Codes/Resuscitations

[HoloDoc]

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In which specialty do doctors find themselves responding to the most codes or resuscitations? EM? CCM? A surgical specialty (patients crashing on the table)?

How often do you find yourself responding to a code or resuscitation?

 

[fakin' the funk]

In which specialty do doctors find themselves responding to the most codes or resuscitations? EM? CCM? A surgical specialty (patients crashing on the table)?

Who do you think is at the head of the bed during an OR code?

 

[Smurfette]

It's pretty rare to have an intraop code except for emergency procedures (traumas, AAAs, septic dead gut, etc.) or transplants...hopefully the elective patients have been "tuned up" pre-op by their primaries. Otherwise trying to explain why your lap chole for symptomatic cholelithiasis/hernia repair/mastectomy died on the table will be a brutal M&M to present.

Anesthesia and the medicine code team/MICU service respond to all codes in the 3 hospitals I rotate in....with medicine running the code. Surgery will respond if it's our patient or if we have nothing better to do (i.e. not in OR or otherwise busy) or are trolling for lines for junior residents.

 

[southerndoc]

I would imagine the anesthesiologist runs the codes in the OR (when they occur).

EM docs don't see as many codes anymore now that EMS personnel are pronouncing patients in many systems.

 

[Winged Scapula]

As above, intraop codes are not all that common. I've been involved in a couple through the years.

At all the hospitals I've worked in the "Code Team" Or "Rapid Response Team" has been made up of anesthesia and medicine residents or at the community hospital I moonlit at, it was the ED physicians and hospitalists. The only times I've been involved is either:

1) its a patient on my service
2) they need a line
3) its in the SICU and I'm on service
4) I was walking by.

Every hospital has different policies about this but its generally not helpful to have surgeons on the Code Team as we can't usually leave if in the OR.

 

[Danbo1957]

Looking at the numbers alone over the last several years at our general hospital, outcomes for RRT calls outside of CCU are 80% successful, compared to outcomes for Code Blue calls that were 40% successful.

Blows me away to think about the big picture of it all...

 

[roja]

Depends on where they code and how the hospital is set up. In big hospitals with a big CCM faculty, usually the ICU will respond to floor codes.

Codes in the ED are run by EMP's. In smaller hospitals or ones without residencies/fellowships, often the EMP's will run all hospital codes.

Where I was, we had plenty of codes in the ED (180K visits a year = plenty of codes) and we also covered codes in rads. All others were taken care of by the CCM team.

OR codes ,I imagine are run by Gas and surgeons.

 

[docB]

I work at 5 large community hospitals and the EPs run all codes except those in the OR. We also do all the on the floors and in the ICUs.

 

[Apollyon]

I work at 5 large community hospitals and the EPs run all codes except those in the OR. We also do all the on the floors and in the ICUs.

I work at a large university hospital, two small community hospitals, and a standalone ED with an attached "long term acute care" unit. At both community hospitals and the standalone, the hospitalist (or even moonlighter overnight at LTACH, who may be a 2nd year IM resident) runs the codes. Only at LTACH do I even tube the patient.

At the university hospital, we cover the ED codes, radiology, and anything that happens outside.

 

[docB]

I work at a large university hospital, two small community hospitals, and a standalone ED with an attached "long term acute care" unit. At both community hospitals and the standalone, the hospitalist (or even moonlighter overnight at LTACH, who may be a 2nd year IM resident) runs the codes. Only at LTACH do I even tube the patient.

At the university hospital, we cover the ED codes, radiology, and anything that happens outside.

At my 4 of my 5 and 2 other small, rural places I go to occasionally at 2am (and really 6pm to 7am) the EP is the only doc in the hospital. The 1 other place has IM and FM residents who respond to the codes but have to be supervised.

 

[Blade28]

I've helped out in codes during residency (usually if I get there first, or the patient needs vascular access) but ran them myself in the SICU and during moonlighting.

Usually the "code team" is made up of IM residents/fellows.

 

[AmoryBlaine]

If the original question was which specialty participates in the most codes I would probably say Critical Care > EM >> trauma surg.

Some ED/trauma bay "codes" are pretty short i.e. CPR ongoing for 2 minutes while the doc establishes that the patient has been and is in fact dead.

 

[nabeya]

family medicine residents run all the codes at my hospital as well as put in the central lines.

 

[8744]

You also need to understand that "codes" are not called for patients in the Emergency Department. The nurse does not run out of the room looking for the blue wall switch and the hospital operator does not announce "Code Blue, Emergency Department." A code in the ED is just another day at the office. At my hospital the second year EM resident responds to codes for intubation and lines but in practice by the time we get up there the usual swarm of people is involved.

