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Code Pink (paediatric emergency but not resuscitation) for PICU staff

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General Points

  1. Code Pink is Starship's version of a medical emergency team.
  2. The aim is to prevent unexpected cardiorespiratory arrests and to reduce unplanned admission to PICU by early identification and appropriate treatment of at risk patients.
  3. The Code Pink team consists of the PICU registrar, a PICU nurse (who carries a pager) and the on call acute paediatric medical registrar.
  4. The Code Pink team needs to respond to a call with in 15 minutes.
  5. Although Code Pink was designed to support the more junior medical staff and nursing staff on the wards, any staff member who identifies a patient at risk may call a Code Pink
  6. It is the responsibility of one of the registrars on the team to contact and speak to a member of the child's medical team (unless they are present during the Code Pink) and also to document the Code Pink in the patient's notes.
  7. A Code Pink is called by dialling 777.
  8. The criteria for Code Pink are a guide, a code does not have to be called just because a patient fulfils one of them. There also needs to be concern for the patient.

Please do not criticise or embarrass the staff who called the Code Pink, be supportive and take the opportunity to educate.

Code Pink Criteria

Any ONE or more of:

  • Any patient you are seriously worried about regardless of criteria below
  • Airway compromise
  • Breathing: Sats<90% or <60% if congenital heart disease, severe respiratory distress or apnoea
  • Breathing too fast or too slow:
Age Too fast  Too slow
0-3 mths >80 <25
4-12 mths >60 <20
1-4 yrs >40 <15
>5 yrs >30 <10
  •  Circulation >60 ml/kg fluid required to maintain BP in < 4 hours
  • Tachycardia or Bradycardia:
Age Too fast  Too slow
<12 mths <100  >180
1-4 yrs <90 >160
5-12 yrs <80 >140
>12 Yrs <60 >130
  • Hypotension:
Age Systolic BP
0-3 mths <50
4-12 mths <60
1-4 yrs <70
5-12 yrs <80
>12 yrs <90
  • Acute Change in Neurological Status:
    • Decrease in GCS of >2 points
    • Repeated or prolonged seizures

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Document Control

  • Date last published: 31 October 2005
  • Document type: Clinical Guideline
  • Services responsible: Paediatric Intensive Care Unit
  • Owner: Gabrielle Nuthall
  • Editor: John Beca
  • Review frequency: 2 years