# My first code



## MissTrishEMTB08 (Aug 6, 2008)

Hi. My name is Trish, Ill be 20 years old on the 30th. I got my EMT license a couple months ago and havent been able to get a job. My apostrophe or quotation key doesnt work right now so Im not clueless as to what they are. Im currently in Medic school, about halfway through.

I am the cursed student. I never get anything good, a station could have a code every day for two weeks prior and the day that I get there they wont have a single call. At the hospital we always have a slow day with no patients.

Yesterday we were doing 16 hours at the hospital. Our clinical instructor dropped the ball so we have to pull doubles to get all our clinical time done on time. Yesterday everything changed.

I had my first ever code.

THe woman wasnt my critical patient. My critical patient was an 84 year old man with CHF struggiling to take every breathe. I was sure that I was going to see a code, because I was sure HE was going to code. My classmate had her. She was a 51 year old woman with a sudden on set of difficulty breathing while moving furniture. I watched her stabilize and then went to check on my patient and check in some rescues that came in. Suddenly, not five minutes later my insturctor was calling me back in.

I came in to see CPR and intubation in progress on that 51 year old. I had never done CPR before so I was excited when they told me to jump up as soon as my classmate took a break. My hands shook putting my gloves on. Suddenly it was my turn and Im pumping away on her chest. My hand placement is wrong so they slide my hand over an inch. It feels squishy and I can feel her bones breaking. My arms are tired. I look up at my classmate _Switch?_ So we switch, I grab the bag and he takes compressions. Im bagging now. 1...2...3...4...5 bag. 1..2...3..4..5 bag. Meanwhile I hear the nurses joking with the doctor and I cant help but think _This woman is dying! How can you joke?_ Her eyes are half open and fixed on the ceiling. I knew in the back of my mind. They push epi, atropine, more epi, more atropine. A student nurse jumps in to take over compressions and gives my classmate a rest. Im still bagging...1..2..3..4..5. bag. The doctor asks _Does anyone else know of anything we can try?_ Another nurse yells out _shock her just to see!_ But the doctor sighs and calls the time of death. \47 pm Tuesday August 5th, 2008. I dont know if Im supposed to stop suddenly so I bag once more and the nurses yell out _Stop it! Its over!_

My face goes red and Im fighting back tears. I was talking to this lady not too long beforehand. I turn around to throw out my gloves and lose it. My instructor tells me to go wash my face and well talk. I have just witnessed my first code, and lost my first patient. In the bathroom I grip the counter. I cry. I tell myself its ok. We did all we could. Im ok. Some people just die. But I dont believe it. I have a gnawing ache in the pit of my stomach that knots up as I hear anguished cries of the family.

Once I get out, Im ambushed by a group of the nurses telling me its ok, the first is the hardest, there was nothing left to do. They all tell me about their first, but I dont feel it was ok. A woman was dead. And 30 minutes later we were going to go have dinner like there wasnt a problem in the world.

We got out of the hospital at midnight. I came home, I tried to talk to my mom about it, she doesnt understand what it felt like, to have this womans life dangling in your hands, while youre listening to jokes from the nurses and RT. To have been talking to this lady one minute and come in to see CPR in progress the next. She shrugs. _You did your best _ and went to bed.

I couldnt get this womans face out of my head while I was trying to sleep. I couldnt help but think.. maybe if I hadnt of had to slide my hands over. Maybe if I had bagged faster... And her poor family. She was only 51. My mom is older than that.

How do you deal with it? Your first code? How do you get them out of your head and accept the fact their dead and you did all you could.


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## Jon (Aug 6, 2008)

The first can be tough... and sometimes we have other bad ones, too.

One thing you saw was the physician running the code ask if anyone had any other ideas... this is VERY common in a teaching hospital.

How can we joke? To quote Steve Berry... "How can we not?"
Humor, espicially dark humor, is a coping mechanism. It helps us ignore that we were talking with the patient 10 minutes ago.


As for eating: The patient died. You did what you could, so did everyone else. You need to take care of yourself... there isn't anything you can do for the patient.


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## legion1202 (Aug 6, 2008)

I know it is very hard. I am not a emt or medic yet but I did Loose a older lady while helping out with a roll over including kids. It was in NC while i was moving back to FL. My dad and I started cpr on a lady and the medics did not know what they were doing.. They didnt have the right equiment according to my dad. He is a retired cop/paramedic. I was doing compression why he was bagging for about 15mins. I was doing compression for what seem like 3 hrs. We did get a heart rate when we boarded on the Resue but  she died on the way to the hospital.

I had to drive home still and i was alittle confused and out of it. I asked my dad if i was doing cpr right and if there was anything else we could have done. My dad looked at me and said "son you can do 1 thing to one pt and they will live. But another pt might die doing the same thing with the same injuries". In this profession I think you need faith. If it is there time it's there time. I think you did all the right things. And trust me she wasnt going to live or die because you started doing cpr in the wrong spot of her chest. 

You didnt make her code, Nor did you put her in the hospital. Think of it this way.. You were there trying to help her in the last few secs of her life. Thats somthing to be proud of. You didnt freak out or Freeze while it was happening.. You did it. You did good.. But god had a diffrent plan and I know it sucks.

I still remember the ladies face and her kids who said thanks to my dad and I.
I`m sure  the next one will bother you. Its normal if you didnt care you arent human. People just deal with it diffrently then others. My dad and his old partner use to listen to music after a code or a bad scene. I hope I helped alittle..

Greg


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## Ridryder911 (Aug 6, 2008)

Not to sound callous but it's called.... Life. People live, people die and have since God created them. The only difference is NOW you are noticing it. Medicine is a business, when you work in it, it's just a job... nothing more, that's it .. Really, no heroic music, dimmed lights, and break to a commercial. 

Now, one should be the best and remembering it is just a job, one should deliver the best care and part of that care is empathy.. not sympathy ( yes, there is a BIG difference). 

One has to develop a sense of separation. For several reasons. One is maintain your own sanity, to be able to continue in this profession and to improve upon your care. Second, for the next patient. By remembering and thinking about the last patient, you are not giving 100% of your attention to that patient and they deserve and need it. 

Part of the problem in EMS is we teach way too much .."dream world visions". That the care we provide actually changes things, people get better when we treat them, and most people care about our profession. People die in high numbers, CPR is pretty much worthless (but it is the only thing so far we can do) and people become accustomed to their job. 

Like others describe, all have felt similar feelings and continue too, we better ever so often or we become jaded. Yes, if you continue onward you will find yourself doing the same.. you have to. Take time, look at the whole picture and attempt to get more exposure. Many can get through the transition and some don't ... nice to find out earlier.


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## Hastings (Aug 6, 2008)

> I came in to see CPR and intubation in progress on that 51 year old. I had never done CPR before so I was excited when they told me to jump up as soon as my classmate took a break. My hands shook putting my gloves on. Suddenly it was my turn and Im pumping away on her chest. My hand placement is wrong so they slide my hand over an inch. It feels squishy and I can feel her bones breaking. My arms are tired. I look up at my classmate Switch? So we switch, I grab the bag and he takes compressions.



