Greg Whiteley is a retired Dallas firefighter/paramedic, respiratory therapist, and flight medic who works with Eagle Life Saving in Allen, Texas. He is also an EMS educator, and one of the things he teaches is running a code.
In medical terminology, when a patient “codes” it means the patient is having a life-threatening event, such as a cardiac arrest, bradycardia (low heart rate), or tachycardia (dangerously high heart rate). Mr. Whiteley teaches how to run a more efficient code using the colors of code drug packaging as mnemonic devices to help students remember what medication does what. The box colors are industry standard.
- Atropine sulfate: Atropine sulfate comes in a purple box. This chemical compound is used to treat bradycardia. An extremely low heart rate can lead to a cyanotic appearance, with blue lips or a dark color around the mouth. The cyanotic discoloration occurs because oxygen is not circulating properly; bradycardia is a heart rate that is too low to effectively perfuse oxygen throughout the blood. Atropine sulfate brings the pressure up gradually by increasing the heart rate. Do not give this medication if the patient is in cardiac arrest; also avoid if the patient is having an “active heart attack.” It can make the symptoms of a heart attack worse by increasing workload and oxygen demand, which can cause the patient’s condition to deteriorate.
- EPINEPHrine 1:10,000: A patient in cardiac arrest will have an ashen color; their skin tone will be pale taupe or grayish beige (depending on their race, of course). Reach for the corresponding colored box, which should be epinephrine. Epinephrine, also known as adrenaline, is the primary drug administered to reverse cardiac arrest through vasoconstriction to increase pressure and increase the mean diastolic pressure for better perfusion. It is also used to relieve respiratory distress due to a severe asthma attacks or allergic reactions.
- Amiodarone or lidocaine: Vials of these medications often have a red top, which should make students think of the heart. Amiodarone injection is used to treat a possibly fatal irregular heartbeat, such as ventricular fibrillation, pulse-less ventricular tachycardia, and pulse-less Torsades de pointes. Lidocaine, usually lidocaine HCl 1 or 2 percent, comes in red box, and in a code is also used to treat lethal rhythms.
- Calcium chloride: Calcium chloride injection is used in cardiac resuscitation; it helps the tissues absorb potassium as well. Bananas are rich in potassium, which is how to remember calcium chloride is in a bright yellow box.
- Sodium bicarb: This IV medication used to treat severe metabolic acidosis, a buildup of acid in the blood due to an excessive loss of bicarbonate. Acidosis can lead to renal failure, which results in dark urine – just like the color of a sodium bicarb box.
Most medications used in the field of EMS or in emergency room and hospital crash carts are for "fast-paced" base usage. Pulling medications by box color to represent what code the patient is in at the moment is a good mnemonic device to learn. If not colored, most boxes would look the same aside from the name of the box or vial. Teaching these visual cues in the classroom and simulation scenarios will enhance student learning and prevent confusion in a real-life, fast-paced emergency.
To teach about code drugs, see the Prefilled Crash Cart Drawer Insert. Filled with Demo Dose® Simulated Medications, this drawer fits most emergency carts.
Readers, have any of you learned this? Do you have similar methods for turning complex lessons into more simplified information? Leave us a comment below!
Much thanks to Greg Whiteley for reviewing this article and correcting any misleading statements. Jayme Maley is Pocket Nurse Marketing Manager; she attended Greg’s presentation at the Pocket Nurse Corporate Headquarters in Monaca, PA, as part of the ongoing Product Education Program.