Note Template – Code Note

(You can directly edit this note to suit your specific condition by directly clicking on parts that you wish to edit. Copy and paste note after you are done editing)

Initial Rhythm:  Bradycardia followed by asystole

Description of Code:

I responded to overhead code blue page. CPR was initiated and conducted as per ACLS protocol.

Total duration of CPR: 12 minutes


– Epinephrine x ***

– Insulin + D50 as well as calcium gluconate for hyperkalemia as potential etiology of cardiac arrest

– Sodium bicarb for treatment of acidosis

– Fluid bolus

– Atropine at ROSC

– Pressors initiated – ***

Intubation: Performed by anesthesia team

Lines Placed: Right femoral line placed

Result of Code: ROSC/Death

Next of kin notified: Yes

Primary attending notified: Yes

Labs ordered: ABG, CBC, CMP, sr lactate