Sounds exactly like my first arrest situation in the hospital. Actually makes me smile looking back. Well, all things considered, a good experience for you.

Edit: Oh, and as for never getting anything good...that'll change quickly. Especially if you have an internship. In fact, it's often the students that got nothing good during the program that get the wildest internships. Every time I was doing a ride-along at the fire department, they'd go from 12 calls in 12 hours the day before to 0 calls in 12 hours. At the private services, it'd be transfers and alcoholics. But as soon as I hit my internship, I had a critical patient every other day.


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## BossyCow (Aug 6, 2008)

This was your first code. So it carries a lot more emotional weight than it will when you have seen dozens of them. 

Be very careful of the tendency to  beat yourself up over what you could have, should have, might have done that would have changed this outcome. Especially since this was in the ER. If there was something else that could have made a difference, it would have been done. 

CPR doesn't cure anything. Doing picture-perfect CPR is not going to change the fact that this woman's body was not able to overcome the cascade of ill effects of whatever caused her demise. This was her emergency, not yours.

Very often new EMTs will see themselves as heros, fighting death against the odds, snatching the helpless pt back from the jaws of death. This is a very dangerous image because its impossible to maintain in the face of doing this job for any length of time. 

Those who last are those who are humbled in the face of the fragility of human life. Our job is to assist those who are going to make it, and to ease the passing of those who aren't. The decision is not ours, the outcome is not up to us and the results are what they are.

It does get easier. This is not a bad thing. It doesn't mean you have lost your humanity or your ability to feel. It means that you have increased your sphere of experience to include a familiarity with death. Hang in there, talk about it with those close to you. If you find that you can't get over it, find a therapist or other mental health professional to help you develop coping skills. Growth is generally painful at first.


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## el Murpharino (Aug 6, 2008)

It's pretty normal to feel the way you did about this patient after your code.  I think after my first code I was pretty bummed for a few days afterwards.  I accepted what happened, and moved on.  You can't let it consme you.  Learn from the experience, and accept that death happens.  It's part of the job.  It's not being cold hearted...it's the nature of the beast.  Before you know it, you'll be running a code while talking about the baseball game or arguing about what song to play on the radio.


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## mikeylikesit (Aug 6, 2008)

It happens all the time and sometimes you get used to it while sometimes you don't. i feel personally that is always bad to act off emotions or carry them with you because your more likely to make further mistakes.


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## Jeremy89 (Aug 6, 2008)

I can understand being emotional about it.  Being a guy, I was more shocked than saddened by my first code (also during ED clinicals, 52 y/o Male, started with resp arrest like yours).  I got to see the whole thing including intubation.  Once we called him (~40 minutes later) I got a pat on the back from the doc while he said "good job".

It doesn't seem like your ED team was very dedicated to saving the pt.  Hell, we pushed 4-5 rounds of Epi, plus Atropine, even went down to Sodium something or other.  They hooked up the defib and alternated pacing him with compressions.

After all that, we bagged him up for the coroner's office.  Then went and had a bite to eat.  Not like nothing happened, i mean we talked about it and everything, but you can only do so much.  I understand how you feel, but like Rid said, life happens.  Obviously she was meant to be elsewhere and you or the doc or anyone couldn't stop it.

I guess different people react differently in situations.  I channeled my feelings into a positive "what can I do better next time" attitude, where you chose to dwell on those sad feelings.

The first one is always tough.  My thoughts and prayers are with you, and hopefully you will do better next time!  Good luck!


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## Onceamedic (Aug 6, 2008)

My first code patient was 3 1/2 months old.  We could do nothing for the baby and after he was declared, the family became my patients.  I know I was a great comfort to the mother and I find a lot of satisfaction in that.  I can honestly say that it did not bother me.  Everything that could be done for that child was done and done well.  If something had been undone or done badly, then I would have been quite upset.  I got angrier in a case of a broken leg where I felt the patient was on the backboard for much too long.  I am not a cold person but as Rid points out, death is a part of life.  If it tears you up repeatedly, then you may need to reconsider your career choice.  Good luck to you.


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## mikie (Aug 6, 2008)

I've only had one 'code' so far and I probably won't stop dwelling on what I did wrong and what I could have done right.  Odds are the patient was already dead on scene, but it still makes me think, "what if I did better compressions" or "I should have done this before that" etc!

Do these thoughts go away?


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## rhan101277 (Aug 6, 2008)

I wanted to note, that during my ambulance drivers course.  Our instructor who was a paramedic, remembered his pt that died.  It was a 7 year old boy who was hit by a car while on his bicycle, he still remembers the face from 1988.  He said he could draw the way he was lying on the floor.


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## KEVD18 (Aug 6, 2008)

Jeremy89 said:


> It doesn't seem like your ED team was very dedicated to saving the pt.  Hell, we pushed 4-5 rounds of Epi, plus Atropine, even went down to Sodium something or other.  They hooked up the defib and alternated pacing him with compressions



i dont see where you get this at all. they did cpr, tubed, pushed meds; short of open cardiac massage, theres not much left to do.

4-5 rounds of meds? well, im sure R/r will be along to tell you that 3/5 of those were wasted. think about progressive ems systems. cpr/defib/2 rounds of drugs and if no improvement call it a day. since the overall results for cardiac arrest are pretty dismal regardless of setting, you'll see more of this type of code being run. the numbers just dont support the effort.

oh, and the sodium something or other was sodium bicarbonate.


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## emtjen15 (Aug 6, 2008)

*First Code*

My first coed was a lady who was about 6 months pregnant and had a PE.  I did not work her but the other crew did for the family's sake.  If was a difficult call. She had died before she fell to the floor.


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## Ridryder911 (Aug 6, 2008)

Jeremy89 said:


> It doesn't seem like your ED team was very dedicated to saving the pt.



Why did you say that? 

From what I read, they did far more than the usual. Most physicians will call off a code after the second round of medications. The old work-em days are over. If there is a question we will document in two leads and maybe check with u/s to verify no mechanical function (PEA) but that is very seldom. 

What I have seen is the usual code now lasts about maybe 10-30 minutes in duration if that long. If they arrived per EMS & demonstrated no response (with ALS) they are stopped immediately. 

R/r 911


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## MAC4NH (Aug 6, 2008)

You always remember the first one.  However, as many have posted so far, you have to learn to compartmentalize.  Unlike student clinical time, when you're out in the big, bad world, you won't have the luxury of spending time talking it over with your instructor, etc.  You'll have to clean up the bus, call back in service and go on to the next one like nothing happened.  As Ridryder pointed out, you owe the next patient 100% of your attention or you're not doing your job.  BTW, that next patient might become your first (or next) save.


