Code Bag Contents

[h2oriderz]

What should be included in our code bags for those dredded floor code situations? And by that I mean, bare essentials. We have a code bag that weighs too much and needs to be streamlined, however I would like to do it in a safe way to make sure I don't get caught with my pants down when the moment arises.

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[Jeff05]

a fishing tackle box works well.
1. mac 3/4/miller2
2. lma 3-5
3. oral airways
4. tubes 6/6.5/7/7.5, stylettes
5. drugs: vasopressin, phenylephrine, ephedrine, epi, atropine, sux, roc, lidocaine, propofol, etomidate.
6. extra syringes, filler needles
7. 1-2 iv packs if you need to get access in a hurry and floor nurses are being floor nurses.
8. +/- topical anesthetic spray

 

[2ndyear]

I highly recommend taking it to an institutional level and having everything you want on the code cart that is stored on every floor. It's all fairly basic stuff for airway management. LMA's should be included in accordance with the difficult airway algorithm. I hate running around with a bag full of crap that should all be standard anyways. So I don't anymore, it's all right there.

 

[coprolalia]

I highly recommend taking it to an institutional level and having everything you want on the code cart that is stored on every floor. It's all fairly basic stuff for airway management. LMA's should be included in accordance with the difficult airway algorithm. I hate running around with a bag full of crap that should all be standard anyways. So I don't anymore, it's all right there.

The code cart is going to get opened anyway. Just have the crap on the cart. That way you don't have to take time to go find and then run through the hospital with a tacklebox in your hand.

-copro

 

[2win]

Just get a candle and a prayer book.....

 

[periopdoc]

Just get a candle and a prayer book.....

Isn't that what page 183 of Obama's Healthcare Plan outlines for emergent airway management?


- pod

 

[2win]

Isn't that what page 183 of Obama's Healthcare Plan outlines for emergent airway management?


- pod

2win

 

[pgg]

Isn't that what page 183 of Obama's Healthcare Plan outlines for emergent airway management?

Dunno, I heard that all of the pages past 12 were just left blank to save on printing costs, since they knew no one would read it anyway.



/ with apologies to Douglas Adams

 

[coprolalia]

a fishing tackle box works well.
1. mac 3/4/miller2
2. lma 3-5
3. oral airways
4. tubes 6/6.5/7/7.5, stylettes
5. drugs: vasopressin, phenylephrine, ephedrine, epi, atropine, sux, roc, lidocaine, propofol, etomidate.
6. extra syringes, filler needles
7. 1-2 iv packs if you need to get access in a hurry and floor nurses are being floor nurses.
8. +/- topical anesthetic spray

One more thing....

What's up with the lack of 8.0 tubes? Lately I've seen a plethora of very large people being brought into the ER - large males - with 7.0 tubes in. WTF? I took over a case of someone last week who was crashing and emergently intubated then brought to the OR for a perfed viscus. They put a GD 7.0 tube in this guy. And, he was a friggin' whale.

That just creates more problems post-operatively. Put the right size tube in, preferably at least an 8.0 in a male who is 140+ kgs.

Thank you.

-copro

 

[2win]

One more thing....

What's up with the lack of 8.0 tubes? Lately I've seen a plethora of very large people being brought into the ER - large males - with 7.0 tubes in. WTF? I took over a case of someone last week who was crashing and emergently intubated then brought to the OR for a perfed viscus. They put a GD 7.0 tube in this guy. And, he was a friggin' whale.

That just creates more problems post-operatively. Put the right size tube in, preferably at least an 8.0 in a male who is 140+ kgs.

Thank you.

-copro

Copro - the men in my family have a saying:
"The size is not important!"
When you have a "code blue" - you have to perform...
You can change it anytime in OR to a size 8...or in ICU. If the nurse (sorry the doctor nurse) will call you.
2win

 

[Fastrach]

Copro - the men in my family have a saying:
"The size is not important!"
When you have a "code blue" - you have to perform...
You can change it anytime in OR to a size 8...or in ICU. If the nurse (sorry the doctor nurse) will call you.
2win

Have you ever had a huge guy in whom you could put a 7.0 tube that you couldn't just as easily put an 8.0 in? Seriously?? I agree with Cop, just use the correct size tube from the get go and be done with it already......

