Running a code

[emtB123]

Not that anyone can tell when it would happen, but I'm super nervous about running a code. I sometimes take things really hard so there's no predicting how I'm going to take it either. Any advice?

 

[STXmedic]

It's not your emergency. Learn from any mistakes you make and move on. It'll take a while to truly become proficient at running a code.

 

[Summit]

Remember, once you get CAB covered, which is typically straight forward, and shocks going, you got time to think. You will be surprised how much thinking you can do in 30 seconds during a code. You'll think 10 minutes have passed.

Practice and simulation and experience are the best.

 

[Gurby]

As a brand new EMT, you likely won't be the one "running the code" (unless your partner feels like pushing you out of your comfort zone).

In a year of working as an EMT-B, I never really played a role with any responsibility during a code (other than doing compressions and BVM, which are huge responsibilities of course, but in a different way). Especially if you work in a tiered system, ALS should theoretically be going to those calls, and more often than not you'll just be a driver or a spare set of hands for compressions, etc.

Maybe I'm spoiled because here we get fire responding to pretty much every call... But any code I've been to there are always 10 other people who have done this a million times before, everybody pretty much knows what to do, and it's not a big deal.

 

[akflightmedic]

Just remember this...

A code is the easiest call you will ever run. The script very rarely changes. ***The patient is ALREADY DEAD*** They cannot get any deader!

It is the ones who are circling the drain, the ones who you cannot figure out what is going on or the ones who have multiple comorbidities all feeding one another at same time that are the scary cases to work.

A code is not a big deal, it is only the most "dramatic" one thanks to years of TV.

 

[Tigger]

I agree with the intent of the above post wholeheartedly.

However I'm not a fan of the "you can't make them more dead" line of thinking. Such thinking promotes throwing the book at these patients and providing interventions with no evidence. We do not know if these interventions actually make resuscitation or post ROSC care more challenging. While you could give every medication imagineable, that does not mean you should. Too many times I hear silly interventions justified with the "they won't get deader line."

 

[Nightmare]

Just remember that a full code is a possibility, my first call was a traumatic arrest and I was the only EMT there (small volunteer FD with transport) as a BLS provider running a code is really quite simple, secure the airway (OPA, NPA, head tilt chin lift, jaw thrust), while you're doing that somebody should be doing compressions, then its just a simple 30 to 2 ratio or 15 to 2 (god help you if thats your first code) and a heavy foot on the way to the hospital. Should ALS be there then its their code to run, they may ask you to get an airway but it is their code either way.

If you really are that concerned about it then ask some of your members to run through a full code on the manikins with you. First do it as a helping hand, then you lead it. Practice makes perfect, and in a situation like this if you practice it enough instinct will take over and you won't even know whats happening until its all over.

 

[akflightmedic]

I agree with the intent of the above post wholeheartedly.

However I'm not a fan of the "you can't make them more dead" line of thinking. Such thinking promotes throwing the book at these patients and providing interventions with no evidence. We do not know if these interventions actually make resuscitation or post ROSC care more challenging. While you could give every medication imagineable, that does not mean you should. Too many times I hear silly interventions justified with the "they won't get deader line."

My intent was about the poster's feelings/attitudes more than the poster's actions...big difference.

Trying to alleviate the fear, reluctance, insecurity aspect in order to clear the brain for logical thought and hopefully better care.

So...do not be scared, they are already dead. It is the living in front of you who will soon be dead that should concern you more.

 

[Tigger]

Hence the "I agree wholeheartedly with the intent" part.

But once people do get more comfortable, that attitude can get them into trouble.

 

[EpiEMS]

Codes can be scary. But, fortunately, they're scripted -- more so than anything else is, I'd say. Don't think too hard, just follow the script. My first code was scary, and I think that if I had thought less, I would have performed better. Since then, I've followed the script pretty closely, and it works nicely.

After your first code, sit down and think. And definitely talk it out if you're disconcerted in any way.