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## Jeremy89 (Aug 7, 2008)

Ridryder911 said:


> Why did you say that?
> 
> From what I read, they did far more than the usual. Most physicians will call off a code after the second round of medications. The old work-em days are over. If there is a question we will document in two leads and maybe check with u/s to verify no mechanical function (PEA) but that is very seldom.
> 
> ...



Just the way she stated some things, it seemed like they didn't really care.  Though I did miss the part about Epi, Atropine, Epi, Atropine



MissTrishEMTB08 said:


> ...Meanwhile I hear the nurses joking with the doctor and I cant help but think _This woman is dying! How can you joke?_






> The doctor asks _Does anyone else know of anything we can try?_ Another nurse yells out _shock her just to see!_ But the doctor sighs and calls the time of death. \47 pm Tuesday August 5th, 2008. I dont know if Im supposed to stop suddenly so I bag once more and the nurses yell out _Stop it! Its over!_



Correct me if I'm wrong, Trish?


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## KEVD18 (Aug 7, 2008)

well, while it might seem crass, joking during serious events happens. code are mentally easy to work. these drugs for this rhythm, these drugs for that one, pump, blow etc. ive discussed dinner plans, sports, while working a code.

"does anybody have any ideas" thats also pretty easy. they had done everything in the book. the doc was asking for a left field i read about it an a journal idea. at that point, death was the only option other than something crazy. nobody had any decent ideas so he called it. thats sort of how codes end. 

i think your wrong on this one sir. everything that could be done was. and the op is, by her own admission a rookie who therefore hasnt "been there and done that" therefore her take on it isnt entirely reliable.


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## firetender (Aug 7, 2008)

...and, now begins your relationship with death.

Not a whole lot of people get to do this.

It's not particularly pleasant.

And sometimes you WILL feel like you're playing Tug of War with God,
but you won't talk much about that because it's just too nuts

At some point you'll have to look death in the face and see yourself.

(Not a whole lot of people get to do this.)

But there are things there to learn, and you'll have to experience your humanity to do it. 

Of course, you could always pile layer upon layer of insulation between you and your experience of it.

But then, insulation isn't porous, so nothing else gets in either.

It boils down to a series of new choices you'll learn to make.

They'll either allow you to move forward with new tools to use that are life-affirming for others in need

(in this way, death becomes one of your greatest teachers) 

...or withdraw into your own world where death has the upper hand.

And, yes, you can experience the pain without it getting to you. 

(It only gets to you when you hold on to it.)

 Life is nothing more than moments passing through you, and now, because of the work you do, some of these include death.

You're the one who decides how they are used.


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## Ridryder911 (Aug 7, 2008)

I have to admit out of the sight of the family, I joke, whistle and become very relaxed during codes. This occurs after I have seen that the patient is not responding to therapy. It usually relaxes the members of the team and myself. Their boring, methodically and usually a waste of time. Only on television does one see the dramatics and seriousness occur or when an emotional contact if the family is present. 

In a non-viable patients (as in 99.6%) of all cardiac arrests, the emphasis is to attempt to see if the patient will respond or not. It NOT inappropriate for the physician to ask.. "*Does anyone have any suggestions or ideas*"....Actually, AHA ACLS megacode highly suggests and promotes such ideas as being a team effort and usually is the last ditch. I honor the physician as doing so, they were actually following current standards. 

It's easy to come to the forums and judge, especially when one has not even performed the real job yet. Personally, I feel you cannot consider yourself experienced in codes until you have past the four digit numbers. When that occurs you will see and develop a different understanding of codes. 

R/r 911


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## MissTrishEMTB08 (Aug 7, 2008)

I dont feel the doctor gave it his all, simply because we pushed a few drugs, pumped for a little and called it a day.
My other two classmates (There are 3 medic students remaining at my school, me and two boys.) had talked about a code they had the week before. They worked that man for 2 hours, and they pushed so many drugs into him that they had to grab a second crash cart from another room. And this was the same doctor. The two patients were almost identical from what Ive heard. Both in their 50s, both didnt take too good care of themselves (This woman had a BGL of over 700 yet her family claims she wasnt a diabetic) both had a c/c of S.O.B. One was male, one was female. I dont feel it fair that the same doctor put two hours into one and 30 minutes into another. Why couldnt they have shocked? What would it have hurt? Who is to say that the asystole wasnt a very fine fib? Ive seen a rhythm strip like that. I know you dont shock for asystole but at that point why not? It wasnt going to hurt her any further. 

Im getting over it slowly, Ive never dealt with death on any level, so it was just a shock.

I did learn a lot. I saw agonal respirations, a couple of really good rhythm strips, listen to intubated breath sounds and feel the eerie coolness of her skin, feel what CPR actually felt like, watch an A-line and I got to BVM an actual patient and not a dummy.

Im not going to quit over this, I love EMS. I understand in the field you have to just throw it away and move back into service it just threw me for a shock and now Im over it and Im better and ready for the next code.


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## BEorP (Aug 7, 2008)

MissTrishEMTB08 said:


> Why couldnt they have shocked? What would it have hurt? Who is to say that the asystole wasnt a very fine fib? Ive seen a rhythm strip like that. I know you dont shock for asystole but at that point why not? It wasnt going to hurt her any further.


Because it is futile. I am sure that the physician or someone there took a good look at the rhythm and it was asystole and not VF. As for working the other patient for hours, it sounds like it was a waste of time. Maybe they had a slow day and needed something to do? I don't know...


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## upstateemt (Aug 7, 2008)

Ridryder911 said:


> I have to admit out of the sight of the family, I joke, whistle and become very relaxed during codes. This occurs after I have seen that the patient is not responding to therapy. It usually relaxes the members of the team and myself. Their boring, methodically and usually a waste of time. Only on television does one see the dramatics and seriousness occur or when an emotional contact if the family is present.
> 
> In a non-viable patients (as in 99.6%) of all cardiac arrests, the emphasis is to attempt to see if the patient will respond or not. It NOT inappropriate for the physician to ask.. "*Does anyone have any suggestions or ideas*"....Actually, AHA ACLS megacode highly suggests and promotes such ideas as being a team effort and usually is the last ditch. I honor the physician as doing so, they were actually following current standards.
> 
> ...




You makes some VERY good points, ones I hope the poster takes to heart. 

Many people enter the medical field with no more knowledge or experience than that provided by TV shows.  On TV almost everyone is saved by heroic medics or dr's in seemingly impossible circumstances.  In real life that simply doesn't happen, and if it does it's rare.  

The entertainment value of medical programs on TV is great, it touches  on an area (DEATH) that most people are uncomfortable with.  Unfortunately when lay people then bring their loved one in to the hospital they expect the same results.  

The number one cause of death is life.  All life ends in death.  In my 25+ years in the medical field I have always considered it an honor to be with a patient as they make that transition whether in the chaos of a code or in the peaceful quietness of a hospice patient that has been well managed.  

The poster needs to be very careful about judging the effort of the medical staff handling the code.  The calm exterior of the attending usually masks a frantic mental effort as every option is being considered.  It's a bit like the saying: "Be like a duck, calm on the surface and paddling like crazy underneath". 