 

[2win]

Have you ever had a huge guy in whom you could put a 7.0 tube that you couldn't just as easily put an 8.0 in? Seriously?? I agree with Cop, just use the correct size tube from the get go and be done with it already......

To reformulate -
Have you ever had a huge guy in whom you could put a 7 ett but not a 8?
Yes - I had.
I didn't disagree with Cop - i just said that in an emergency situation - and I stress emergency - I would really satisfied with a 5 tube IF this is the one that I can put in.
And the ever going debate 7 versus 8....Come on ...

 

[Fastrach]

To reformulate -
Have you ever had a huge guy in whom you could put a 7 ett but not a 8?
Yes - I had.
I didn't disagree with Cop - i just said that in an emergency situation - and I stress emergency - I would really satisfied with a 5 tube IF this is the one that I can put in.
And the ever going debate 7 versus 8....Come on ...

Point taken and understood, a suboptimal airway is indeed preferable to none at all.

 

[cchoukal]

the problem with stocking the code cart with airway stuff is that not all airway consults are 'code blues,' so you either have to break into the cart unnecesarily, go back to the OR and get what you want, or just wait (it'll be a code eventually!). my previous institution talked about stocking the floors with airway stuff and drugs, but the concern was that as soon as something is missing and 'anesthesia' shows up empty-handed, everyone knew where the finger of blame would point (squarely at us). So, we just kept carrying the code bag with a standard list of stuff (much like that described above, but with an intubating LMA, and a few other goodies). it never failed, though; each attg had their own ideas about what the resident should have with them, whether it was on the standard list or not, and the bag's contents just kept growing and growing...

The tube size issue is interesting to me. at my previous institution, the idea was 'go big or go home.' at my new place, it's just the opposite. I don't know what's behind it, but I'm not a fan. Dudes w/ 7-0's? Please.

 

[drccw]

Code situations or potential prolonged vent-> I place a #7.5 tube because of how often ICU patients get bronched. I almost never place a 8.0 tube.

on another note- how many different defibrillators do you guys have at your institution. I went to a code last week and they pulled a cart in with a defibrillator that nobody could seem to work (I think it was Phillips and they had Zoll pads on the cart). I walked around yesterday and saw 4 different defibrillators.

 

[Bertelman]

I used to be the "go big or go home" camp. I thought it was masculine to stick the biggest tube I could find in that hole. I'm a little more reasonable now, typically placing a 7.5 for males and 7.0 for females, but I'll quickly go up a size if they look large (which is most of the time).

 

[pgg]

For elective outpatient cases, the largest tube I'll use is a 7. There is no reason to put in anything bigger, and smaller tubes do reduce postop sore throat discomfort.

Anyone who might go to the unit postop gets an 8 to make the bronchs easier. In a code, a virgin trachea gets an 8 for the same reason. The fat mofo that's been vented for a week before self extubating ... still grab the 8 first, but I'll have a smaller tube with a stylet ready just in case airway edema makes things difficult. Nothing like trying to shove an 8.0 tube into a 7.5 hole.


As for the code bag, I'd rather go with my eyes taped shut than rely on whichever clock-punching clueless clown of a floor nurse/tech/janitor stocked & inventoried the crash cart months ago. I've seen nurses tube orders to the pharmacy for drugs needed in a code before. Bring your own.

 

[Fastrach]

I've seen nurses tube orders to the pharmacy for drugs needed in a code before. Bring your own.

Friend of mine said once she ran to a code since she was nearby but didn't have time to grab an airway box. Asked for some epi & the nurse said she'd need to put the order in the computer first.

 

[2ndyear]

Friend of mine said once she ran to a code since she was nearby but didn't have time to grab an airway box. Asked for some epi & the nurse said she'd need to put the order in the computer first.

Unbelievable. This is a Joint Commission thing by the way. Making healthcare safer for all... I wonder what would happen if it were a JC family member coding. Are they still for locked drugs and carts at all times?

 

[pillowhead]

I responded to a code and was about to intubate a basically dead patient in the middle of resuscitation when one of the nurses in the room said we needed to stop and do a time out before we intubated because it was an invasive procedure. She wasn't kidding either.

I don't think I've ever barked such a strong response to a nurse in my life.

