Saturday, August 25, 2007

"Code Blue, 6West, Back Hallway"

So last night I was doing an overnight in the ER, and I had my first code of this summer. I've seen 5 or 6 in the past, and participated in 3 or 4, but this is the first one since I started at the hospital this June.

Dr. M (ER doc), the ER tech, and I, all head out of the ER and towards the elevators. We are met there by 2 ICU nurses and 2 Respiratory Therapists. We get up to the 6th floor, and head to the 'back hallway'. As we walk through the nurses station, I'm completely surprised as to how empty it was. They must all be with the Code, I figured. And I was right. As we enter the hallway, I see a scramble of nurses, frantically doing things to save the old man on the floor. I ask for the story, and try and see his face to see if he was one of ours (on the Hospitalist service - he wasn't). He's had had a couple stents placed this morning, and had seemed to be doing fine. He was taking a walk (who goes for a walk at 3.15am?!) with his nurse, when he started to feel faint, brady'd down, and collapsed. No pulse, no respirations - so the Code was called. After a couple rounds of CPR and drugs, we get him onto a bed and into a room. It was then that I realized how many people respond to a code. Roughly 30 nurses, techs, CNAs, 1 doc (which should've been 3 - the ER, the Intesivist, and the patient's Cardiologist), and a handful of Respiratory Techs.
I was standing outside at this point, and couldn't see much of what was going on. I did hear the patient, however: "GET OFF ME! YOU'RE KILLING ME! LET ME GO! LET ME GO!" (we were holding him still while trying to start an IV). These words were masking those of the Respiratory Tech: "Calm down, sir. Your heart stopped and we've had to CPR on you!"

Eventually, he stabilized, and Dr. M went off to talk to the patient's Cardiologist. He didn't feel much like coming in to write orders, and wanted to send his NP to do it. Now, I have nothing against NPs, but if you're a Cardiologist, and you cath'd someone this morning, and they Code: come in. What about the patients family? It's your responsibility to let them know what happened. But anyway, I digress.

By now, he's lost his pulse again. On with the compressions. We secure the airway with endotrachial intubation. The patient kept fluctuating between PEA, Asystole, and Brady, all the way down to the ICU. We get down there and continue compressions. Dr. M puts in a femoral arterial line to see if the compressions are working, as well as if the patient's heart is beating on its own.

At 4.116am, roughly an hour after the Code was called, Dr. M pronounces the patient. The monitor is turned off, and everyone stops what they're doing. We look down at him, and see that his larynx is moving. Either he's trying to breathe on his own, or he's swallowing. Either way, that's not what a dead person does. We feel for pulses: one on each fem, one on each carotid. One of the ICU nurses swears she feels a pulse. Other people feel it as well, so we turn the monitor back on - but they don't match. It's much faster than what is on the monitor. I tell them to feel their own pulse while they're feeling the patients. Yep, those match. I guess it kind of goes to show how much health care professionals want to save their patients. We listen for heart sounds, check reflexes - nothing. His throat was probably just agonal breathing (last breaths).

Time of Death, 4.20am.