Monday, April 18, 2011

beware the morning rounds code

one of our responsibilities in residency was to carry the code pager.  whichever residents were on the cardiology service were responsible for all the non-surgical and non-pediatric codes in the hospital.  surgery and pediatrics had there own teams.  typically there would be two residents and two interns carrying code pagers.  the pager went off at about the same time as an overhead announcement, 'code 100, 6 west, code 100, 6 west, code 100, 6 west.'  the sound of that pager and overhead call was definitely something to get your adrenaline flowing and your heart pumping.  if for some reason that didn't work, there was always the long run through the hospital and up the obligatory three or four flights of stairs to get your heart going.  invariably you were as far away from the code location as physically possible without leaving the hospital and you couldn't risk getting caught in the elevator.  so you ran.

despite the gravity of each situation, there were some funny happenings.  once, in the middle of the night when the two residents and i that comprised that night's code team were getting some precious sleep, a code was called.  we were in a set of three call rooms that all opened into a little hallway.  we each came racing out of our respective rooms, disoriented from sleep and blinded by the light of the hall, and ran smack into each other.  two of us landed on the floor, then had to scramble to get everything back in our pockets before racing out the door.

some codes were not funny, but maybe ridiculous, like this code at 5 am.  the alarms went off and we ran to the room.  a thin muscular man lay on the bed, no rise and fall of his chest, no heartbeat.   my senior resident immediately had me start chest compressions, as the second year started to work inserting a central venous catheter.  the nurses were busy with the crash cart.  the senior resident, observing my chest compressions, repeatedly asked me to press harder.  i was kneeling over this guy, two hands on his chest, pressing as hard as i could.  despite the board we'd put under his back, i was barely moving his chest.  at this point the anesthesiology resident sauntered in (they never ran, knowing the nurses would use the ambu bag until they arrived to establish the airway),  walked to the head of the bed, pried the patient's lips apart, noted the firmly clamped jaw, and walked out of the room shaking his head.

rigor mortis.  this man had been dead for hours.  the nurse had come in to get morning vitals, noticed the patient had none, and called a code.  that certainly explained my inadequate chest compressions, and also the congealed blood the second year resident was pulling out of his central line...

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