My first code

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.
 
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.
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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...
 
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.

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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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.
 
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.
.
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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.
 
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.

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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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.
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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.
 
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.
 
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.
 
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
 
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.
 
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
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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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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.
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I happen to agree with him.
 
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....
 
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!
 
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.
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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.
 
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!
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I gotcha.... that would be the same here. I just mis read the post a little... thanks.
 
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.
 
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?

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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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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