Like Ridryder911 I tend to become very calm and casual in a code.  My fellow Cath Lab nurses always told me they would rather work a code with me than anyone else, my calmness always kept them calm.  It didn't mean I put any less effort into the code it just ment I realize that a requirement of a clear mind is calmness. 

It is normal to view a death with some saddness and regret but you do need to accept that death is a part of being an EMT and it is going to happen.  Some deaths have a more lasting impact on us that others, every death is a learning experience but death is something that anyone working in a medical profession needs to come to terms with.


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## firecoins (Aug 7, 2008)

upstateemt said:


> The entertainment value of medical programs on TV is great, .


were watching the same programs, right?


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## firecoins (Aug 7, 2008)

MissTrishEMTB08 said:


> I dont feel the doctor gave it his all, simply because we pushed a few drugs, pumped for a little and called it a day.
> My other two classmates (There are 3 medic students remaining at my school, me and two boys.) had talked about a code they had the week before. They worked that man for 2 hours, and they pushed so many drugs into him that they had to grab a second crash cart from another room. And this was the same doctor. The two patients were almost identical from what Ive heard. Both in their 50s, both didnt take too good care of themselves (This woman had a BGL of over 700 yet her family claims she wasnt a diabetic) both had a c/c of S.O.B. One was male, one was female. I dont feel it fair that the same doctor put two hours into one and 30 minutes into another. Why couldnt they have shocked? What would it have hurt? Who is to say that the asystole wasnt a very fine fib? Ive seen a rhythm strip like that. I know you dont shock for asystole but at that point why not? It wasnt going to hurt her any further.
> .



Did the other patient survive?  If the pt did not what was the point of the extra time spent with the other patient if it was just as futile.  He should called that one sooner and lengthed his time with yours.  Of course, that assumes rhythms other than asystole were not showing.


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## upstateemt (Aug 7, 2008)

firecoins said:


> were watching the same programs, right?



yea well, I'm being kind.


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## Jon (Aug 7, 2008)

> The entertainment value of medical programs on TV is great





firecoins said:


> were watching the same programs, right?





upstateemt said:


> yea well, I'm being kind.



I have to agree with Upstate. I can't help but laugh at times. Although the predictability of ER does get old.


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## Jon (Aug 7, 2008)

MissTrishEMTB08 said:


> I dont feel the doctor gave it his all, simply because we pushed a few drugs, pumped for a little and called it a day.
> My other two classmates (There are 3 medic students remaining at my school, me and two boys.) had talked about a code they had the week before. They worked that man for 2 hours, and they pushed so many drugs into him that they had to grab a second crash cart from another room. And this was the same doctor. The two patients were almost identical from what Ive heard. Both in their 50s, both didnt take too good care of themselves (This woman had a BGL of over 700 yet her family claims she wasnt a diabetic) both had a c/c of S.O.B. One was male, one was female. I dont feel it fair that the same doctor put two hours into one and 30 minutes into another. Why couldnt they have shocked? What would it have hurt? Who is to say that the asystole wasnt a very fine fib? Ive seen a rhythm strip like that. I know you dont shock for asystole but at that point why not? It wasnt going to hurt her any further.
> 
> Im getting over it slowly, Ive never dealt with death on any level, so it was just a shock.
> ...


MissTrish,

I'm happy to see you are still around. Too often, people post and don't come back to read our responses.


The hypergylcemic code you describe was likely a VERY rare occurrence. Additionally, the staff probably got ROSC (Return Of Spontaneous Circulation) several times... causing them to essentially start from the top of the algorithm every time the patient lost a pulse again.

As R/R and Kev said... often times, after 2 rounds of drugs and no changes, the asystolic patient is pretty much a lost cause, and is GONE.



> Why couldnt they have shocked? What would it have hurt? Who is to say that the asystole wasnt a very fine fib? Ive seen a rhythm strip like that. I know you dont shock for asystole but at that point why not? It wasnt going to hurt her any further.


Asystole is asystole. Additionally, if you DO get someone back after an extended downtime (30 minutes), they will be likely be a gorped-out vegetable with no quality of life, and they will live on a vent in the ICU for hours or days until the family pulls the plug.

30 minutes is a long time to work a code. I've seen many called faster.


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## MissTrishEMTB08 (Aug 7, 2008)

My instructor summed up everything perfectly for me today. He said:
_I guess the patient didnt realize that once you do CPR shes supposed to wake back up like in them movies! You know.. cough a few times, moan, then pop up like nothin ever happened and go runnin into the sunset with the doc.
Dont you know that 90% of the time you do CPR your patient is going to die? But its that 10% you keep truckin for. Some patients die no matter what you do, and some patients live no matter what you didnt do. Thats the way life is_
I love my instructor!
Thank you for everyone who posted, I really just needed to vent it off a little bit more than anything else, but I appreciate all the feedback, it has certainly given me a lot to think about and understand.


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## KEVD18 (Aug 7, 2008)

each code is different.

if the patient is in persistent vfib, or is constantly changing rhythms, they will work the code much longer than if the patient was in asystole, or converted into asystole shortly after arrival. also, you have to look at the cause of the arrest. traumatic arrests get called just as fast as the doc can manage since they pretty much define pointless. but a pedi code s/p choking will get worked until everybody in the hospital including the janitor is tired from compressions.

the extenuating circumstance's could be different. there could be something your missing because of your experience level. thats not an insult by the way, just a statement of fact. this was your first code. your just learning.


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## Ridryder911 (Aug 7, 2008)

Couple of things.. there is a difference of working a code to work it and then having to continuous working on a patient that codes. 

I have "coded" patients for several hours.. as an ICU/CCU nurse it was not unusual to see patients coding 5, 6, even 7 times in a shift. Do they make it? No. Yet, as long as the patient responds back and there is no DNR, you do what you have to do. Yes, it makes for a long shift...... and then comes the charting. 


I wish the statistics demonstrated CPR was 90% effective in reality it is <4% effective and even worse in a hospital setting... Consider, for every 100 patients you might get 4-5 back with a pulse... NOT a save but a pulse. That itself is a separate discussion, but most consider one that is a mentally functioning patient afterwards. 

Technically, if there was a procedure that was as bad in outcomes as CPR we would abanden and never endorse such.. but, since there is not and since there is nothing better we can do.. We have no other choice but to use it. 

R/r 911


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## mycrofft (Aug 8, 2008)

*The aftermath is what gets wierd sometimes.*

Some poeple get depressed, some are philosophic, others start looking for someone to blame, and some just head-down, clean the unit, and go back into service.

One of our folks above said it...99%-plus of these pts are *dead*. We give them their best shot, but most often the cause of clinical death is insurmountable despite any interventions.

Don't be confused about how you feel about a death, and don't expect everyone to feel the way you do. I feel that breast beating and scattering blame does the pt no service, nor the family. Talk to folks, including your religious or philosophical mentors, parents, professional counselors.


