Code Blue

August 9, 2000

Dr. Karl

Running a cardiac arrest for the first time can be one of the most anxiety-filled experiences in residency. It's also your chance to save a life!

This issue, Q Fever!’s I&R correspondent, Dr. Karl Newman, walks you through an approach to: Code Blue.

Aaaaah, Codes! If residency is a plate of bubbling gruel, codes are a side order of buffalo wings.

It's like my senior resident used to tell me:

If you really wanna save a life,
A code's no time to call yo' wife!

Here's a little scenario to getcha in the mood. The code pager goes off: "Code Blue, 5-West, Code Blue, 5-West". You bolt outta the call room and run down the flight of stairs to the cafeteria. You quickly buy your last slice of pizza for the night, and sprint back to the elevators to wait impatiently for the elevator back to the fifth floor. You run down the hall to the room... it's time to run a code!

WAIT!It's an old rule but it still holds: before you do anything, take your OWN pulse. I like to take my intern's pulse too. If the medical student on the team is a cutie, I take her pulse also, but femorals are strictly out of bounds.

Now, here are a few quick rules to help you run a code like Dr. Karl:

1. Should The Patient Be Resuscitated?

Be sure and check with the floor nurses whether the patient is "DNR" or "CMO" before you begin resuscitation efforts. But remember: it ain't cool to avoid resuscitating patients just because you can't find the chart. As my senior resident used to say:

Primum non nocere,
semper vivici mostrere!

2. The ABCs

Remember these? Airway, Breathing, and Crowd control. Huh?!?! You heard me: crowd control. There's nothing to make hospital types rubberneck like the energy and excitement of a code. You don't need more than five people in the room to run it right, and that includes the poor guy gettin' the chest compressions! Be forceful. Janitors on smoke break, chaplains itchin' for action, unit coordinators fussin' with paperwork: tell 'em to cool their heels in the hall. Sez who? Sez you!And don't forget, you've got 360 joules of defibrillator firepower backing you up!

3. Everybody Clear…

The ACLS manual goes on and on about the potential dangers of defibrillator paddles, but once you've let loose with the juice a couple of times, they become a lot less scary. If you're the one operating the paddles, it's considered good form to make sure everyone's far away from the bed or gurney. Off the record, though, I can tell you this from experience: if the orderly happens to have a pinkie touching the bed-rail when you press the magic buttons, it ain't gonna do much except erase a little bit of recent memory.

Make no mistake about it: the defibrillator paddles are trés importante for the successful resuscitation of an arrest victim. I made up a little poem to remind myself how important they are:

Shock, shock, shock!
Everybody shock!
Pull up your sock,
And shock, shock, shock!

Feel free to use this poem to help remind yourself about the importance of the shocks!

4. Other Stuff

There's a bunch of drugs that are supposedly helpful too, but several of them have long, hard-to-remember names, and frankly, they're just not as enjoyable to administer as electric shocks. I generally avoid 'em. I also have a hard time remembering which drugs can be given down the endotracheal tube, but you can stay out of trouble by remembering this short list of substances which you should NEVER put down an endotracheal tube:

• Woolite
• Tapioca pudding
• Cat hairballs
• Snuff

5. When Your Efforts Are Unsuccessful

Let's face it: no matter how good you get at running codes, most times you will be unsuccessful. Even if things were pretty hopeless, I try to make everyone feel better by saying things like "don't blame me, 'cuz it's all the stupid intern's fault." Saying this in front of the intern will also keep 'em motivated to hone those skills for the next code...

...and remember: there's always a next code!!

“Just tell ‘em Dr. Karl sent ya!”

Remember: Quality Without The Q Is Just Uality!