 

[pjl]

I responded to a code and was about to intubate a basically dead patient in the middle of resuscitation when one of the nurses in the room said we needed to stop and do a time out before we intubated because it was an invasive procedure. She wasn't kidding either.

I don't think I've ever barked such a strong response to a nurse in my life.

That nurse was just begging to do a "sux race"

Our bag:
2 tubes (7 and 8)
1 LMA
1 bougie
2 blades (Mac 3, Miller 2)
A little drug bag - Etomidate, sux, calcium, epi, phenylephrine, atropine, vec, saline
A few different IV sizes
Some 12 cc syringes with needles
Plus whatever the guy before you felt it was imperative to have - sometimes it feels like this includes a teddy bear and a brick.
We have a pretty small bag, which almost never actually gets cracked into because normally by the time we get there the code cart is open and the code intubating supplies are available

 

[rsgillmd]

This is about 1-2 years old. When I went to the floor intubations we had:

1 6.0 Tube
1 6.5 Tube
2 7.0 Tubes
2 8.0 Tubes
1 9.0 Tube
Mac 3/4/Miller2
2 Stylets
1 LMA 4
1 LMA Fastrach 3
1 Bougie
2 EtCO2 detectors (paper but last year we started carrying the digital with us)
Tape/Oral Airways/4x4s/Tongue Depressors/Long soft suction catheter
1 McGill's Forcep
2-3 10 ml syringes
2-3 blunt needles

The drugs were carried by the resident (so you don't have to worry about old drugs sitting at room temperature for a while). I carried Etomidate/Propofol/Lidocaine/Sux

When I was on I would also toss in a 14 ga. angiocath with a 3 ml syringe, mainly because I was paranoid -- never had to use it.

Also in my lab coat I would have a stubby handle and Miller 2 blade because I've arrived on the floor to find there was no light. This was much more common before the hospital changed from the standard handles/blades to the fiberoptic handles/blades.

I used to try to put a size 8 in just about everyone for a floor intubation. The particularly huge patients I would try to put a size 9. I occasionally had to go down to a size 7. Only twice did I have to go smaller (once 6.5 and once 6). We didn't have half sizes for tubes above 6.5 at Maimonides. While I tried for a size 8 in all floor intubations, a small tube is better than no tube in an emergency. You can always try to change it to a bigger size later.

 

[lord_jeebus]

I didn't realize how extreme our bags are...

Drugs: Etomidate, roc, sux, neo, ephedrine, and saline flushes pre-drawn by pharmacy every 24 hours, code drugs, plus a vial of almost everything in our carts in a separate pocket with syringes and blunt-tip needles.

Airway: 2 handles, 4 blades (Miller 2/3, Mac 3/4). 6/7/8 tubes, styletted. Bougie, various sizes of oral airways and nasal trumpets. Suction catheter. Cric kit. CO2 detector, esoph bulb. McGill forceps. Several flavors of LMA. There is also pediatric airway gear in the bottom of the bag with smaller sizes of everything.

Mapleson and 2 sizes of face mask. Tape. IV and A-line stuff. Yankauer suction tip.

Billing sheets.

I'm sure I'm forgetting some things - this bag is probably too large to take onto a plane as carry-on.

 

[Bertelman]

I didn't realize how extreme our bags are...

Drugs: Etomidate, roc, sux, neo, ephedrine, and saline flushes pre-drawn by pharmacy every 24 hours, code drugs, plus a vial of almost everything in our carts in a separate pocket with syringes and blunt-tip needles.

Airway: 2 handles, 4 blades (Miller 2/3, Mac 3/4). 6/7/8 tubes, styletted. Bougie, various sizes of oral airways and nasal trumpets. Suction catheter. Cric kit. CO2 detector, esoph bulb. McGill forceps. Several flavors of LMA. There is also pediatric airway gear in the bottom of the bag with smaller sizes of everything.

Mapleson and 2 sizes of face mask. Tape. IV and A-line stuff. Yankauer suction tip.

Billing sheets.

I'm sure I'm forgetting some things - this bag is probably too large to take onto a plane as carry-on.

That's kind of ridiculous. It's reached far beyond the realm of emergency airway mgmt when you include stuff for IVs and A-lines.

