August 14, 2006, 7:15 pm

Code a la Carte

Punchout.JPG

Doctor and Nurse Punch Out?

Now, I’ve seen “scream outs”.

And back when HIV/AIDS was an automatic death sentence, I watched a surgeon fling a contaminated chest tube across the room, tiny droplets of blood leaving a trail of infection to the sink twelve feet away.

I actually yelled at him!

“We don’t throw things in this ER!

Shocked the heck out of myself!

I’ve heard of kids “playing” doctor.

I preferred to play “nurse”, of course.

But I’ve never witnessed a punch out.

Not that I haven’t met doctors out there who needed a good punch, right in the kisser.

And a few that probably wanted to whack me a good one, too!

Thank goodness we are all professionals.

I’d rather be diplomatic than ecchymotic!

******************************

When a patient in the ER goes into cardiac arrest, the entire staff mobilizes to bring the patient “back”.

There are many roles to fill on the “Code Team”.

You can identify the personalities of the health-care providers by the role they assign themselves during the code.

Let’s look at who responds to the cardiac arrest patient and what their roles say about them:

  • The Emergency Department Physician. There are three personality variants here.
    • The Quiet Man
      • Never raises his voice
      • Wants no extraneous speaking or noise in the room
      • Gives orders in a soft, efficient manner
      • Wants only basic details from the medics.
    • The Cool Cucumber
      • Has an amost blase’ approach
      • Allows the medics to give report to the recording nurse and listens
      • No hint of emotion as he/she works their way down the algorhythms,
      • Is actually the most reluctant to actually “call” the code (stop resuscitation)
    • SuperDoc
      • The adrenaline in the room is palpable.
      • Gives orders in rapid fire fashion – if he orders Epinephrine, you had better have given it yesterday
      • Wants the blood results before the blood has been drawn.
      • Grills the paramedics down to what size Jockeys the patient is wearing.
      • Thinks the defibrillator takes too long to charge up to 360.
  • ICE (R)T – The Respiratory Therapist
    • This dude is totally down with the suction!
    • Able to handle two different suction catheters at the same time while..
    • Securing the ET tube and
    • Adjusting the vent settings with their left foot.
    • Able to avoid projectile emesis as they are at the head of the bed.
    • Wiling to give their life to maintain the airway.
  • The Monitor Maven
    • Steps up to the monitor and mans the defibrillator….
    • Because no one else quite remembers which button to push
    • Gets to stand to the side
    • She is the DEFIBRILLATOR! (Eat your heart out, Ahnold!)
  • ER RN Joe
    • Lives for the Code 3 ringdowns!
    • Gets into the down and dirty – every IV, blood, NG tube, urine, feces, stomach lavage….
    • Can push drugs, put in an NG tube and search for another IV, run a strip and do chest compressions. At the same time.
    • Pops the tops off the pre-filled syringes so hard they hit the ceiling before landing on the sterile field set up for the foley. Oooops.
    • Thinks documentation is a waste of time.
    • Adds four-letter words to the English language with every code.
  • Radiation Roberta
    • Shoves a film under the patient the minute circulation is restored
    • Is the only person who can clear a code room by yelling, loudly, “X-RAY!”
    • Tells the patient to “take a deep breath and hold it”, even if the patient is unconscious and ventilated. Some habits are hard to break.
  • Tigger the Tech
    • Has to maneuver around three bazillion people to get the EKG if there is a rhythm
    • Takes over compressions when ER RN Jim, reluctantly, has to stop to do other tasks
    • Is called Tigger because the ACLS guidelines now require so many compressions, he looks like “his top is made out of rubber, his bottom is made out of springs” (Disney referenence, for those with no kids).
  • The Scribster
    • Immediately screams out “I’LL WRITE!” when the Code 3 ringdown comes in
    • Sets herself up with a bedside table at the edge of the room
    • Writes meticulously consise notes, including the size of the patients Jockey shorts for SuperDoc
    • Uses paper towels when she has to write too fast for the notes to look good and writes the encyclopedic version later, even if she has to stay over to do it
    • Is suspiciously like yours truly
  • The Foley Fairy
    • Decides this is her mission in life, to place a foley in the coding patient
    • Synchronizes her Foley insertion with the exact moment of rapid-sequence intubation so that the catheter is in before the patient has a chance to become incontinent
    • Is not always truly appreciated for the wet beds she prevents and the ability to now monitor both urine outputs and core temps with her “tube”.
    • Thank you, Foley Fairy!

And our final member of the team:

  • Clean Up Cathy
    • Wanders about the room while the code is going on, straightening linen and picking up pieces of plastic caps and tubing off the floor.
    • Washes blood off the patient’s hands as he is being intubated because it doesn’t “look nice”.
    • Readjusts the contents of the IV tray as ED RN Jim grabs them by the fistfull
    • Disappears completely after the code so she won’t have to take care of the now resuscitated patient.

And that is what we in the biz call “The Code Team”.

******************************

Oh, and who does get to take care of the now resuscitated patient?

THE SCRIBSTER!

Yep, I get em’ every time…..

                      6 Comments


                      • Cassie

                        August 14, 2006 at 8:44 pm

                        This is so spot-on Kim! So finny, and strange, to have it pointed out though. What does it mean that I’m the Med Pusher Maven???

                        Cassie



                      • Intelinurse2b

                        August 15, 2006 at 11:52 am

                        you showed great restraint in not linking to Grunt Docs post about why nurses choose to cath during a code…lol. Funny post.



                      • DisappearingJohn

                        August 15, 2006 at 2:44 pm

                        Well, I recognize almost everyone from our unit, except at our hospital, one of the RTs does compressions, while another one handles the vent/ET tube etc… (yeah, we always get at least two RTs at every code)

                        I usually am “compression guy” until RT shows up. One of the female RT’s actually body-checked me off of a patient when she sowed up, and I’ve given her hell ever since.

                        From then on, I’m usually “gopher guy”. I try to anticipate what is going to be needed next, and hand it off to the “Drug pusher”..



                      • PDXEMT

                        August 15, 2006 at 10:57 pm

                        That’s great!

                        Someone should do a version for EMS. I know medics who will run a code sitting on the patient’s couch with the monitor on their lap. (Okay, just one, but still.)



                      • Chele

                        August 16, 2006 at 11:20 am

                        I remember the very first code I witnessed. I was a tech on a medsurg floor and a patient coded. As everyone rushed in and took over, I stood on a chair so I could survey the whole scene!! My first code as a RN, (on that same medsurg floor) it was me and a clueless house officer. As we stood there looking at the patient and each other, the patient stopped breathing. I yelled…hit the code button! as I climbed on top of the patient (yes actually climbed up on the bed a la dramatic movie scene) and started compressions. Nowadays, I’m more low key…but its always interesting.



                      • Michael L.

                        October 4, 2006 at 2:34 pm

                        Good info.

                        Herbal Man


                      About Me

                      My name is Kim, and I'm a nurse in the San Francisco Bay area. I've been a nurse for 33 years; I graduated in 1978 with my ADN. My experience is predominately Emergency and Critical Care, and I have also worked in Psychiatry and Pediatrics. I made the decision to be a nurse back in 1966 at the age of nine...

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