Wayfaring MD

I am a family medicine resident who likes to highlight the hilarious in medicine as I write about patients, medical school, residency, medical missions, and whatever else strikes my fancy.



Disclaimer:
HIPAA is for reals, folks. All of my "patient stories" have been changed to protect patient privacy. I will change any or all identifiers, including age, location, race/ethnicity, sex, medical history, and quotes. Also, I am an anonymous internet person. Why should you trust an anonymous internet person to give you medical advice? Don't ask me, ask your doctor!
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Posts tagged "acls"
When you’re using the defibrillator, you’re going to want to take any jewelry off the patient that might get in the way. Usually necklaces. But if they have nipple rings, belly button rings, or rings in more private areas, they’ll just have to get electrocuted and get scarred. But that’s why God made cocoa butter.

The guy teaching our CPR / Life Support class. (via wayfaringmd)

During Advanced Cardiac Life Support recertification…

36-week pregnant L&D nurse is doing chest compressions on the dummy.

Wayfaring runs the code.

Wayfaring: don’t stop! Keep contracting! Faster contractions!

Nurse: *stops* Do you mean compressions?

Wayfaring: I mean…whatever. 

What are codes? - anon

Every hospital has “codes” that they will call over an intercom to alert employees to an emergency situation. For example, at my hospital, code red is fire, pink is a stolen baby, green is hazardous materials exposure, and gray is “code act a fool,” alerting security to come take care of some belligerent family members ;).

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The designations vary from hospital to hospital, but almost universally a "code blue" stands for cardiac / respiratory arrest. The code blue is the most commonly called code, and thus often is shortened to just “a code”. When we say that a patient coded, this is what we mean. 

Real life codes are WAY different than on tv.

When a patient is found in cardiac arrest, the first responder immediately starts chest compressions and calls for help. A team will come into the patient’s room with a crash cart containing various medications, a defibrillator, intubation supplies, and a heart monitor. While chest compressions are being done, someone else will assess the patient’s airway and likely will start giving breaths by a bag.

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You’ve seen this all on tv. What you don’t experience on tv is the simultaneously squishing and grinding sound of ribs cracking and rubbing against each other when CPR is done properly. They tend to gloss over the eternity that is the 2 minutes of chest compressions between every pulse check and epinephrine administration. You don’t experience the unmistakable smell of stomach contents as the patient vomits involuntarily and aspirates on their own gastric juices. They clean up codes on tv. They don’t want you to see a patient’s head flopping around with eyes rolled back or a nurse jam his hand into a patient’s crotch to try to find a central pulse. 

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On tv they show you two shocks (even in asystole, when you’re not supposed to shock) and the patient miraculously recovers with full brain function. They don’t show a chaplain explaining to family members that the patient has died and the team is trying to bring them back. And they certainly don’t show the transfer to ICU, the intubating, the starting of pressors, or the eventual exam to declare someone brain dead. 

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You see, only 11-35% of people who have cardiac arrest IN the hospital survive to discharge, and only 6-17% survive with good neurologic function (reported by he National Registry of Cardiopulmonary Resuscitation). So yeah, we can bring people back. Sometimes. But most of the time their brains are gorked. Codes are violent, messy, and often unsuccessful. They do occasionally save lives, but when it comes to me, hey, don’t code me bro. 

shanamaideleh replied to your quote: “V-tach, stable or unstable rhythm? What do y’all…

DOESN’T VTACH MEAN LIKE, YOU’RE DEAD?!

Well it can lead to death (and often does), but death is not always permanent. 

V-tach, stable or unstable rhythm? What do y’all think? Some people out there say if the patient is conscious, you can consider it a stable rhythm. I’m not so sure about that. V-tach really ups my pucker factor.

one of my recent ACLS instructors

In the next 2 weeks, I will have to take:

  • ACLS (Advanced Cardiac Life Support)
  • PALS  (Pediatric Advanced Life Support)
  • NRP (Neonatal Resuscitation)
  • ALSO (Advanced Life Support in Obstetrics)