Is there still room for a laptop and an iPod?

 

[anesthesiadoc]

I don't get rattled by much, but I've taken a big issue with the rest of the code team trying to stick the patient for blood gasses during codes. what do they expect to find? I've told them to stop, picturing interns sticking themselves during chest compressions as I'm doing my laryngoscopy. How does the gas change management, I've repeatedly asked. If you get a gas during a code with chest compressions and without a controlled airway, I predict a mixed metabolic and respiratory acidosis... usually get it right.

Chris

That's kind of ridiculous. It's reached far beyond the realm of emergency airway mgmt when you include stuff for IVs and A-lines.

Is there still room for a laptop and an iPod?

 

[Arch Guillotti]

Personally I hated lugging all that crap around in the airway sack. And I think aline setups ans circuits are ridiclous.

HOWEVER, I went to some codes in prety unusual and remote spots - MRI scanner, parking lot, outpatient office, rehab center. I can pretty much guarantee that the code cart was dysfunctional in all these places (f it even existed in the first place). Personally, I always checked the bag when I was responsible for carrying it because there was no guarantee that the guy before me replaced what he used.

Essentials:

Couple od et tubes, oral airways, np airways etc.

Functional lights on the blades (mac 4 esp)
bougie
FTLMA

the rest of the stuff i didn't get too excited about. I always carried a sack full of my own goodies. Despite my aversion to those idiotic calls in the middle of the night after some ******* (usually GS) toad induced and tried to intubate some fat trauma person in c collar, I usually liked the adventure of an airway call. There was something gratifying about hearing an audible sigh of relief that "anesthesia is here". I also kind of liked carrying around a big bag of mostly mysterious syringes.

 

[Gimlet]

HOWEVER, I went to some codes in prety unusual and remote spots - MRI scanner, parking lot, outpatient office, rehab center. I can pretty much guarantee that the code cart was dysfunctional in all these places (f it even existed in the first place).

Wow, parking lot? I think that would be a call to EMS around here rather than an overhead page inside...sounds a little silly, but I think it makes sense when you think about how much better equipped they are to handle things in the outdoors. Our parking lots are huge, though.

There was something gratifying about hearing an audible sigh of relief that "anesthesia is here". I also kind of liked carrying around a big bag of mostly mysterious syringes.

I remember making that sigh a couple of times during M3/4 year while watching an intern flail around at the head of the bed. Can't wait to be the one prompting that sound...

 

[MErc44]

I also think that the code bag should be stocked with face masks that are used in the OR. Had to use the ambu bag in the pacu the other day and the mask it comes with is a piece of sh@t.

 

[cchoukal]

I've somehow been nominated to find and purchase a new airway/code bag for the residents to carry around -- our old one is being retired because it's falling apart. We're looking for something medium-sized to carry around a case of basic induction meds and pressors, some LMAs, a bougie, syringes, etc (ETTs, blades/handles and oral airways are already stocked everywhere in the hospital in pre-packed intubation trays). Also something sturdy and professional-looking. Any recommendations based on experience with a certain brand/bag?

We used a rolling bag, which I think worked well. Something like this:

http://www.victorinox.com/product/4...1;jsessionid=3FA6DC2116D17DEF0E9B5AD1B48D611E

but with wheels that were a little more butch. It took a beating and needed to be replaced annually, but it worked pretty well.

 

[psychbender]

I've somehow been nominated to find and purchase a new airway/code bag for the residents to carry around -- our old one is being retired because it's falling apart. We're looking for something medium-sized to carry around a case of basic induction meds and pressors, some LMAs, a bougie, syringes, etc (ETTs, blades/handles and oral airways are already stocked everywhere in the hospital in pre-packed intubation trays). Also something sturdy and professional-looking. Any recommendations based on experience with a certain brand/bag?