 

[Tired]

You also need to understand that "codes" are not called for patients in the Emergency Department. The nurse does not run out of the room looking for the blue wall switch and the hospital operator does not announce "Code Blue, Emergency Department." A code in the ED is just another day at the office. At my hospital the second year EM resident responds to codes for intubation and lines but in practice by the time we get up there the usual swarm of people is involved.

At my ED, which does not train residents, they do call Code Blue. Critical care responds and generally runs things.

 

[OB1🤙]

Our local VA, which as part of the abysmal care it provides to our veterans, does not staff its ED with actual EM doctors. As such, codes are most certainly called in the ED, since the researchers doing a little moonlighting in their spare time generally cannot handle coding patients.

 

[Winged Scapula]

You also need to understand that "codes" are not called for patients in the Emergency Department. The nurse does not run out of the room looking for the blue wall switch and the hospital operator does not announce "Code Blue, Emergency Department." A code in the ED is just another day at the office. At my hospital the second year EM resident responds to codes for intubation and lines but in practice by the time we get up there the usual swarm of people is involved.

The hospital I moonlit at as a fellow did call Codes (or "Case One" which is what they called it there) for the ED.

I heard one called overhead in the hospital where I was operating at the other day as well.

So obviously not a ubiquitous truth that Codes aren't called in the ED.

 

[polygonal]

Having worked at many EDs (big and small, urban and rural) in my life, I can say I've never seen a code "called" in the department. In fact in most places, the ED doc responds to the codes throughout the hospital.

Having said that, I could see that being the case in a few situations. The VA often does not have a true ED but rather a LSU or "life support unit" that is not staffed by EPs. Small places may not have enough staff to run a code (one or two nurse operation). There are also a lot of places that still don't have trained Emergency Medicine physicians staffing the ED so they may not feel comfortable with it (one of the many arguments against having non-EM trained docs in the ED).

So there may be some variation. I can assure you that any residency trained EP feels VERY comfortable running any code.

 

[Winged Scapula]

I think we need to be careful about making such statements as "in most places...etc."

At my large residency hospital, EPs did NOT respond to codes hospital wide. The code team was made up of anesthesia and IM people. Codes were NOT called in the ED via the overhead system.

In the smaller community hospital were I did some rotations (and was the only resident in house) and moonlighted as a fellow, ED physicians (mostly not EM trained) DID respond to hospital codes house-wide and codes in the ED WERE called overhead. I always kept my ears open for those because if the patient survived I may have been paged soon for a central line placement.

Thus, even my own meager experience shows that there is a wide variety of what happens in the world out there.

 

[southerndoc]

I think we need to be careful about making such statements as "in most places...etc."

At my large residency hospital, EPs did NOT respond to codes hospital wide. The code team was made up of anesthesia and IM people. Codes were NOT called in the ED via the overhead system.

In the smaller community hospital were I did some rotations (and was the only resident in house) and moonlighted as a fellow, ED physicians (mostly not EM trained) DID respond to hospital codes house-wide and codes in the ED WERE called overhead. I always kept my ears open for those because if the patient survived I may have been paged soon for a central line placement.

Thus, even my own meager experience shows that there is a wide variety of what happens in the world out there.

I think ED docs probably do not respond to codes in any hospital with in-patient docs (residents, hospitalist attendings, etc.).

It appears, at least from my experience, that ED docs only respond to codes in community hospitals where physicians aren't in-house 24/7.

 

[Winged Scapula]

I think ED docs probably do not respond to codes in any hospital with in-patient docs (residents, hospitalist attendings, etc.).

It appears, at least from my experience, that ED docs only respond to codes in community hospitals where physicians aren't in-house 24/7.

Agreed. My response was in large part to polygonal's statement above mine that, "In fact in most places, the ED doc responds to the codes throughout the hospital."

 

[dragonfly99]

In my teaching hospital the Code Team that responds to all codes in the hospital is the internal medicine team that is in the medical ICU. So we would leave our ICU patients to respond to any and all codes in the hospital. Anesthesia also comes (usually a little later) and would deal with airway issues, but the medicine resident would run the code. If during the daytime, often a medicine fellow would be around and run the code (or sometimes an attending, if it was their patient). Surgery would occasionally run a code if it was a surgical ICU patient, etc.

 

[docB]

So ultimatley we have shown that who responds to codes is highly instution dependent. This shows that if you do or don't want to be responsible for responding to codes you need to check this out wherever you are thinking of working.

 

[soonerpillow]

At the hospital I work in, the Anesthesia interns (myself and my colleagues) run all codes and RATs.

