Monday, July 2, 2012

All Codes Are NOT Created Equal

  Due to low census, I worked all three shifts this week in the ED. I think there is a conspiracy brewing to convince me to transfer over, as everyone has been super nice to me and asking me if I like working there better than in the ICU. Every time someone asks me this question I am totally honest, they may share a lot of commonalities but they are two very different worlds and I enjoy both.

  For example, my last night on the red line (direct line to ambulance) buzzed and alerted us to a code coming our way. Teenage male found down in home in asystole and was headed our way in a hurry, ETA was about 10 minutes. I tagged along to see how the ED handles a code figuring that since it was looking like I might be spending a lot of time here I would get a feel for how things are done here.

  They opened the ambo room, it has big double doors that opens right up to the ambulance driveway so they can wheel the patient straight in. The code cart was wheeled in, IV start cart was brought in, and IV poles positioned. The staff began to divvy up tasks, two nurses assigned to starting large gauge IV, one nurse to record, two RT's to assist with intubation, three staff were assigned compressions,  one nurse was handling the code cart and meds and me, the runner. The Doc began giving the RT's orders on what to set up for intubation. Then we waited with the bay doors open wide, several minutes ticked by and then we heard it, the wail of the ambulance sirens. The ambulance pulled up and the lead EMT immediately gave report to the Doc.

  What followed next was 10 minutes of what looked nothing like an ICU code to me. If you watch medical dramas like ER and see those crazy, wild frantic codes with everyone yelling and it looks like chaos, well that is what an ICU code looks like. The code that I saw last night was clean, controlled and although the tension was coiled tighter than a bed spring there was no chaos, just a group of well trained people who knew their roles and worked like a well oiled machine.

  Afterwards I stopped to think about why I saw such a difference in that room and then it hit me. Preparation, because of the red line heads up everyone was ready for what was coming. Everyone knew their jobs and had some idea of what the situation was. In the ICU we don't get much of heads up, yes you can "see" a code coming by monitoring your patient well, but you can't predict when they are going to crash. This gives you little time to do more than nudge the code cart closer to the patients room so you don't have to run as far. 

  The other thing I noticed when all was over was that the staff seemed less impacted by the code. In my limited experience in the ICU, most people look a little shaken and need a moment to recover. The nurses in the ED returned to business rather quickly afterwards, very few of them looking overly shaken up. Perhaps just having that moments notice, having a minute to prepare mentally for whats to come really does help.

  As for me and what department I like better, I am unsure at this moment, but I can say with certainty that I am very lucky for this unique opportunity to try my hand at both the ED and the ICU and learn what I can from both. Not many newbies get such an opportunity, and I am truly grateful for it.


  1. Not many new grads get this opportunity! Congrats! Enjoy it!

  2. yes, that is super awesome!!
    we have to do a small rotation through the ER in a few months.
    i think we'll mostly be getting our practice in starting IV's and foley catheter's.
    i'm not super great under emergency pressure - good thing it ran so smoothly for you!

    1. It's awesome that you get the chance to go to the ED. If you can take a few hours in Triage. I know you don't get any skills like IV's there but you get a great chance to work on your assessment skills. I spent a day in triage and it helped me SO much when I started working.

  3. I have never seen an ED code, but I have seen plenty of ICU codes. I find that teaching hospitals have messy codes. It's chaos. It makes me want to slam my head into a wall. At the last place I worked at, everyone was calm and collected. There were no extraneous people. We just got it done. In the teaching hospital, residents run from all over the hospital to get in on the action. Thank god there's locks on the doors because I am sure it would be worse.


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