I used one of these as a response bag at one of my old jobs, and tried to get it adopted as a replacement code bag at my program (instead, we kept the gigantic bag-o-random-crap that we have now, which is almost as large as some of our residents).
http://www.lapolicegear.com/tabaoutbag.html

Or the slightly larger variant:
http://www.lapolicegear.com/jumbo-bailout-bag.html

 

[Idiopathic]

This is about 1-2 years old. When I went to the floor intubations we had:

1 6.0 Tube
1 6.5 Tube
2 7.0 Tubes
2 8.0 Tubes
1 9.0 Tube
Mac 3/4/Miller2
2 Stylets
1 LMA 4
1 LMA Fastrach 3
1 Bougie
2 EtCO2 detectors (paper but last year we started carrying the digital with us)
Tape/Oral Airways/4x4s/Tongue Depressors/Long soft suction catheter
1 McGill's Forcep
2-3 10 ml syringes
2-3 blunt needles

The drugs were carried by the resident (so you don't have to worry about old drugs sitting at room temperature for a while). I carried Etomidate/Propofol/Lidocaine/Sux

When I was on I would also toss in a 14 ga. angiocath with a 3 ml syringe, mainly because I was paranoid -- never had to use it.

Also in my lab coat I would have a stubby handle and Miller 2 blade because I've arrived on the floor to find there was no light. This was much more common before the hospital changed from the standard handles/blades to the fiberoptic handles/blades.

I used to try to put a size 8 in just about everyone for a floor intubation. The particularly huge patients I would try to put a size 9. I occasionally had to go down to a size 7. Only twice did I have to go smaller (once 6.5 and once 6). We didn't have half sizes for tubes above 6.5 at Maimonides. While I tried for a size 8 in all floor intubations, a small tube is better than no tube in an emergency. You can always try to change it to a bigger size later.

what

 

[Idiopathic]

I remember making that sigh a couple of times during M3/4 year while watching an intern flail around at the head of the bed. Can't wait to be the one prompting that sound...

yeah its nice for the majority of times when you can get it but the silence when you cant is easily the worst sigh youll ever hear. im lucky in that of my 300+ floor intubations as a resident there was only one that i couldnt intubate (ended up blind nasal) but it was by far the most difficult patient ive ever encountered

be ready for anything in a code. take the most complicated patient youve ever had in the OR...and give them a variceal bleed - thats your ideal floor code patient!

 

[Narcotized]

I didn't realize how extreme our bags are...

Drugs: Etomidate, roc, sux, neo, ephedrine, and saline flushes pre-drawn by pharmacy every 24 hours, code drugs, plus a vial of almost everything in our carts in a separate pocket with syringes and blunt-tip needles.

Airway: 2 handles, 4 blades (Miller 2/3, Mac 3/4). 6/7/8 tubes, styletted. Bougie, various sizes of oral airways and nasal trumpets. Suction catheter. Cric kit. CO2 detector, esoph bulb. McGill forceps. Several flavors of LMA. There is also pediatric airway gear in the bottom of the bag with smaller sizes of everything.

Mapleson and 2 sizes of face mask. Tape. IV and A-line stuff. Yankauer suction tip.

A Mapleson Circuit?? Or how bout all 6, A-F?
For our emergent floor intubations we prefer open drop induction with Schimmel masks.

Agree with pgg; bring your own. Nothing more annoying during a CODE than hearing, "Can someone see if we carry that in the Pixis?"

 

[fakin' the funk]

That's kind of ridiculous. It's reached far beyond the realm of emergency airway mgmt when you include stuff for IVs and A-lines.

And yet...

Called to a code on a tubed pt, septic shock, 4 pressors going, PEA...no A-line. When circulation was restored, used the code bag contents to place a femoral A-line. ICU nurses didn't even know where that stuff was kept. Medical residents hadn't thought of placing one.

Called to a code in medical records -- someone's family member was having a seizure. This is in the basement, floors away from any IV start kits or equipment rooms. ...Other than the stuff in the code bag. Popped in a foot IV and the pharmacist supplied the lorazepam.

 

[fakin' the funk]

I didn't realize how extreme our bags are...

Drugs: Etomidate, roc, sux, neo, ephedrine, and saline flushes pre-drawn by pharmacy every 24 hours, code drugs, plus a vial of almost everything in our carts in a separate pocket with syringes and blunt-tip needles.

Airway: 2 handles, 4 blades (Miller 2/3, Mac 3/4). 6/7/8 tubes, styletted. Bougie, various sizes of oral airways and nasal trumpets. Suction catheter. Cric kit. CO2 detector, esoph bulb. McGill forceps. Several flavors of LMA. There is also pediatric airway gear in the bottom of the bag with smaller sizes of everything.