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## ILemt (Aug 8, 2008)

Ridryder911 said:


> I have to admit out of the sight of the family, I joke, whistle and become very relaxed during codes. _This occurs after I have seen that the patient is not responding to therapy_. It usually relaxes the members of the team and myself. *Their boring, methodically and usually a waste of time.*
> 
> R/r 911



I don't care how many codes you have worked, how long you've been in Emergency Medicine or what your pedigree is. This is the most callous insensitive load of smoke I have ever heard from anyone in healthcare. In the absence of a DNR, regardless of the present response to therapy, you work them til the end with your full attention and ability PERIOD. You do not lose your focus and you darn sure dont _relax_.
I wonder how many lawsuits and review boards you would face if the families of your patients ever came to hear you refer to their loved ones as a _waste of time_...

Save the jokes until after the pt is declared or the shift is over.


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## firecoins (Aug 8, 2008)

ILemt said:


> I don't care how many codes you have worked, how long you've been in Emergency Medicine or what your pedigree is. This is the most callous insensitive load of smoke I have ever heard from anyone in healthcare. In the absence of a DNR, regardless of the present response to therapy, you work them til the end with your full attention and ability PERIOD. You do not lose your focus and you darn sure dont _relax_.
> I wonder how many lawsuits and review boards you would face if the families of your patients ever came to hear you refer to their loved ones as a _waste of time_...
> 
> Save the jokes until after the pt is declared or the shift is over.



I happen to agree with him.


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## mdtaylor (Aug 8, 2008)

I'm curious about your compression/bag ratio. You said, 1..2..3..4..5..bag, ..1..2..3..4..5..bag...

Does the hospital where you did your clinicals use the 5:1 ratio still or have they conformed to the AHA standard and your post was just an anxious moment misprint?

The reason I ask, is that our teaching hospital ED director is also our medical director and he is quite adamant about consistency between the pre-hospital care protocols and the ED protocols.

Just wondering what CPR protocol is in that hospital....


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## MissTrishEMTB08 (Aug 8, 2008)

The CPR protocol in the hospital is compressions are continous once the ETT is in place, 1 2 3 4 5 bag was bagging every five seconds. I counted it in my head, we dont have the ResQPods yet. I wish we did, those are so freakin cool!


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## BEorP (Aug 8, 2008)

ILemt said:


> I don't care how many codes you have worked, how long you've been in Emergency Medicine or what your pedigree is. This is the most callous insensitive load of smoke I have ever heard from anyone in healthcare. In the absence of a DNR, regardless of the present response to therapy, you work them til the end with your full attention and ability PERIOD. You do not lose your focus and you darn sure dont _relax_.
> I wonder how many lawsuits and review boards you would face if the families of your patients ever came to hear you refer to their loved ones as a _waste of time_...
> 
> Save the jokes until after the pt is declared or the shift is over.



Tell me how many patients you have seen who are elderly, asystolic, unwitnessed arrests with no bystander CPR who survived to hospital discharge with good neurological outcomes. 

You can relax and still treat the patient appropriately. On any call I think that it is important to stay relaxed so that you can think clearly. But anyway, dead is dead. Let's stop living in the fantasy world of "Saved" where everyone has a chance.


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## mdtaylor (Aug 8, 2008)

MissTrishEMTB08 said:


> The CPR protocol in the hospital is compressions are continous once the ETT is in place, 1 2 3 4 5 bag was bagging every five seconds. I counted it in my head, we dont have the ResQPods yet. I wish we did, those are so freakin cool!



I gotcha.... that would be the same here. I just mis read the post a little... thanks.


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## upstateemt (Aug 8, 2008)

I think you are misinterpreting what Riryder911 is saying.  No where did the poster say they took the situation any less seriously.   All too often I have witnesses hospital codes that escalate to the point of hysteria when staff become so focused on a good outcome that they lose sight of "the right thing to do". 

As an ICU nurse, early in my career I all too often saw pt's "brought back" after prolonged codes, maintained on life support for days or weeks only to ultimately code and die. 

Keeping your mind calm does not mean you are not doing everything you can for the patient, every time.  A calm, centered person is much less likely to make a mistake than one caught up in the hysteria of the situation.

We are all guilty of being callous at times, can anyone of you say you have not made a unprofessional  comment to your partner after a call, or a non text book thought.  Even as we are doing everything we can for a patient there is nothing wrong with mentally acknowledging that this case will not have a good outcome.


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## upstateemt (Aug 8, 2008)

mdtaylor said:


> I'm curious about your compression/bag ratio. You said, 1..2..3..4..5..bag, ..1..2..3..4..5..bag...
> 
> Does the hospital where you did your clinicals use the 5:1 ratio still or have they conformed to the AHA standard and your post was just an anxious moment misprint?
> 
> ...




I assumed she was refeerring to bagging every 3-5, I often count in my head while bagging so as not to hyperventilate.


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## BEorP (Aug 8, 2008)

MissTrishEMTB08 said:


> The CPR protocol in the hospital is compressions are continous once the ETT is in place, 1 2 3 4 5 bag was bagging every five seconds. I counted it in my head, we dont have the ResQPods yet. I wish we did, those are so freakin cool!



ILCOR guideline is 8-10 breaths per minute when there is an advanced airway. And what is so "cool" about the ITD?


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## MissTrishEMTB08 (Aug 8, 2008)

Uhhhm... We were taught, and still are taught, that once every 5 to 6 seconds with an ETT tube. THat is how my instructor and the hospital staff do it. Thats how I do it.

I think ResQPods are pretty cool. They have a light that flashes when you ventilate and a valve that keeps air where its supposed to be. What isnt cool about them?


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## MissTrishEMTB08 (Aug 8, 2008)

We as in my class. Thats how I go by, is what Im taught in my class.


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## BossyCow (Aug 8, 2008)

> I guess the patient didnt realize that once you do CPR shes supposed to wake back up like in them movies! You know.. cough a few times, moan, then pop up like nothin ever happened and go runnin into the sunset with the doc.



Yeah, I call this "Baywatch CPR"


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## BEorP (Aug 8, 2008)

MissTrishEMTB08 said:


> I think ResQPods are pretty cool. They have a light that flashes when you ventilate and a valve that keeps air where its supposed to be. What isnt cool about them?


Could you please explain to me how it actually works in terms of keeping "air where its supposed to be"?


