# First mega code..



## legion1202 (May 17, 2011)

So.. Just im p3... 12 weeks left of school and I am done!!! its been a long 16 mos.. We started doing mega codes today in lab.. And wow.....

My team was the first team to go through and I was the code leader. We did fairly well but I made a few mistakes mostly because i was nervous. My mistakes were I  gave 25mg's of d50 when it should have been 25grams opps not enough.. And I choose to start a IV over putting my tube in first...

The guy was flat lined and my airway guy told me he had a opa and good bagging.. So I thought I could wait another round of cpr and and get some vaso and d50 in him. Then tube... Opps... The next coupe of groups killed people further and didnt know how to do cpr so I felt pretty good after my mistakes... God I love this :censored::censored::censored::censored:.B)


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## ArcticKat (May 17, 2011)

More info:

What was the presenting dysrythmia?
Was D50 the first medication you gave?  Why?

I see no issue with starting the IV first, AHA guidelines even changed to de-emphasize intubation in 2010.


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## Shishkabob (May 17, 2011)

Unless compliance is bad, our you suspect airway aa cause....line should come first. 


I have my EMT insert a King tube as I do the line. After we're set, I reevaluate the tube and decide if I need to do something further.


Codes take some getting used to running...give it time.


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## fast65 (May 17, 2011)

I agree with the others, don't sweat doing the line before tubing them, if an OPA and bagging is managing the airway just fine, then go ahead and get the IV first. 

Did they use a sim-man or did you just verbalize everything? I know when we started running megacodes, we just verbalized everything other than working the monitor and then my instructors switched it up and made us use the sim-man. You learn just how little time 2 minutes is lol.


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## legion1202 (May 17, 2011)

No d50 was the 2-3th drug I gave..The guys sugar was 4. Man had been down longer then 10mins, beer cans every where, He had a empty bottle of jack in his hand.. I was going through my H's t's at this point.. I tried to work this very fast. The rhythm was asystole and my first drug was vaso precision(spelling) of 40u. During the 10mins I got a tube, sugar, checked him over,and even got another line in. Should I have done more?


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## legion1202 (May 17, 2011)

we used a sim man


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## usalsfyre (May 17, 2011)

Treating the "H's & T's" should come before blindly following an algorithm. 

Don't worry about the tube, it's WAY down the ACLS priority list.


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## legion1202 (May 17, 2011)

usalsfyre said:


> Treating the "H's & T's" should come before blindly following an algorithm.
> 
> Don't worry about the tube, it's WAY down the ACLS priority list.



what do you mean.. I started treating his "heart" He was flat lined... Shold I have pushed the dextrose first?


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## ArcticKat (May 17, 2011)

legion1202 said:


> what do you mean.. I started treating his "heart" He was flat lined... Shold I have pushed the dextrose first?



No, what he means is that the Hs and Ts are are something to consider and correct throughout the code, from the very beginning.  Hypoxia is one of the H's, and it gets corrected right away, others are corrected for as you progress through the code.

At least I hope that's what he means

When you say the BGL was 4, do you mean 4 mmol/L?  Americans use a different measuring system and 4mmol/L would equate to roughly 72mg/dl.  Personally, high enough that I wouldn't have been concerned with spending time on D50 quite so early.  4mg/dl on the other hand is a different story.


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## usalsfyre (May 17, 2011)

legion1202 said:


> what do you mean.. I started treating his "heart" He was flat lined... Shold I have pushed the dextrose first?



If his BGL was 4mg/dl dextrose was the first drug to push, similarly, in a dialysis patient who's missed a few appointments in fib you should think about calcium right off the bat or the COPD'er in bradycardia PEA you need to be giving epi and getting good mechanical ventilation going. 

If you don't treat underlying causes you'll find your resuscitations to be wasted effort.


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## fast65 (May 17, 2011)

legion1202 said:


> No d50 was the 2-3th drug I gave..The guys sugar was 4. Man had been down longer then 10mins, beer cans every where, He had a empty bottle of jack in his hand.. I was going through my H's t's at this point.. I tried to work this very fast. The rhythm was asystole and *my first drug was vaso precision(spelling)* of 40u. During the 10mins I got a tube, sugar, checked him over,and even got another line in. Should I have done more?



vasopressin, also known as ADH


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## Chief Complaint (May 18, 2011)

Since you are just getting into them, megacodes are going to seem chaotic and tough to manage.  Trust me when i say this....it gets much easier. 

Once your ACLS algorythms become 2nd nature, things just start to fall into place.  With the help of a halfway decent teacher, you'll have your megacodes down in no time.


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## Akulahawk (May 18, 2011)

They do get easier... but remember that algorithms do change. Be able to change when they do. Also, as has been said already, keep considering the H's and T's during the code. There's no specific algorithm for those. Look for them, try to correct them, if possible.


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