From Freezing to Focused: Lessons Learned During My First Code Blue

    During my first year of nursing school, I had my first night clinical shift in the Medicine ward. That’s when I saw CPR being performed on a patient for the first time. We had learned about CPR in theory, but not in enough detail to actively participate in such a high-stress resuscitation. So, all I could do was stand in the doorway, watching as nurses rushed to push medications, doctors performed compressions, and visitors cried in the background.

    I was frozen—not just because I didn’t know what to do, but because the reality of chest compressions was far more intense than what I had practiced on a mannequin. The sheer force used shocked me. It was nothing like the controlled, step-by-step technique we were taught in class.

    Despite the resuscitation team’s best efforts, the patient didn’t make it. It was a sobering lesson: no matter how well you memorize the checklists or ace the theoretical knowledge, a real Code Blue is something you can’t fully grasp until you’re in the middle of it. Looking back, I wish I had asked more questions—what medications were being pushed? At what doses? But at that moment, all I truly learned was this: 

'When it comes to chest compressions, you push harder than you think.'

    Fast forward a few months later, and I’m now a licensed registered nurse. My first Code Blue came early on, during my third or fourth week working in the ICU. This time, I wasn’t just a spectator- I was expected to act. My senior nurse called the Code and immediately began CPR. I wasn’t shocked by the compressions anymore, but I froze again—unsure of what exactly to do.

Everyone else seemed to know what needed to happen:
✔️ Someone grabbed adrenaline.
✔️ Someone grabbed the defibrillator.
✔️ Someone brought the CPR board.
✔️ Me? I stood there, unsure where to start.

    It felt like I was reliving my student days—watching instead of acting. But this time, I made sure to learn from the chaos.

    I observed what needed to be done when you’re not the one doing compressions:

🔹 Medications:

• Adrenaline

• Amiodarone

• Sodium bicarbonate

• Calcium gluconate 10%

• Always follow every medication with a saline flush

🔹 Task prioritization:

• Not everyone should crowd the bedside—some nurses need to step back and tend to other patients.

• Prioritize chest compressions over bagging.

• Clear communication is key—ensuring everyone knows their roles to avoid confusion, task repetition, or abandonment.

🔹 How to assist:

• Grabbing the emergency cart, preparing medications, and helping with intubation if needed.

• Recording and time-keeping during the resuscitation efforts to keep track of medications and interventions.

• Ensuring a smooth workflow and being ready for anything that comes your way.

The biggest lesson? 

'You won’t truly understand Code Blue until you’re in the middle of one.'

    No amount of reading or simulations can fully prepare you for the adrenaline, the split-second decisions, and the sheer intensity of a real emergency.

If I could go back and tell my past self one thing before my first Code Blue, it would be this:

Even if you freeze, observe and learn, watch people move and see where they are going and what they are doing. The more you experience, the better prepared you’ll be for the next one.

    Now that I’ve been part of multiple Code Blues and resuscitation efforts, the most important lesson I’ve learned—above all the medications, dosing, or even the joules of energy—is the importance of staying cool-headed. Yes, medications and proper dosages matter, and proper energy settings are crucial, but the biggest takeaway is this:

You must stay calm.

    When the heart has stopped and CPR is underway, your focus should be on delivering the most effective chest compressions to restart the heart. A few seconds' delay in pushing adrenaline isn’t the end of the world, so there’s no need to stress about it. Code Blues are already intense, high-stakes situations, and your mind needs to process information quickly. Adding anger or frustration to the mix only makes things more complicated.

    Clear communication, giving and receiving orders with a level head, ensures that everyone understands their role. Being calm allows you to think clearly and adapt quickly, helping you come up with new interventions or solutions when necessary. Staying cool under pressure is often the difference between just following procedures and truly being effective in resuscitation efforts.

    If you find yourself or anyone else frustrated with a delay in orders/action or feeling stressed by the rapid pace, it’s important to gently encourage stepping back and taking a breath. In moments like these, chest compressions are the most crucial element—so long as they’re being performed effectively, that’s the priority. 

    Both nurses and doctors should remember that orders are being followed, even if things seem to be moving slower than anticipated. If you feel frustrated or angry, it’s crucial to cool off and refocus. Give and take orders with a clear mind, ensuring that everyone understands what needs to be done. Cool-headedness in these situations can mean the difference between success and failure, helping you think more clearly and make better decisions as a team.

"This is my take on the first Code Blue and the invaluable lessons I learned. Do you resonate with the emotions I felt during my first experience? What was your own Code Blue moment, and what lesson has stayed with you the most? I'd love to hear your stories and insights in the comments!"