Login
Try for Free
Home
Cardiac Arrest
Cardiac Arrest
Copy Link
Created by Qualaris Staff
Critical Access Hospital
Quality
Table of Contents
Audit Form
Audit Form
Cardiac Arrest
Required
Observed Date
Unit
ED
ICU
Med-Surg
PACU
Rehab
Type of Patient
In house
Pre-hospital
Treatment Prior to Hospital
BLS
ALS
None
NA
Lines
Select an Option
Cardiac Arrest Checklist
Mark all as...
Code Blue system activated?
Yes
No
N/A
Code Blue announced over PA system with destination?
Yes
No
N/A
Code Team arrived within 1 minute?
Yes
No
N/A
Was Pt ventilated via Ambu bag?
Yes
No
N/A
Was Pt intubated?
Yes
No
Was Pt intubated without difficulty?
Yes
No
Was there documentation of ETT confirmation?
Yes
No
Was medication administered?
Yes
No
If medication administered, was the dose documented?
Yes
No
N/A
Was ACLS protocol followed?
Yes
No
Is there documentation of initial rhythm?
Yes
No
Are there rhythm strips attached to medical record?
Yes
No
Was all equipment present and ready to use?
Yes
No
Was CPR delivered per AHA guidelines?
Yes
No
Was physician present?
Yes
No
