Worried about ACLS and running a code as psych intern

[lilek22]

Title pretty much covers it all. Doing the online portion of the ACLS now and I just don't think I'd ever be able to remember this stuff unless I studied it on a weekly basis. On general medicine, neuro, or peds, would psych interns be expected to run the code?

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[DrBowtie]

Title pretty much covers it all. Doing the online portion of the ACLS now and I just don't think I'd ever be able to remember this stuff unless I studied it on a weekly basis. On general medicine, neuro, or peds, would psych interns be expected to run the code?

Like every intern in the country just pull your cards out and follow the algorithm.

 

[Bartelby]

Two things:

1 - I second the card idea, if it comes to that you can do your best running through the algorithm, but...

2 - It's extremely rare that you would run an entire code without assistance as a PGY-1. Even on nightfloat it is likely that a more senior resident will be on the scene of any code very shortly after you (or at the same time). In addition at the hospitals I have worked in either a code team or an ICU attending comes to run the code or assist the primary team in running the code. That means you are likely looking at a couple of minutes unassisted on the high end. Get moving on attaching the defibrillator, starting compressions, etc etc and help will almost certainly be there before you start making really complicated decisions.

 

[Shikima]

Two things:

1 - I second the card idea, if it comes to that you can do your best running through the algorithm, but...

2 - It's extremely rare that you would run an entire code without assistance as a PGY-1. Even on nightfloat it is likely that a more senior resident will be on the scene of any code very shortly after you (or at the same time). In addition at the hospitals I have worked in either a code team or an ICU attending comes to run the code or assist the primary team in running the code. That means you are likely looking at a couple of minutes unassisted on the high end. Get moving on attaching the defibrillator, starting compressions, etc etc and help will almost certainly be there before you start making really complicated decisions.

I remember running codes as an Intern and the "senior" resident was a PGY-2 who knew as much as I did.

 

[Igor4sugry]

Title pretty much covers it all. Doing the online portion of the ACLS now and I just don't think I'd ever be able to remember this stuff unless I studied it on a weekly basis. On general medicine, neuro, or peds, would psych interns be expected to run the code?

I recommend to go along with the code team in your hospital to get more exposure to codes. Do this for 10-20 codes and you will feel more prepared.

 

[Doctor Bagel]

Title pretty much covers it all. Doing the online portion of the ACLS now and I just don't think I'd ever be able to remember this stuff unless I studied it on a weekly basis. On general medicine, neuro, or peds, would psych interns be expected to run the code?

Probably not -- certainly not without assistance from a senior resident. At my program, we carried the code pagers on medicine call, but we were essentially back up to the ICU resident team. Our only likelihood of really have to lead the code would be if the ICU team were all across the way in the cafeteria having lunch or something. Even still, your senior also carried the pager and would be expected to assist as well. For the psych intern to lead the code, all of the ICU residents + the IM ward senior would all have to be unavailable, which is pretty unlikely. I never did any codes in residency.

 

[Crayola227]

just remember the patient is already dead so you can't really **** up

just remember to get quality chest compressions going and you'll have bought yourself the time you need to figure out what the **** to do

also, look into closed loop communication and use it

 

[hamstergang]

just remember the patient is already dead so you can't really **** up

I said this to my fellow psych interns all the time but it never seemed to make them more comfortable. Doesn't make it less true, of course.

 

[Shikima]

Going along all depends on what your duties are and if you are permitted to.

 

[whopper]

In all hospitals I've seen the psych doctor didn't do the ACLS except when I was at U of Cincinnati when they moved the psych units to a different hospital about 1 mile away from the main hospital.

Now this was a real bad situation cause I was running a geriatric unit. Consults didn't show up most of the time. We had IM show up daily but nothing beyond this. The hospital argued the IM doctor could handle it. Well #1 the guy was only there about 2 hours a day, and #2 They argued if it was too much for the IM to handle we could transfer the patient to the main hospital. Well guess what? About 50% of the time they refused to take them even when the IM doctor thought it was dangerous to keep them on the psych unit.

While I loved U of C, this geriatric unit 1 mile away was really ticking me off. I did have certifiable cases where worse outcomes happened because of this including a guy with a post surgery spinal cord infection and everyone besides me and the IM doctor were blowing it off. It got to the point where I had to have the guy sent to our own ER cause ID, surgery and neuro consults refused to show up.