Mapleson and 2 sizes of face mask. Tape. IV and A-line stuff. Yankauer suction tip.

Billing sheets.

This approach is less "code bag" and more "anesthesia machine and equipment cart in a portable shoulder bag." I think we should throw on a bottle of sevo and a mini O2 tank.

 

[Idiopathic]

I didn't realize how extreme our bags are...

Drugs: Etomidate, roc, sux, neo, ephedrine, and saline flushes pre-drawn by pharmacy every 24 hours, code drugs, plus a vial of almost everything in our carts in a separate pocket with syringes and blunt-tip needles.

Airway: 2 handles, 4 blades (Miller 2/3, Mac 3/4). 6/7/8 tubes, styletted. Bougie, various sizes of oral airways and nasal trumpets. Suction catheter. Cric kit. CO2 detector, esoph bulb. McGill forceps. Several flavors of LMA. There is also pediatric airway gear in the bottom of the bag with smaller sizes of everything.

Mapleson and 2 sizes of face mask. Tape. IV and A-line stuff. Yankauer suction tip.

Billing sheets.

I'm sure I'm forgetting some things - this bag is probably too large to take onto a plane as carry-on.

just so everyone knows, the Joint Commission does not allow either pre-drawn drugs or labeled syringes to be in the code bag.

 

[Monty Python]

I responded to a code and was about to intubate a basically dead patient in the middle of resuscitation when one of the nurses in the room said we needed to stop and do a time out before we intubated because it was an invasive procedure. She wasn't kidding either.

.

 

[pgg]

And yet...

Called to a code on a tubed pt, septic shock, 4 pressors going, PEA...no A-line.

Off topic for this thread, but this reminds me - I did an emergent ex-lap yesterday for a suspected GI bleed. She'd been circling the drain for about 10 hours while they waffled about whether to call surgery. I went to the ICU to get the patient. Now on Levophed 12/min. BP 60/20 (when the NIBP could be measured at all), HR 165. No a-line, no central line, not even a peripheral IV. They'd been using a portacath for access the entire time. Horribly under resuscitated - 500 cc of crystalloid bolused in the elevator brought her HR down to 100.

It's like they weren't even trying.

/ vent off

 

[lord_jeebus]

This approach is less "code bag" and more "anesthesia machine and equipment cart in a portable shoulder bag." I think we should throw on a bottle of sevo and a mini O2 tank.

One of our attendings (forgot who) told me that we might get a battery-powered portable fiberoptic bronchoscope to add to the bag. I've toyed with the idea of throwing in a light wand, just to put on a spectacle for the medicine residents who are no longer wowed by my Miller 4. "Dim the lights, Anesthesia has arrived."

Also, since I posted that list, we got these new-fangled silver-coated endotracheal tubes. Of course, they didn't replace the old ETTs - now we have two kinds of ETT in each size.

 

[jwk]

just so everyone knows, the Joint Commission does not allow either pre-drawn drugs or labeled syringes to be in the code bag.

Ditto. I know everyone thinks it's a pain, but a drug bag/code box that is not secured would be a big red flag for the JC.

If the code carts at your hospital are that poorly stocked and maintained, you REALLY need to work at that at an institutional level. We have dozens of code carts throughout the hospital, and a few extras are kept in pharmacy. When a cart is used, after the code that cart is taken to the pharmacy, and the defib is swapped over to a freshly stocked cart and returned to the appropriate spot.

All our code carts carry the appropriate 1st and 2nd tier ACLS drugs, as well as an assortment of pre-mixed pressors. There is also a drawer with laryngoscopes and blades, and an assortment of LMA's. You don't need NMB's for a code, and we don't take anything with us if we respond to a code.

If we are specifically called to intubate someone, we have an airway box available if we want to take it (it doesn't have anything the code cart doesn't have) and we can take one of our drug trays from an anesthesia cart or OR pharmacy with us. Our difficult airway cart can be taken out of the OR as well if need be, but that's rarely been necessary. Unless you know in advance of an unusual situation, there's not much reason to take EVERYTHING with you.

 

[jwk]

Also, since I posted that list, we got these new-fangled silver-coated endotracheal tubes. Of course, they didn't replace the old ETTs - now we have two kinds of ETT in each size.

