Running codes as an intern?

[sean wilson]

Various stories abound regarding this issue, but what I've heard most commonly is that interns do not run them. Instead, residents handle them, though you might be pimped as to the right thing to do during the code or afterwards as an intern.

Anyone run codes as a fresh PGY-1?

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[apma77]

usually there is a code team that is already set in place at each hospital so the intern is hardly ever the one running the show...most code team mebers are well versed in acls and bls....you dont need to worry as an intern how to run a code,,just be a part of it

 

[lf777]

At my institution, interns participate in the code team, however the code leader is a PGY-3.

lf

 

[DrQuinn]

It depends. As an EM intern, my first day in the ED I ran two med resusc codes in the ED (with my attending behind me, but they let me do everything). On the floors as house officer, I would run the codes unless one of the senior residents wanted to take over.

If you're at a big institution, likely you will never be the only physician there. However if you're at a rinky dink little community hospital you may run it by yourself.

They're not as bad as you think. Just remember basics!

Q, DO

 

[DocWagner]

When I was an intern...if you new your stuff you could run it. All of the EM residents are expected to run codes as an intern.

 

[Apollyon]

When I did prelim IM, I ran two codes as an intern, when the PGY-3 didn't step up.

Today, it was liberating to call the code as soon as the pt came in, with ETCO2 of 5 and no cardiac motion on U/S.

 

[Sessamoid]

My first off-service rotation in residency was MICU, and I ended up doing all the codes myself because the 2nd year IM resident had a tendency to just sit around wringing his hands wondering what to do next.

 

[16846]

It depends. As an EM intern, my first day in the ED I ran two med resusc codes in the ED (with my attending behind me, but they let me do everything). On the floors as house officer, I would run the codes unless one of the senior residents wanted to take over.

If you're at a big institution, likely you will never be the only physician there. However if you're at a rinky dink little community hospital you may run it by yourself.

They're not as bad as you think. Just remember basics!

Q, DO

I've never heard an American use the term "House Officer" before. I thought this was strictly a European expression.

 

[joaquin13]

My first off-service rotation in residency was MICU, and I ended up doing all the codes myself because the 2nd year IM resident had a tendency to just sit around wringing his hands wondering what to do next.

how funny is it on rotations when you know more than interns/residents? I am a 4th yr student, my attending had me teach the new intern how to do a central line the other day (the poor intern didnt even know the LANDMARKS of the central line, leave alone how to suture it in!)

 

[Sessamoid]

how funny is it on rotations when you know more than interns/residents? I am a 4th yr student, my attending had me teach the new intern how to do a central line the other day (the poor intern didnt even know the LANDMARKS of the central line, leave alone how to suture it in!)

I had the same experience, having to explain and show an intern how to place a central line during my 4th year of medical school. Combination of luck and aggressiveness during medical school, I guess.

 

[Sessamoid]

I've never heard an American use the term "House Officer" before. I thought this was strictly a European expression.

It's not as commonly used in the US as it once was, but it's still understood by any of us in medical education. More common where I've been is referring to the residents as a group as the "house staff".

 

[DrQuinn]

I've never heard an American use the term "House Officer" before. I thought this was strictly a European expression.

Oh I forgot to mention that I'm at Tampa General Hospital in the republic of Brunei.

Yeah, at TGH the overnight intern who cross-covers the IM teams is teh "house officer." A small DO hospital in Clearwater where I did my third year rotations also had "house officers" to do night admissions and floor calls.

Q, DO

 

[njbmd]

Various stories abound regarding this issue, but what I've heard most commonly is that interns do not run them. Instead, residents handle them, though you might be pimped as to the right thing to do during the code or afterwards as an intern.

Anyone run codes as a fresh PGY-1?

Hi there,
I had to initiate and run a code as a brand new intern. It was in the middle of the night and I was the first on the scene. Fortunately, I had my ACLS manuel handy so I could flip through if I forgot anything. It really wasn't so bad since I had participated in several codes as a medical student.

Taking care of a crashing patient in SICU is much more difficult.

njbmd

 

[LaCirujana]

Residents at my program are "House Officers" (or H.O.'s, if you prefer) and yes, I had to run a code my second week of internship--one of my classmates had 3 codes his first night on call as an intern.

 

[notstudying]

I've never heard an American use the term "House Officer" before. I thought this was strictly a European expression.

We don't use the term that often, but we do use the expression "Call HO" on admit orders, which always makes me chuckle...

 

[Whisker Barrel Cortex]

I went through 5 months of inpatient wards q4d call without ever having a code. After that I had three. Many of the other interns had an average of 1-2 a night. I think I had a white cloud. I never ran one, but felt like I was when my upper level was indecisive.

 

[dobonedoc]

In our community hospital all of the interns have had plenty of experience running codes. At night we cover them with the code team. During the day we are expected to step up and run them, even if other physicians are present. Seems like we have had fewer "Code Blues" over the past few months, but perhaps it is because they do not cause the same level of anxiety they used to just 1 year ago.

 

[PGY2]

As an anesthesia resident, almost every patient we induced was like doing a mini code. Once you push that muscle relaxant you've made a stable spontaneuously breathing patient into one who will only survive if you can manage his airway and hemodynamics. As for running codes, anesthesia is probably the best in the hospital because its what we do everyday. Resuscitation drugs are our standard everyday drugs.

To all interns, dont worry, you will get comfortable with time... remember, check your pulse first!

Peace!

PGY5 (anesthesia pain fellow)

 

[thepretender67]

Just curious, do medicine interns run codes these days? Does it matter if you are prelim vs categorical?

 

[gutonc]

Yes and no. In that order. Although "run the code" is a relative term for an intern.

 

[link2swim06]

Codes are really pretty simple if your team is trained. If you can follow a recipe to make brownies you can follow ACLS. Especially if they are already hospital patients and you know you aren't doing a thoracotomy for penetrating injuries or some other crazy procedure. If it is only clueless floor nurses then it is less about your amazing medical decision making but more about your ability to herd cats and make sure the the algorithm is followed.

Peri-code is much more challenging. That isn't as cookbook and unlike the actual code your choices offer matter a ton (i.e. you gave cardizem to that a fib WPW rhythm, opps...now they are actually coding).

 

[Crayola227]

Someone once put it to me, "Running a code isn't as much of a big deal. I mean, the patient's already freaking dead at that point, how much more can you really **** it up? It's when they're crashing before they've died that is a big deal."

Ok, that's a little dramatic, but remember, if they have no pulse, as long as you start and keep the chest compressions going, you have plenty of time to play a head game with yourself: tell yourself you have all the time you need, all the time in the world to just take a step back, relax, take a deep breath, gather your thoughts, get out your ACLS, and follow the recipe. Doing this seems like it takes a lot of time, but it's only seconds, and staying calm with your wits about you makes the whole thing much easier and faster in the long run. The hard part is having a cool non-panicked head, and realizing that as long as the chest compressions are going, you do have the mere seconds it takes to run the card, AKA run the code.

Repeat after me: the chest compressions are going, I have time to think.

Or just talk all your admits into being DNR/DNI and you won't have to deal with it. You can just let them die, and dead patients are a lot easier. (OMG I AM J/K OK).

If this isn't a pulseless arrest, then they're still alive and live patients are scary and I don't know what to tell you. Living patients on the edge of death are above my paygrade.