When I did it surgery blew up at me and refused to see the guy despite that he lay in the ER for 8 hours. It got to the point where the head of the ER department called the head of Surgery to force the surgery resident to see the patient (it was the resident refusing to see the patient). During the 15 minutes it took for him to prep himself, with him openly insulting the patient, the patient's family, and saying things to the effect that psychiatrist aren't real doctors and we always over-react, when he checked the site of infection his jaw dropped and demanded the patient immediately go to surgery. (I'm not kidding).

Several ER staff witnessed what happened and the family was present and they all told me what happened. I recommended the family report to the state medical board what happened and to complain to the hospital about the unprofessional behavior of one of it's residents. At this point I didn't give a damn about the institution because my job is to heal the patient, not apologize for the institution for doing bad work.

As upsetting as this entire thing was, and despite that consults still refused to show up, at least the hospital didn't rake me over the coals. In fact if anything my stock went up because I was was one of the only guys trying to do the right thing.

 

[HarryMTieboutMD]

The the original poster... like everything in medicine this seems more complex than it is because you actually have to be in the situation to learn how to do it... but ultimately it becomes algorithmic (the experienced nurses, RTs, etc will know what to do anyway) Agreed with above about the off service psych intern not running the code in most situations. S0metimes the medicine senior residents would let interns do it later in the year

 

[Crayola227]

yeah I feel sorta weird even leaving the house without my cards (they've got defibrillators everywhere now, you can argue I don't need them as I wouldn't have access to any meds but not my point)

now that I have them they are *always* with me

the key thing is to keep your wits about you and start compressions

 

[hamstergang]

In all hospitals I've seen the psych doctor didn't do the ACLS except when I was at U of Cincinnati when they moved the psych units to a different hospital about 1 mile away from the main hospital.

Now this was a real bad situation cause I was running a geriatric unit. Consults didn't show up most of the time. We had IM show up daily but nothing beyond this. The hospital argued the IM doctor could handle it. Well #1 the guy was only there about 2 hours a day, and #2 They argued if it was too much for the IM to handle we could transfer the patient to the main hospital. Well guess what? About 50% of the time they refused to take them even when the IM doctor thought it was dangerous to keep them on the psych unit.

While I loved U of C, this geriatric unit 1 mile away was really ticking me off. I did have certifiable cases where worse outcomes happened because of this including a guy with a post surgery spinal cord infection and everyone besides me and the IM doctor were blowing it off. It got to the point where I had to have the guy sent to our own ER cause ID, surgery and neuro consults refused to show up.

When I did it surgery blew up at me and refused to see the guy despite that he lay in the ER for 8 hours. It got to the point where the head of the ER department called the head of Surgery to force the surgery resident to see the patient (it was the resident refusing to see the patient). During the 15 minutes it took for him to prep himself, with him openly insulting the patient, the patient's family, and saying things to the effect that psychiatrist aren't real doctors and we always over-react, when he checked the site of infection his jaw dropped and demanded the patient immediately go to surgery. (I'm not kidding).

Several ER staff witnessed what happened and the family was present and they all told me what happened. I recommended the family report to the state medical board what happened and to complain to the hospital about the unprofessional behavior of one of it's residents. At this point I didn't give a damn about the institution because my job is to heal the patient, not apologize for the institution for doing bad work.

As upsetting as this entire thing was, and despite that consults still refused to show up, at least the hospital didn't rake me over the coals. In fact if anything my stock went up because I was was one of the only guys trying to do the right thing.

What does any of this have to do with the OP, and why is it that the most outrageous stories seem to only happen to you?

 

[lymphocyte]

.

 

[FlowRate]

Just remember the key steps in the algorithm.

 

[Ceke2002]

and why is it that the most outrageous stories seem to only happen to you?

Have you seen Whopper's experience and credentials? I actually think he's holding back on the outrageous stories meter. 😱

OP: Can't give you any sort of proper medical advice on running a code, because I'm not a Doctor. I am; however, a trained first aider and I agree with @Crayola227 that getting good chest compressions going is a must. Don't worry if you crack a few ribs, bones will heal, just hit that chest and start pumping. 👍

 

[Ceke2002]

just remember the patient is already dead so you can't really **** up

Yep, exactly. The patient is clinically dead at that moment, so it's not like you can make them any deader. Also you'd be really surprised, once that 'oh cr@p' moment has passed, just how quickly your training can kick in.

