Monday, January 27, 2014

two codes for the price of one

Yesterday we had two codes happen, at the same time, in beds 8 and 10. Yes, right next to each other.

We were all congregated around bed 10, who was getting a paracardiocentesis for cardiac tamponade. Exciting stuff. He was also on 100% FiO2, PEEP 20, nitric oxide, and two pressors (for non-ICU folks, just think MAX life support). Suddenly, alarms and the nurse in bed 8 yelling, "guys I need help!!!" Her patient bradied down, lost a pulse, and almost everyone (except the cards people who were doing the cardiocentesis) ran into bed 8 to code him. We did a round of epi and atropine, got a pulse back, and no sooner did we get it but we here shouting from bed 10. Everyone stampedes back over there, because he's gone into Vtach and the cards people are doing chest compressions.

We have only one crash cart for the ten beds on our south side and one for the other ten on the north side. Since we had just cracked a cart for bed 8 and he was wearing the defibrillating pads, we had to go running full speed to the other side of the unit for their crash cart. Hope no one over there codes now!

This brought a few nurses from the north side over to help us, as that side was currently coasting on easy and we were drowning. I had finished helping stabilize bed 8, so the code was in full swing in bed 10 and I asked around, "has anyone gotten the family?"

It's important to have at least one family member there to witness the code. We have someone stand with them, a nurse or social worker, to explain what is happening. We want them to see the sequence of events, so that it isn't a surprise, and so they can see how much effort we put into resuscitation.

The code was 15 minutes in, and everyone knew that this young man had a large, very involved and concerned family. I ran down the hall to the waiting rooms, asking anyone if they were here for him. I finally found someone, explained that he had gone into cardiac arrest, and asked her to come with me immediately. She got the wife, and the brothers, and we stood with them as they prayed and cried.

And he did not make it.

He had been diagnosed with AML on Sunday, at the ED, where he had driven himself for "flu-like symptoms". He had been admitted to the ICU with respiratory failure which turned into ARDS. He developed a large cardiac effusion, and then tamponaded. Seven days after his diagnosis of cancer, one week after eating dinner with his family on a normal weekend evening, and on the day of his birthday, he died after a 40 minute code. His family was hysterical. His wife looked bad, in shock, unable to cry or walk.

I carried them all home with me, last night.

(By the way, bed 8 recovered and as far as I know didn't code again that night.)

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