (If another clinician pronounced, document their name and time.)

Disposition & Communication

• Destination: [Unit and receiving team]
• Handoff: [Time and receiving clinician]
• Key information communicated: [Rhythm course, shocks, airway, access, medications, ROSC times, suspected cause, pending diagnostics]
• Family/surrogate communication: [High-level summary of discussion and any goals-of-care decisions or clarifications]

Attestation & Billing Documentation

(Include when billing critical care time or procedures.)

• Attestation: [Author presence and role during event]
• Procedures performed: [Intubation / Central line / Arterial line / IO / Other] (Reference separate procedure notes.)
• Critical care time: [Total minutes personally provided this date, excluding CPR time and separately billable procedures]
• Family discussion: [If counted toward critical care, document medical necessity and that patient could not participate]