 

[whopper]

and why is it that the most outrageous stories seem to only happen to you?

Hmm I can say this. Most residencies have limited clinical scenarios. E.g. I've seen people do private practice and nothing else after residency. I've seen people do just one thing and one thing only after residency and stay with that thing and as a result of this don't know how to do other things.

Once in the forensic unit I had a guy brought to the unit still withdrawing from Heroin. I treated it by myself. The next day the chief clinical officer had me go to his office and pretty much tell me psychiatrists don't know how to treat opioid withdrawal and chastising me for not getting IM to check the guy out despite that this is the norm in many urban psych units and it's treated by psych residents all the time.

Also, and this is my opinion, people in medicine don't complain even when they should be complaining. I have an opinion. Screw 100 lawyers by charging them $1000 for something where they should be charged $50 and expect 100 litigants, screw 100 doctors and they work extra hours to pay for the fee.
For example, Masterofmonkeys has been on the forum for years. I don't remember him mentioning how bad the forensic situation is in Missouri. I wrote about it recently in another thread.

The forensic situation is about as bad as Whopper paints, as far as incompetent to stand trial.

(Although yes he also did say some things are better in Kansas City than in St. Louis).

Or as HarryMTieboutMD pointed out it seems there's a correlation between addicts and addiction psychiatry. Again this is a type of thing too many doctors don't talk about but they see it happening.

I do know that a lot of the stuff I complain about happens to a lot of people here, just that they don't complain about it. A lot goes without saying but quite often you get a medstudent or new resident here not know the reality of the situation and ask about it. By the time resident reaches year 3-4 they know that bipolar disorder is misdiagnosed often, irrational polypharmacy is out there by the truckload and, psychiatrists only seeing patients for 5 minutes-10 minutes tops happens often.

Or another phenomenon, borderlines going to the ER all the time and being discharged without any referral for DBT or admitted and placed on a polypharm regimen that doesn't help their borderline PD. It happens, we know it happens, yet some people don't talk about it.

What does any of this have to do with the OP

Like ACLS being done by a psychiatrist this was another situation in the hospital where a psychiatrist was stuck in a position where the psychiatrist shouldn't have been in.

 

[thoffen]

The one and only time in my life where I was one of the first 3 people at a code, I had a hard enough time figuring out how to turn on the oxygen much less perform ACLS tasks.

You would have to talk to your co-residents to see what capacity they will be involved in for codes, but honestly knowing how to do good chest compressions, ventilate, and how the basic equipment (O2, AED) works seem infinitely more important to me.

 

[whopper]

ACLS and codes and doing them well requires good experience and some of the skill at it is muscle memory. You can have everything memorized in your head from the textbook but until you do it several times you won't be good at it. Things like how hard to press, not freaking out when you are cracking ribs, which drawer to pull open to get the right medication are things memorizing from a textbook don't teach.
A few hospitals I worked at had a specific code team that did ACLS with someone very experienced heading it all the time surrounded by other staff members that were learning it. Each month the team rotated to new members but they made sure at least a few really good people were on the team to make sure someone could command the situation well while the others learned.

Some of you might be at a hospital where this has always been in effect and say "duh?" everyone has that. Not when I was a resident. My second year the hospital I was at finally put one in place.

 

[clausewitz2]

The one and only time in my life where I was one of the first 3 people at a code, I had a hard enough time figuring out how to turn on the oxygen much less perform ACLS tasks.

You would have to talk to your co-residents to see what capacity they will be involved in for codes, but honestly knowing how to do good chest compressions, ventilate, and how the basic equipment (O2, AED) works seem infinitely more important to me.

In our program everyone does time as basically the medical service for a 300 bed psych hospital, so overnight there is just a psych resident and a nurse to respond to codes in-house. Granted, a critical care team responds from the fancy academic center across the street, but it still takes ten minutes for them to physically turn up. As a result, our folks are sometimes the MDs on the scene rather longer than might happen on your typical inpatient unit nestled snugly in a larger hospital.