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## upstateemt (Aug 8, 2008)

http://orlandohealth.com/media/media_news_details.aspx?NewsID= 138


ResQPOD helps Code Team at ORMC   

Date : 06/15/2006  
Media Contact :  Sabrina Childress 
321.841.8748 
sabrina.childress@orlandohealth.com 

 ORLANDO, Fla. (June 15, 2006)

Restarting a heart after cardiac arrest is top priority for the Code Team at Orlando Regional Medical Center (ORMC). The ResQPOD? Circulatory Enhancer is a new device being used during cardiopulmonary resuscitation (CPR) to help the team of nurses, respiratory therapists and doctors restore an efficient flow of blood and oxygen to the heart, brain and other organs — with the hope of increasing survival and improved quality of life. “During basic CPR, a rescuer may use a portable respirator and hands to compress the blood to the heart and lungs to stimulate breathing and heartbeat which moves blood and oxygen to the brain,” said Terry Suarez, RRT, life support coordinator, Orlando Regional, and training coordinator for the Orlando Regional Healthcare American Heart Association Training Center. A challenge with CPR is the possibility of delivery of too much air, too often, making the compressions less effective. ResQPOD is designed to reduce the chances and improve the quality of CPR, bringing new hope of more lives saved. “ResQPOD, shaped similar to a cylinder, is a control valve that attaches to a bag mask valve respirator or a mask to help decrease the pressure in the chest to improve blood flow to the heart during decompression phase of CPR,” said Suarez. “Then with each compression, more blood will be pumped out to the brain and other vital organs. 

Imagine the heart is a sponge, this device helps fill up the sponge faster for the next squeeze. ResQPOD also flashes a light signal, to help clinicians maintains proper breathing rate and speed of compressions.” While it is estimated that more than 95 percent of cardiac arrest victims die before reaching the hospital, death from cardiac arrest is not inevitable. “CPR alone can double a victim’s chance of survival until more advanced care can be given,” said Suarez. “In the hospital setting, our Code Team always seeks ways to improve patient outcomes. In its winter 2005 guidelines for CPR and emergency cardiac care, the American Heart Association released new evidenced based guidelines that list Impendence Threshold Devices (ITD), such as ResQPOD, as a Class IIa device. We look forward to adding ResQPOD to our continued efforts in quality care for heart patients.”


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## BEorP (Aug 8, 2008)

Thanks, upstate. I have a full understanding of how the ITD works, but I was wondering if the OP did. It frustrates me to see an EMT who calls something "cool" and may or may not have an understanding of what it actually does.


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## upstateemt (Aug 8, 2008)

Since she is a new EMT perhaps you could show her a bit more tolerance.  We all started somewhere.


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## MikeRi24 (Aug 8, 2008)

to the OP: welcome to the wild and crazy emotional roller coaster that is EMS. Like others have said, usually after a couple rounds of drugs if you're not getting anything then its a lost cause. It also depends on the hospital and the doctors there at the time. For example, I know in my area that Hospital A generally is more willing to worke a code longer than Hospital B, and at Hospital C, you are lucky if you even get into a room before the doc calls it, and so on. Being in the ambulance is a little different. Do you have pts that will be talking to you one minute and you're doing compressions on them the next. I've had it happen. But most of the time,  you don;t know these people, they're already down when you get to them, and you'll never see them again in a half hour. You just do your job and thats it. You start to become numb to the whole death and sympathy for the pt after a while. Is that kinda sad? Yeah I guess but really after a while it just becomes part of your job. I've worked with some people are frantic as can be and rushing around trying to get stuff done as afast as they can when working a code and they just make everything so chaotic. My current partner has been a medic for quite some time and has been a fire chief for even longer, and when we work a code he's as calm as can be (I think he gets more excited over eating his lunch lol), does what he needs to do and thats it. 

2 Things to take away from this that I think might help you, because I know they helped me a LOT:
#1 It's not your emergency, its not your arm thats cut off and bleeding, its not you that coding, so why bother getting all excited about it? If you're freaking out, the other people working with you will freak out, and the pt will freak out and then everything is a mess. if you're calm, you will find it a lot easier to do what you need to do.
#2 In the world of EMS, you wear many different hats: EMS worker, psychologist, counselor, taxi driver, maybe some days your just someone for that old lady who has no one to talk to and is lonely. But above all, the one hat that you can never put on is God.


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## MissTrishEMTB08 (Aug 8, 2008)

BEorP said:


> Thanks, upstate. I have a full understanding of how the ITD works, but I was wondering if the OP did. It frustrates me to see an EMT who calls something "cool" and may or may not have an understanding of what it actually does.



Sorry. I wasnt aware you were the "How it Works" police. Jeez louise.


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## teehehe (Aug 8, 2008)

BEorP said:


> Thanks, upstate. I have a full understanding of how the ITD works, but I was wondering if the OP did. It frustrates me to see an EMT who calls something "cool" and may or may not have an understanding of what it actually does.



You're right. In order to call something "cool" you must demonstrate complete understanding of the device in question. I guess that means I can't call NASA's spacecrafts "cool" anymore because I'm not a rocket scientist. <_<


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## BossyCow (Aug 8, 2008)

And I suppose I can't describe Sean Connery as "Sexy" because I'm not sleeping with him.


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## Ridryder911 (Aug 8, 2008)

ILemt said:


> I don't care how many codes you have worked, how long you've been in Emergency Medicine or what your pedigree is. This is the most callous insensitive load of smoke I have ever heard from anyone in health care. In the absence of a DNR, regardless of the present response to therapy, you work them til the end with your full attention and ability PERIOD. You do not lose your focus and you darn sure dont _relax_.
> I wonder how many lawsuits and review boards you would face if the families of your patients ever came to hear you refer to their loved ones as a _waste of time_...
> 
> Save the jokes until after the pt is declared or the shift is over.



Obviously, you are not a professional provider and rather still in the embryo of EMS and medicine. You still think and believe what you see on t.v. as being actual and real. Get over yourself and your self righteousness of what you think medicine is like and than what it truly is. Not all of us get excited and teary eyed every time there is a sick person. The reason is because it is my job, a job that I do take extremely serious and do extremely well with great results and damned fine care.. Remember, take your job serious not yourself..

A monkey can perform a code. It is an obviously a cookbook steps. Obviously you do not even understand litigation...your patients cannot get any worse.. their dead!  

P-l-e-a-s-e get a taste of reality. Do you really think that there is not practical jokes performed during surgeries on a daily basis or their not listening to rock music during a heart transplant? ... Geez. get over yourself. Your naivety is grossly obvious. 

You are in a world of trouble if you think everything is dealt with seriousness. As well, you will be a short timer not realizing your  own limitations and how to deal with them. Either you will learn this is the "normal" reaction of most or not be able to "deal" with the day to day workings. I have seen many not "deal" with the work and attempt to be serious all the time, they don't last long either in the profession or in life.

It is called "black humor or gallow humor" as well. It is well documented as a stress relief by the American Psychological Association as a coping mechanism  for those in EMS and those that perform in stressful environments. We find things funny most do not. The reason there is few litigation's is because attorneys/judges understand and have it too. Don't believe me, just go into a judges chambers and hear the jokes being made. As well, humor may be called inappropriate to some but is NOT negligible. Where you may see it as tasteless, I see being over sympathetic to patient as disgustingly if one loose their objectivity. There is a BIG difference of being empathetic and sympathetic. Please leave the sadness and tears to the family and allow me to do what I am supposed to do.. take care of patients. Life does go on. 

