I follow a mental checklist.
1. pull out my iphone and start the stopwatch once i hear a code is called. I always personally track the time intervals during the code.
once you arrive to the room, announce yourself to lead the team.
and turn on the effing lights. As a nocturnist, 90% of the time the room is still dim and dark whenever i get to the code
2. Verify a backboard is in place, proper compressions are done, and that the bed height is lowered or step stool provided for the compressor as needed
3. Verify iv access. Order your team to place IO or central line as needed
4. ensure someone is bagging the patient; pause for 2 breaths every 30 compressions (if no adv airway)
5. Order 1 mg epi to be given, i give it every 3 minutes
6. order someone to obtain fingerstick glucose check
7. order someone to call anesthesia, intensivist or whoever is responsible for airway during a code at your hospital, if they haven’t arrived
8. order someone to double verify code status in chart and to call family asap
9. optional: order someone to get an Ultrasound to later image the heart for thrombus/tamponade and get pulse doppler if available
10. Order for defib pads placed, as it should be near time for pulse and rhythm check by now. During this first check, order the bed be pulled out from against the wall to give the intubator space when they arrive
11. if a shockable rhythm, order compressions resumed and charge to 200J, when charged clear everyone and deliver shock, then immediately resume compressions
12. If it was shockable rhythm, give 300 mg amiodarone and IV Mag. Give 150 mg amio if refractory vf/vt on the next check. I give 100 mg lido if still refractory. Try to avoid epi within the next 2 min of known vt/vf.
12. Whether the rhythm check was or was not shockable, keep going: epi q3min and pulse/rhythm checks q2 min. 1 breath q6-8 seconds plus continuous compressions when intubated.
as the second round of compressions begins, obtain info from the nurse on what happened, if pt was on tele then what was the last rhythm identified, was narcotics given earlier today, what were the last set of labs especially potassium, think your Hs/Ts
13. by the third or fourth round of compressions without rosc, i often give amp of sodium bicarb and Calcium empirically
If rosc is obtained, always keep someone checking the pulse. Check blood pressure and o2 sats immediately. Get Ekg look for stemi. Monitor the etco2. Check neuro response
For specific arrest situations, this link is pretty comprehensive:
I’ve thankfully never ran a code on a pregnant pt but have seen one back in pgy1. Gotta remember to push the gravid uterus aside and get the L+D team stat
ccemjournal.com