 

[vistaril]

Title pretty much covers it all. Doing the online portion of the ACLS now and I just don't think I'd ever be able to remember this stuff unless I studied it on a weekly basis. On general medicine, neuro, or peds, would psych interns be expected to run the code?

lmao.....is this the stuff interns to be worry about? As a psych intern on a medicine service you will be expected to:

1) keep a positive attitude
2) help out the team when needed
3) try hard and be open to learning when it's the appropriate time
4) don't get in the way

You do these four things and your few months on medicine will go just fine. On 'paper' you may(or you may not) have the same responsibilities as the categorical medicine people and mediciney pre-lim types, but in reality you won't. And they may tell you you have the same responsibilities and expectations as them, but you won't.

 

[Ceke2002]

ACLS and codes and doing them well requires good experience and some of the skill at it is muscle memory. You can have everything memorized in your head from the textbook but until you do it several times you won't be good at it. Things like how hard to press, not freaking out when you are cracking ribs, which drawer to pull open to get the right medication are things memorizing from a textbook don't teach.
A few hospitals I worked at had a specific code team that did ACLS with someone very experienced heading it all the time surrounded by other staff members that were learning it. Each month the team rotated to new members but they made sure at least a few really good people were on the team to make sure someone could command the situation well while the others learned.

Some of you might be at a hospital where this has always been in effect and say "duh?" everyone has that. Not when I was a resident. My second year the hospital I was at finally put one in place.

This is a really good, and important point. Theory alone isn't enough, you have to have that hands on practice -- whether in a mock realism training scenario, or under supervision in a real life situation. You have to be able to get to a point where everything is second nature, and once you've gotten past that initial feeling of 'oh ****, that I think everyone experiences, muscle memory takes over and you're working on automatic. Touch wood I've never had to perform chest compressions on anyone, but I have had to provide airway support and perform rescue breathing, and being able to do either of those things effectively was largely down to practical training and not just theoretical.

And that reminds me, I need to get recertified as well.

 

[notdeadyet]

On 'paper' you may(or you may not) have the same responsibilities as the categorical medicine people and mediciney pre-lim types, but in reality you won't. And they may tell you you have the same responsibilities and expectations as them, but you won't.

Aaaaaaaaand again: just want to point out that this is going to be VERY specific to where you train.

At many programs, you will have the same patient load, patient complexity, and care expectations of any of the other interns. One thing you'll find as an intern on medicine is that a LOT of folks do internal medicine rotations who are not gunning to be internists. There will be some interns who are in their element and many interns who are suffering their way through it. Work hard, read, listen, and ask questions, and you'll be fine.

But don't expect to cruise through being treated as the tolerated simpleton. That may happen if that's what your psychiatry program offers up and that may happen if that's the impression that you cut, but there's a good chance you'll be treated like everybody else.

 

[MLT2MT2DO]

Aaaaaaaaand again: just want to point out that this is going to be VERY specific to where you train.

At many programs, you will have the same patient load, patient complexity, and care expectations of any of the other interns. One thing you'll find as an intern on medicine is that a LOT of folks do internal medicine rotations who are not gunning to be internists. There will be some interns who are in their element and many interns who are suffering their way through it. Work hard, read, listen, and ask questions, and you'll be fine.

But don't expect to cruise through being treated as the tolerated simpleton. That may happen if that's what your psychiatry program offers up and that may happen if that's the impression that you cut, but there's a good chance you'll be treated like everybody else.

I agree with this wholeheartidly. Feels good again to disagree with vistaril.

Especially if you do medicine early on the program would and should lean on you more as you should be on near equal footing as your internal medicine peers. Whether you become a lump who wants to be labeled as "just the psych intern" or you want to be known and respected beyond that, is on you.

If you don't feel comfortable with ANYTHING just say so. There's a reason ACGME requires direct supervision for first years.

Sent from my SM-G900V using SDN mobile

 

[FlowRate]

edit: Elaborated too much.

On medicine right now. Having a hard time because the system at this community site is set up to make doing good work very difficult, so everyone just does sloppy work. I don't want to do sloppy work.

 

[Crayola227]

edit: Elaborated too much.

On medicine right now. Having a hard time because the system at this community site is set up to make doing good work very difficult, so everyone just does sloppy work. I don't want to do sloppy work.

lol... I used to feel that way too.

Welcome to modern medicine. It doesn't get much better. Everyone is cutting corners and pooping notes.

