19 December 2008

How (not) to run a code

Happy has a nice post from a week ago about his experiences running in-house codes; it rung very true with me, as I too have run many many codes. The thing that made me laugh was his description about how his younger colleagues run to the codes. Like Happy, on principle, I never run to codes. The stroll there is a useful time to put myself in the right frame of mind to effectively run things, and I know by the location the code is at that there will be trained providers doing ACLS when I arrive (plus, as Happy alludes to, more than half the time the code is a false alarm). In fact, I affect a studied nonchalance about the whole thing -- it's no big deal, I'm such a badass, nothing can ruffle my feathers. It amuses me to do so, and I've been told (to my surprise) that my calmness in the chaos inspires confidence in my leadership. Call it an unintended benefit.

There was one code, though, which in retrospect could have been run a bit better.

This was a few years ago. I was standing in the nursing station chatting with one of my partners about something or another. It was one of those odd moments when we were the only ones in the station. The nurses were all off at their tasks, as were the techs -- very unusual, in that there are usually a dozen nurses and half a dozen techs on shift at any given time. And the unit clerk had stepped out for a moment. So there was just the two of us in the area when a woman rushed out from room seven and announced, "I think my dad's coding!" We reflexively looked at the monitor, which showed asystole, and we bolted into the room.

The patient was indeed unresponsive and not breathing. There was no pulse. We jumped right into action. My partner started chest compressions as I fumbled for the Ambu bag and hooked it up to oxygen. We were a little discombobulated as we got to business -- we are never the first responders and are not used to the role. I can't remember the last time I did CPR. I can ventilate a patient in my sleep, but usually the RT fetches and hooks up the equipment and just hands it to me. So it was with a sense of accomplishment and pride that, after a short time, we met one another's eyes and knew we had the important bases covered. I was bagging, and he was doing great CPR. Not too bad for a couple of docs, right?

There's a moment in the classic Monty Python "The Miracle of Birth" sketch when the doctors look at one another and say "something's missing -- what could it be?" and then simultaneously realize: "Patient!" We had one of those moments as we both thought "what's next... need to intubate -- where's my tube? And someone should be giving meds, and hey, who's going to do that if I'm bagging and you're doing CPR? Hey! Where are all the nurses?"

"We should get some help," my partner weakly offered. There was a security guard standing slack-jawed in the doorway. "Call a code!" we told him, but he was overwhlemed and just stood there. No help. We were stuck. I couldn't stop bagging and he couldn't stop CPR. What were we to do? I remembered the "code blue" button on the wall, and stabbed at it. A minute later, the overhead announcement went out: "Code Blue, ER, room seven." The reinforcements came pouring in moments later, and boy were they surprised to find the two of us there trying to resuscitate a patient all on our own!

They got to work right quick and we soon had him intubated and with a pulse. Honestly, I don't know how long our little "delay" was -- probably a minute or two. It felt like forever. Afterward, we all had a good laugh at our expense. Happy put it well: Without a team there. Without a crash cart. I am but a bystander. And we got a vivid reminder why in CPR class they teach you that the first thing you do in an arrest is call for help.

5 comments:

  1. "sir sir are you okay? you call a code and get the crash cart"

    (sat through CPR class last night)

    ReplyDelete
  2. What a great story. I've got my own I will post someday...

    ReplyDelete
  3. So, after your experience as a first responder, do you still walk to your codes? Just wondering. As a CCU RN, when I was on code duty, walking was not an option, our instructions were to run. Elevators weren't an option either since we didn't take the crash cart. 9 flights of stairs was a killer at high speed!

    ReplyDelete
  4. PS: Of course, walking wasn't optional because we were first responders (as such), who took over from floor staff first responders. With what energy we had left after the mad rush, that is :P

    ReplyDelete
  5. A lot of nurses.. KNOW what your talking about.
    LOL.. a scenario we unfortunately have all been in.
    Thanks for sharing. And yes, it's the TEAM that makes the difference.
    Strong Work.

    ReplyDelete