I have no idea what you're talking about.

 

[lord_jeebus]

I have no idea what you're talking about.

http://jama.ama-assn.org/content/300/7/805.abstract

 

[jwk]

http://jama.ama-assn.org/content/300/7/805.abstract

Always something new.

Why not just stock one type to avoid confusion (and save space)? Just curious - I've never seen them.

 

[Bertelman]

Always something new.

Why not just stock one type to avoid confusion (and save space)? Just curious - I've never seen them.

We use the Ag's with appropriate patients. Basically anyone likely to be tubed >1 week.

Not sure how you would make that determination during a code.

Jeebus, seriously, someone needs to get that bag under control. There's so much ****, it would be hard to find what you really need, which 99% of the time is a Mil 3 / Mac 4 and a 7.5 ETT.

 

[fakin' the funk]

just so everyone knows, the Joint Commission does not allow either pre-drawn drugs or labeled syringes to be in the code bag.

The drugs in the bag in question are in a breakaway-sealed, pharmacy-stocked "fanny pack" type bag tucked away in the code bag.

 

[fakin' the funk]

Jeebus, seriously, someone needs to get that bag under control. There's so much ****, it would be hard to find what you really need, which 99% of the time is a Mil 3 / Mac 4 and a 7.5 ETT.

The bag is a little too big. I mean...it has a Combitube and like 3 different airway exchange catheters.

BUT

Most of the time the bag is used is not for actual code situations. Much more commonly it is used for "this medical ICU pt is failing BiPAP and needs a tube" or "this trauma pt is obtunded/drunk/combative". So that other stuff does come in handy, even though as you say, >90% of the time the airway comes down to MAC and ETT.

 

[Bertelman]

Just different philosophies, I guess. I'm a minimalist when it comes to my setups, etc. I put out the drugs I intend to use, and not much else.

The way I see a code bag, the more **** there is in there, the harder it is to find what you really need. Of course, I'm at a smaller hospital, thus it only takes 5min to make it from the fully stocked workroom to any other part of the hospital. I know when I need an exchange catheter, and it is easier to get when I need it rather than carry 3 to every code. Granted, if I were at a much larger place, I might feel differently.

The bag is a little too big. I mean...it has a Combitube and like 3 different airway exchange catheters.

BUT

Most of the time the bag is used is not for actual code situations. Much more commonly it is used for "this medical ICU pt is failing BiPAP and needs a tube" or "this trauma pt is obtunded/drunk/combative". So that other stuff does come in handy, even though as you say, >90% of the time the airway comes down to MAC and ETT.

 

[Impromptu]

Our code bag is a bright orange shoulder bag which is located in the locked anesthesia supply room. The junior on-call resident must look through it each day and initial a sheet of paper next to it to certify that it is properly stocked (and not overstocked). They then put on a zip tie to seal it. If anyone uses it, they must restock what they used out of it, though we try not to open it when we go to codes. Instead we use the stuff on the floors.

There is a list of what to stock it with. It is very neat and orderly, and seems pretty logical. Off the top of my head:

Main Compartment:
ETT 4.0, 5,0, 6.0, 2X7.0, 8.0
Stylettes
LMA 3, 4, 5
Intubating LMA 3, 4, 5
Reenforced ETT 3 sizes.
Cricothyroid Kit/Jet ventilator
Sealed drug box

Side pouch with little pockets:
Long and Stubby laryngoscope handles with charged batteries.
MAC 3X2, 4
Miller 2, 3
Tongue blades
Oral/nasal airways
lube
clear and silk tape

End pouch: IV stuff
Other End pouch: syringes and needles

Other side pouch:
Bougie
Tube exchangers
Yankauer
Suction tubing

(I do think an ambu bag would be nice, but it is most often the suction tubing and yankauer that is missing when we go to codes).

 

[Arch Guillotti]

You have a jet ventilator in your code bag? Wow, that must be heavy.

 

[ketanchopra]

This is obviously a very old thread but I've been tasked with finding a replacement for the code box at our institution. Currently we use a fishing tacklebox which is massive and a pain to carry around. Anyone have any suggestions for some type of backpack that maybe you use at your institution?