 

[GirevikMedic]

I sometimes take things really hard so there's no predicting how I'm going to take it either.

It's not your emergency. Learn from any mistakes you make and move on.

All the replies so far are pretty spot on but I just thought this was worth repeating and pretty much applicable to any call.

 

[Uclabruin103]

One thing I like to do when family is making the scene difficult is to have a member of the team pull them aside and get the story and demographic info for your pcr.

For me they were the most intimidating call to imagine and go through in my head, but if you can get past the nerves you'll do fine. Just practice practice and more practice with it.

 

[Uclabruin103]

And to make it a lot easier, do an initial assessment or reassessment on the person everytime, then get to work delegating and running the show. If you have multiple medics delegate everything away. Have someone scribe, someone on meds, someone on airway, and compressions. The calmer you can make yourself to be the calmer everyone else will be.

Nothing worse on a code than everyone getting amped up and rushing.

 

[DrankTheKoolaid]

When you do get that call take a deep breath. I know it's easy to say, but really it works. All it takes is just one long slow deep breath to allow you to get your thoughts together and slow the whole scene down.

 

[DesertMedic66]

The first couple of codes you get it will seem really confusing but it's not. IMPO it's easier to run a code than a normal call. Codes are very straight forward. As @EpiEMS stated they are scripted. First you do this, followed by this, and then this.

 

[k9Dog]

Just help your paramedic, get the equipment he needs, get the Epi out and other drugs if needed. Control airway, do compressions, basically whatever is not being done by somebody is what you should be doing. If airway and compressions are covered then spike a line, grab the drugs, position the gurney etc. A code is very simple. I used to be nervous too, That is normal. Over the years you will think it's a piece of cake.

 

[Chewy20]

and a heavy foot on the way to the hospital

Yeah, don't take that advice. You are more than likely having 3-4 providers in the back on the way to hospital. Let's not cause any unnecessary injuries. Slow is smooth, and smooth is fast.

 

[NomadicMedic]

Testify!

 

[SeeNoMore]

Yeah, don't take that advice. You are more than likely having 3-4 providers in the back on the way to hospital. Let's not cause any unnecessary injuries. Slow is smooth, and smooth is fast.

This is just great advice generally for EMS. Especially for new folks. Don't focus on being "fast". There is a huge difference between moving with a purpose and rushing. Those seconds you are trying to save turn into dislodged ETTs, breaks in CPR, accidents using Lights and Sirens, dropped patients, needle sticks, huge periods of time elapsing with no one noticing no repeat blood pressure has been taken, the patient has become bradycardic or hypoxic etc.

OP: I would suggest running through practice codes and making note of which interventions need to be performed in which order. When the call comes focus on the first task at hand and then move down the list. As you become more experienced you will of course learn to merge tasks and perform more fluidly. If you become overwhelmed or mess up just take a deep breath and act to correct the problem. Always return to the essential elements of a call. In the case of cardiac arrest : Are we performing high quality CPR? Are we prepared to assess whether defibrillation is needed and to deliver it? This just becomes more important when you are working a code ALS. Oftentimes providers fall into the trap of forgetting these elements in favor of intubation, IV access, med administration, checking blood sugars , giving Narcan, leaving the scene before an adequate resuscitation attempt has been performed. While you may not be in charge on ALS run codes, you can still perform a valuable service by making sure the core elements of cardiac arrest care are being performed diligently.

 

[Clare]

Just remember that a cardiac arrest is not medically difficult. The patient is already clinically dead so nothing you can do can make them any more dead. The most difficult part is often the family or bystanders, not the patient themselves.

Remember this: patients who leave hospital post community arrest with good neurological function do so by the basics being done very well and not because of intubation, IV access, IV drugs or anything else flash. High quality CPR and defibrillation will save more lives and brains than advanced things.

So, the most important aspect of running a cardiac arrest is high quality CPR and defibrillation.