I highly suggest to see and listen to Steve Berry's lecture of humor in EMS. Yet again, I doubt that you would understand. 

In regards to the Res-Q-Pod. The metro EMS near me have been using them for about 3 years. It started with big results and was the new next thing.. problem is now the numbers have changed and really do not see any evidence of outcome changes. 

Personally, these have been out long enough, we should had seen some major difference in numbers and at >$100 a unit an expensive toy. Again, arguably if one can really increase ATP per ventilation. 

I believe we will see it go to the waste side as a nice idea in theory but did not work out. 

R/r 911


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## firecoins (Aug 8, 2008)

Ridryder911 said:


> Do you really think that there is not practical jokes performed during surgeries on a daily basis or their not listening to rock music during a heart transplant? ... Geez. get over yourself. Your naivety is grossly obvious.
> 
> R/r 911


Thats odd!  I have seen rock music played during orthopedic surgery.


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## mikie (Aug 8, 2008)

firecoins said:


> Thats odd!  I have *seen* rock music played during orthopedic surgery.



Seen or_ heard_?


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## MMiz (Aug 8, 2008)

This thread, like many, has strayed from the original topic.  You're welcome to start a new thread to discuss the multitude of issues discussed in this thread.  If you continue with this thread, please keep the discussion on topic.


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## firecoins (Aug 9, 2008)

mikie333 said:


> Seen or_ heard_?



 watched them hit play on an ipod that played music. I heard that.  You hear waht I am saying or did you just see my post?


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## mikie (Aug 9, 2008)

firecoins said:


> watched them hit play on an ipod that played music. I heard that.  You hear waht I am saying or did you just see my post?



touchée good sir.  what's next, surgeons playing Guitar-Hero during surgery?  

[sorry to interrupt the thread!]


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## MissTrishEMTB08 (Aug 9, 2008)

Wow Rid. Your post came off as really condescending.


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## KEVD18 (Aug 9, 2008)

MissTrishEMTB08 said:


> Wow Rid. Your post came off as really condescending.



you'll get used to that....


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## Ridryder911 (Aug 9, 2008)

MissTrishEMTB08 said:


> Wow Rid. Your post came off as really condescending.



Sorry, tired of reading post from those that have little to no experience in medicine and attempting to inform us .. "how it is and should be".... 

Get some real education, accompanied by decade(s) of experience, then we can have a true debate. 

R/r911


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## mycrofft (Aug 9, 2008)

*At any rate...first code done, press on.*

Can we kill this thread now?


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## mervyn (Aug 9, 2008)

hi trish.
well i feel a little stange posting,im a lurker,from Wales UK  i find it all of interest but difficult to respond to.
Well ok i have been in the Ambulance Service for 36 years the last 12 - 13 years as a Paramedic Over the years i have seen and been involved in many tragic and sad situations,many being DOA on scene,and also many that have died while i have been trying to give them aid.The first Death to the last Death has had an effect on me the extent being on the circumstances,you should feel sad when you witness a deceased body,we are only human,but it is vital you dont dwell on this to long and get back to reality quickly,its true people die,and even while we try to give aid,its not to be,some one once said,once god lays a hand on a patient its time to take yours of,to true.
    While running a code,you must have no emotion but just concentrate on the situation to hand,once the code is closed,only then are you able to relax,even so be aware of the needs of any friends or relatives near,be calm and kind ,family can be a little difficult in these circumstances but rember how upset and shocked they will feel,if needs speak firmly but kindly to them.
The first time you are called to any type of situation,the first time you administer a  drug,or perform a procedure is a little tense,for you,and it is good to get the first time over with [more so if it goes well ] and time and experiance will come and it will make life a little better for you. Myself,i have been very lucky,for the last ten years i worked with a great partner also a Paramedic,after any dubious call or any difficult job we would talk the call through  on our way back to base,[ or as more often,on the way to the next call] and we would go over all the ifs and buts. The Humour i understand i have seen it over here,i understand the need for it,and if used with care its OK but has never been for me. I like to think i have a little more than a job,but i also know my limitations .I can only say, if you are lucky to have a good work mate,dont keep your concerns to your self, talk,it will help you both.    Best  to you.


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## firecoins (Aug 9, 2008)

mycrofft said:


> Can we kill this thread now?



does any one object to this?...........okay I am pronouncing this thread dead at 11am 8/9/08.


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## mervyn (Aug 9, 2008)

*Firecoins*

Sir
 I pluck up courage to contact the thread,and you then mark it dead.Things like this always happen to me.if i upset you with my post sorry i did not try to do so. Ah well back to lurking              Mervyn


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## VentMedic (Aug 9, 2008)

mervyn said:


> Sir
> I pluck up courage to contact the thread,and you then mark it dead.Things like this always happen to me.if i upset you with my post sorry i did not try to do so. Ah well back to lurking              Mervyn



Excellent post on codes and welcome!


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## Onceamedic (Aug 9, 2008)

firecoins said:


> does any one object to this?...........okay I am pronouncing this thread dead at 11am 8/9/08.



No jokes!  start CPR - minimum of 60 minutes and 15-29 rounds of drugs.  Get the defibrillator ready and be prepared to shock asystole!


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## mikie (Aug 9, 2008)

Kaisu said:


> Get the defibrillator ready and be prepared to shock asystole!



I didn't think you could shock asystole?


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## Onceamedic (Aug 9, 2008)

mikie333 said:


> I didn't think you could shock asystole?



It's a joke....   see OPs original comments..   I guess it wasn't that funny. :sad:


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## BEorP (Aug 9, 2008)

I liked it.


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## mikie (Aug 9, 2008)

Kaisu said:


> It's a joke....   see OPs original comments..   I guess it wasn't that funny. :sad:



Ok good, I wasn't sure if it was or wasn't.


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## rmellish (Aug 9, 2008)

But the real question, do threads on EMTLife have a code status? I vote pain management only...


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## KEVD18 (Aug 9, 2008)

nope. threads on emtlife are extremely valuable. the family isnt ready to let them go, so we must provide all possible measures to appease the watching family even if it means endlessly flogging them while pumping them full of drugs and electrocuting them.


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## Onceamedic (Aug 9, 2008)

and remember..  
they're not dead 'til they're warm and dead.....


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## rmellish (Aug 9, 2008)

Thats true, there are quite a few which get "rewarmed" consistently then worked again...


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## firecoins (Aug 9, 2008)

I am sorry but I was presented with a valid DNR.


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## mycrofft (Aug 9, 2008)

*I IM'ed Mervyn, but this one's a Nebraska.*

______________________________________________________________________________________________________________________________


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## Airwaygoddess (Aug 9, 2008)

*Mervyn, Welcome!*



mervyn said:


> Sir
> I pluck up courage to contact the thread,and you then mark it dead.Things like this always happen to me.if i upset you with my post sorry i did not try to do so. Ah well back to lurking              Mervyn



You wrote a great post!  Welcome to the tribe!!