 

[B-Bone]

at one of my large teaching hospitals, the code team is led by the cardiology senior resident. Critical care fellow, anesthesia resident, critical care nurse, pharmacist, RT, and the primary team are also there, along with a critical care consultant for good measure.

at my other teaching hospital, code team is led by critical care senior (senior anesthesia resident or CC fellow) and anesthesia resident comes for airway issues.

Of course, on any "closed unit" (MICU, SICU, CCU, PICU, NICU, neuro-ICU, transplant ICU, cardiac surgery ICU, trauma ICU or ED), the in-house team runs codes themselves with airway support from anesthesia as needed.

 

[bigdan]

At my hospital, we have a Rapid Response Team run by an NP - she lets the medicine and anesthesia residents go to the Code Blues, though.

dc

 

[lowbudget]

Where I trained, large community hospital with unopposed program, FM residents run the codes (CPR, stroke, pediatric), intubates, place lines. ER attendings and anesthesia attendings serve as back up. 24 hour in-house Neo attendings runs neonatal codes with FM resident assisting. Intraop codes are unheard of, but codes do happen in the PACU. ER attendings runs their own codes, but they do activate the code to call on all the techs, nurses, pharmacists, administration, and chaplain.

Residents will step aside when the private attendings seem to know what they're doing, but usually the private attendings will flee. Because residents run the codes, most community docs are out of practice anyways. The exception are Pulm/CC, ER, and CV surgery attendings. Some of the community cardiologists are good, others not so much. Anesthesia are adept at the procedures, but you can tell they're out of practice. CV surgeons have the most awesome codes when they pop their sternotomy wires and stick their hands into the patient's chest and massage the heart (of course, they almost always die). Yea, we usually step aside on that one, thanks.

At another smaller community hospital where we work but don't take in-house call, the ER docs are the only ones around, so they run upstairs to run the codes.

 

[souljah1]

Codes that occur in our SICU, MICU, NICU, CCU and ED are not called overhead and our managed by the folks already working in that unit. Code calls overhead for floor patients are generally managed by housestaff. Surgical housestaff usually run their own codes. Medical housestaff run their own codes. We do have a rapid response team that brings a procedure cart and comes in concert with pharmacy. The rapid response team is usually comprised of a critical care nurse, either a hospitalist or critical care attending not on service in the MICU and a medicine housestaff.

 

[deleted50478]

In which specialty do doctors find themselves responding to the most codes or resuscitations? EM? CCM? A surgical specialty (patients crashing on the table)?

How often do you find yourself responding to a code or resuscitation?

Anesthesiology responds to the most codes here since we go to codes on the medicine, surgery, & peds floors, plus ICU and anywhere else people code. No other specialty goes to all codes everywhere in the hospital, at least at his hospital.

 

[drewpydog]

I think ED docs probably do not respond to codes in any hospital with in-patient docs (residents, hospitalist attendings, etc.).

It appears, at least from my experience, that ED docs only respond to codes in community hospitals where physicians aren't in-house 24/7.

I wish this were true. I am called upon all hours of the day and night (multiple hospitalists 24/7) for codes, lines, semi-elective intubations, even IV access.

Not that this has to do with codes, but a hospitalist called me the other day for "no IV access" - multiple nurses and doctors have attempted. One attempt for me, EJ as big as my thumb.

 

[jennyboo]

In which specialty do doctors find themselves responding to the most codes or resuscitations? EM? CCM? A surgical specialty (patients crashing on the table)?]

Anesthesiology.

Depending on hospital policy, anesthesia typically attends Code Blues in all units (airway), Level 1's in the ER (airway), runs codes in the OR and sometimes runs codes in the SICU.

ACLS-type resuscitations in the OR are relatively rare. However, on a regular basis even on a good day when everything goes well in the OR we do a lot of slow-time resuscitation (transient shock states, hypovolemia, arrhythmias, hypotension, anticipated massive transfusion). On a bad day we can have things that may not involve ACLS protocol but involve, for example, massive unanticipated blood loss, massive transfusion, difficult airways, intracranial hypertension, etc. These can actually be more work, not less, than ACLS which often starts and finishes very fast in comparison.

 

[LanceArmstrong]

At my medium-sized community hospital when a code is called it depends on where it occurs.

Since most of our patients are medicine patients most of the time it's the Senior ICU resident+2 other residents who are on call + respiratory therapy +/- sometimes anesthesia.

 

[anonymousEM]

Agree with the point made above that sometimes a code is called, not because of the physician's comfort or ability but to quickly acquire all of the necessary ancillary services. In most Emergency Departments, a code isn't called in the usual sense but radiology techs, EKG, Respiratory, chaplain etc get some other indication of an ED resuscitation or whatever it's called in that institution. As to the above, anesthesia response is very institution dependent as well.