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best ran code while on call
Started by anesthesia11230
1) Commotio cordis in a 15-year-old. Shocked out of v-fib in the field. Unintubated and seizing upon arrival to the trauma bay. Thiopental induction, tube, post-arrest hypothermia protocol. Walked out of the hospital 6 days later. No neurologic squealae.
2) Post-op stent occlusion resulting in v-fib arrest. Prior bare-metal stent. Worked code in hospital room for 20 minutes, went to cath lab, had stent cleared, walked out of hospital 1 week later. No neurologic squealae.
3) Unwitnessed v-fib arrest in 58-year-old at a gym. CPR in field, sent to outside hospital, transferred to us, arrived to cardiac ICU (when I was on call one night) and initiated post-arrest hypothermia protocol. Started to bleed into chest and was difficult to ventilate. I put in a chest tube and got 900mL of blood. Patient coded afterwards, 20 minutes of CPR, resusciated and put on amiodarone and pressors, emergently to OR for thoracotomy with decortication. Walked out of hospital 10 days later with new AICD. No neurologic squealae.
Is that what you meant?
-copro
2) Post-op stent occlusion resulting in v-fib arrest. Prior bare-metal stent. Worked code in hospital room for 20 minutes, went to cath lab, had stent cleared, walked out of hospital 1 week later. No neurologic squealae.
3) Unwitnessed v-fib arrest in 58-year-old at a gym. CPR in field, sent to outside hospital, transferred to us, arrived to cardiac ICU (when I was on call one night) and initiated post-arrest hypothermia protocol. Started to bleed into chest and was difficult to ventilate. I put in a chest tube and got 900mL of blood. Patient coded afterwards, 20 minutes of CPR, resusciated and put on amiodarone and pressors, emergently to OR for thoracotomy with decortication. Walked out of hospital 10 days later with new AICD. No neurologic squealae.
Is that what you meant?
-copro
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Got called to the icu for a code, 80 something year old guy with chronic renal failure and a multitude of other problems, in icu due to a large stroke. Pt was already intubated in PEA nonshockable rythm, chest compressions, multiple rounds of meds PEA eventually asystole. I called it after about 20 minutes pt was asystolic. Nurse called the primary MD and I was writing his death note when I was asked to come to bedside (about 5 minutes later). Pt now had a rythm (very slow) and a pulse and was making some respiratory effort. He "lived" for another 2 days. I don't know how well run it was but it was pretty interesting anyway.
I was involved with this patient after she was "admitted" to the MICU (meaning she died in the ER before a bed was available) when I was an intern. She arrested in the field, was resuscitated and arrived in the ER with a rhythm and a pulse. Both were subsequently lost and CPR ensued. She was 80-something and looked like death anyway (frail, cachectic), and after a bedside TTE showed no cardiac motion, the code was called. As one of the nurses was removing the R2 pads, she could feel cardiac contracts (PMI) through the chest. Resuscitative efforts resumed, pt was intubated, given access, pressors, etc, but never woke up. The family withdrew support in the morning.
i got called as a resident to one of the medical floors for a code --- it was the 2nd week of July....
there were two nurses pulling in the code cart, two interns with their goofy/scared smiles and the nurse manager -
the intern said the patient was given a dose of dilantin IV for a seizure disorder and became unresponsive
i looked at the monitor - sinus rhythm...
i looked at patient - patient's eyes are bulging out and has a really off-color (blue/purple).
i looked at patient's chest - there are pieces of rice/green peas and chicken from his dinner
i opened patients mouth, took a Miller - saw a wad of chicken on his cords - used some McGill forceps (which thankfully at the time were part of intubation trays - don't know if they still are)... took out chicken chunk...
patient said "Thank You"
I told the interns that this had nothing to do with Dilantin IV
that was my best code call ever...
there were two nurses pulling in the code cart, two interns with their goofy/scared smiles and the nurse manager -
the intern said the patient was given a dose of dilantin IV for a seizure disorder and became unresponsive
i looked at the monitor - sinus rhythm...
i looked at patient - patient's eyes are bulging out and has a really off-color (blue/purple).
i looked at patient's chest - there are pieces of rice/green peas and chicken from his dinner
i opened patients mouth, took a Miller - saw a wad of chicken on his cords - used some McGill forceps (which thankfully at the time were part of intubation trays - don't know if they still are)... took out chicken chunk...
patient said "Thank You"
I told the interns that this had nothing to do with Dilantin IV
that was my best code call ever...
Nearly same situation two weeks ago 85 year old guy, over 1 hour code (not sure why), asystole, no movement on TTE, code called. 10 minutes later they see qrs's complexes on monitor. Oh S@#$. Dump in 2 pressors and code for another 5minutes. Sent to CICU for hyporthermia protocol. Withdrew care 3 days later. Moral of the story, call the code and take off the monitor leads. Do the patient, the family, and the medical system a big favor.
very important lesson. nothing worse than a patients family seeing random electricla activity while they are mourning their loved one.
Just saw this... Excellent! Never forget the "ABCs".