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## MissTrishEMTB08 (Aug 9, 2008)

Hahahahahahahaha!  Kaisu, you witty thing you, thanks for the sarcasm. Really makes me feel like an idiot. Great job, gold star.


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## Onceamedic (Aug 9, 2008)

MissTrishEMTB08 said:


> Hahahahahahahaha!  Kaisu, you witty thing you, thanks for the sarcasm. Really makes me feel like an idiot. Great job, gold star.



lighten up Miss... it wasn't meant to make you feel bad.  It's good that you have an interest in EMS.  It's a great field but don't get offended when you make ignorant statements and get called out for them.  We all subject ourselves to the same risks when posting.  Rather than get offended, perhaps recognize that you don't know as much about codes as just about everybody else on this board and you certainly don't know as much as the doc in the ED that you critiqued.  Take it as an insult if you want to stay ignorant - or look at it as people who care enough to try and educate you; your choice.


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## mikie (Aug 9, 2008)

_______//\\/\/\/\/\/\/\/\\________/\/\/\/\/\/\/

uh oh...I'm seeing runs of V-Tach!  They're alive again (like in the movies/tv)!!


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## firecoins (Aug 10, 2008)

mikie333 said:


> _______//\\/\/\/\/\/\/\/\\________/\/\/\/\/\/\/
> 
> uh oh...I'm seeing runs of V-Tach!  They're alive again (like in the movies/tv)!!



Well the thread is cured. Well discharge immediatly.


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## mikie (Aug 10, 2008)

firecoins said:


> Well the thread is cured. Well discharge immediatly.



I was anticipating a shock!


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## MedicPrincess (Aug 10, 2008)

MissTrish-  I was once beating myself up for the outcome of a pt.  An OLD (yep, I said it... OLD as in over 40) Medic looked at me and said

"Is there anything YOU could have done different that may have changed the outcome of the patient? No, then stop being such a sissy!"

Now, I am not calling you a sissy....but the point he was so delicatley making was, the patient is dead.  She did it to herself.  Its called Lifestyle choices.  There are consequences.

I don't tend to dwell on my patients outcomes.  I have only gone back and checked on less than a handful of patients.  I just move on.  One of my very best friends, MUST go back and check on patients.  I have accompanied her to the ME's office while she found out what made a patient, who was CAOx4, code in front of us.  It helps her to have her "closure."

You have to find out what works for you.  Exercise, play with your kids, take a long nap, stand in a field and scream, talk to your partner, get a couselor if you have to.  If you are going to make it any length of time, you have to find your coping mechanism.  





> Yesterday 04:36 PMfirecoinsI am sorry but I was presented with a valid DNR.


 

You see.... the problem is.... Your DNR is not valid for me.  Sorry.  Haven't had a code or intubation in a while, I'm jumping all over the next chance I get 




ILemt said:


> I don't care how many codes you have worked, how long you've been in Emergency Medicine or what your pedigree is. This is the most callous insensitive load of smoke I have ever heard from anyone in healthcare. In the absence of a DNR, regardless of the present response to therapy, you work them til the end with your full attention and ability PERIOD. You do not lose your focus and you darn sure dont _relax_.


 

Why not relax?  Would you rather the provider working on your mother/father/sister/brother/whatever be wound so tight they could turn coal to diamonds?  A code is a code.  You do compressions, you bag them, treat the rhythms as they present.  You can still talk to the people around you, giving direction, finding out information, ect and still be effective. 

If you are relaxed while doing it, and not stressed out and wound up, it will go smoother.  Even if you work it and call it on the patients living room floor with family standing there.


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## ride2k (Aug 10, 2008)

I witnessed my first code while I was riding with the ambulance service I belong to. I didn't have any certifications (I'm almost done with class for EMT-B at this point) and I was standing in the back watching everything. The guy coded in the back and there was a paramedic and two EMT's with me watching. 

Fortunatly, everything happened quick. He coded while he was hooked up to the medic's heart monitor, and 2 person CPR was started quickly. Shortly after, the medic was ready to intubate.

We never found out what caused this to happen, for when we walked into the house, we were suspecting possible stroke, which was not the case. But we did get a letter a month or so later from the wife, saying that this guy had survived. He beat the odds, and I'm glad to say I was there to witness his survival.


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## emt19723 (Aug 12, 2008)

i was fortunate enough that we saved my first code. so that kinda made it a little easier when i did lose my first one.

but i gotta go along with everyone else....the really morbid senses of humor we develop is definitely a defense mechanism. if you cant develop one, you are doomed in this field.
and sometimes docs make the call and we dont like it. you just gotta keep your head high, and be satisfied knowing that you did everything in your knowledge and power as per protocols that you did all that you could. just do it a little better the next time and get the next one back and hopefully that same doc will be there to treat that pt and you can stick your tongue out at him!


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## emtd29 (Aug 14, 2008)

Trish,

People die. It's inevitable.

One thing you will learn is that you cannot win them all


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## BossyCow (Aug 14, 2008)

My first code also survived. When I left the ER the doc was having the 'it's time to make some decisions' talk with the family. I went on 4 more calls with that lady. Blind, stroked out, in her 90's, living in an adult foster home, no kids, grandkids just a distant great-niece who never visited by made the decisions for her care.


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## emt_angel25 (Aug 18, 2008)

the first code is always the hardest. it gets easier but its still pretty hard to know that you tried with all your might and someone still didnt live. you have got to be able to seperate your self from the "calls you run" or this job will burn you out. its tough and i know that my first code was almost 5 yrs after i got my liscense. you got lucky so to speak you got to experience something so dramatic so early. so you can ask your self "is this really for me" i dont know if i was helpful or not but dont beat yourself up cause there was nothing you could do to change the coarse of fate. its life you will never get out alive. losing a pt is rough but being there for a code when they survive makes it all worth while.


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## Aileana (Aug 20, 2008)

Everyone's first code seems to carry a lot more emotion than all the following ones. It's if every code induces that sort of response, you might want to reconsider. 

My first code, I remember every little detail still (and probably will through my whole career). Got him shockable, but it just didn't take. I remember in the hospital, the nurses were laughing because they had to bring me a stool to do my compressions from (I'm 5'1). Dark humour is a big part in emergency services, guess it helps with coping. After the patient was pronounced, I remember looking at him and saying 'goodnight', then going back to paperwork. 

But just remember (as pretty much everyone else has said), people live and people die. Life wouldn't be possible without death. As long as you did your best, stop second-guessing yourself. No matter how great one is treated, it doesn't guarantee a bring-back; the result doesn't necessarily reflect the effort. 

In EMS you will lose patients, it's just a fact of the job. Hopefully the next codes aren't as emotional for you


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## Jeremy89 (Aug 20, 2008)

Aileana said:


> I remember in the hospital, the nurses were laughing because they had to bring me a stool to do my compressions from (I'm 5'1)



I'm 5'11" and they still had me use a stool.  I think just for better leverage.


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