 

[Gavanshir]

What an embarrassing thread.. just man up and do your best, you are a doctor afterall.

Feeling overwhelmed as an intern is not unique to psych.

 

[Crayola227]

What an embarrassing thread.. just man up and do your best, you are a doctor afterall.

Feeling overwhelmed as an intern is not unique to psych.

I think saying this is embarrassing is a little harsh.

"You are a doctor afterall..." lolol. Totally gonna pump this pysch intern up for those chest compressions!

Sack up OP & crush some bones!

 

[lymphocyte]

What an embarrassing thread.. just man up and do your best, you are a doctor afterall.

Feeling overwhelmed as an intern is not unique to psych.

Harsh and not helpful. Everybody feels anxiety about codes (or should) until they've been through a few. That's totally normal. And surely the OP wants to do his or her best, or they wouldn't be so concerned about remembering all the details. In fact, a number of studies now show that most doctors don't do a great job of running resuscitation. Why? Because they're rarely trained in a low-stakes/high-realism setting. There should be more hand-holding for junior doctors--to lay the foundation for quality habits in the future. "Man up and do your best" is exactly the wrong attitude.

But I agree with the general sentiment: every doctor should confidently know ACLS. It's a core, life-saving skill.

OP, if your programme has a sim centre, those are incredibly useful and might allay your anxiety.

We did about 30 hours of videotaped simulation during my ICU term, and I had to call 4 codes later on during my rural rotation as a medical student with senior help about 10 minutes way. Those codes would've been Code Browns if I hadn't had done the simulations first. For me, the most challenging part was just being assertive and definitive. The algorithm should teach how to be definitive, but being assertive just comes from exposure.

And frankly the only early interventions that have been shown to improve neurologically-intact survival are chest compressions and maybe defibrillation (though the data aren't as clear for in-hospital cardiac arrests). This may be controversial, but if you're by yourself with help on the way, forget airway and breathing, just get pumping!

Girotra S, Nallamothu BK, Spertus JA, et al. Trends in survival after in-hospital cardiac arrest. N Engl J Med. 2012;367(20):1912-20.

We found that survival after cardiac arrest improved regardless of whether or not the initial cardiac-arrest rhythm was treatable by defibrillation. In patients with ventricular fibrillation or pulseless ventricular tachycardia, improvement in survival over time was not accompanied by shorter defibrillation times. These observations suggest that factors other than rapid defibrillation may have accounted for the improvement in survival. These factors may include earlier recognition of cardiac arrest (i.e., shorter response times), quality of acute resuscitation (e.g., greater availability of trained personnel and provision of high-quality chest compressions with fewer interruptions), and postresuscitation care (e.g., therapeutic hypothermia and early cardiac catheterization).​

 

[Crayola227]

This may be controversial, but if you're by yourself with help on the way, forget airway and breathing, just get pumping!

But really, that's awesome you got so much exposure. I think that training helps tons.
No joke get compressions going, that's been the number one mistake I've seen in simulations.

 

[lymphocyte]

But really, that's awesome you got so much exposure. I think that training helps tons.

Yes. My motto for life, really.

But we just got very lucky. Our ICU director was a surgeon with a masters in medical education. "For 90% of you, only 4 things to remember: you never need to intubate, only ventilate; compress the chest; preload; and all bleeding stops eventually."

 

[whopper]

Touch wood I've never had to perform chest compressions on anyone, but I have had to provide airway support and perform rescue breathing, and being able to do either of those things effectively was largely down to practical training and not just theoretical.

I did it a few times and the first one was back in the day when they still thought mouth-to-mouth was needed. I was in a restaurant, an older man stopped breathing starting turning blue and didn't respond to me pinching him real hard (to the point where he could've bled).

I did CPR and two guys came out of the woodwork to help. I remember 1 was a fireman. I took command of the situation and I asked if anyone wanted to do mouth-to-mouth and they both nodded no. I thought to myself "cowards" and went at it giving him the full on kiss, our saliva mixing.

Well I'm sure my mouth-to-mouth didn't help given that we now know it doesn't make a difference but the CPR did work. EMTs didn't arrive for about 12 minutes and he lived to the point when they got there and they were able to send him to the hospital.

Some entertaining points (despite this was a terrible situation cause I'm sure the guy had brain damage from anoxia).
1-The waitress that alerted me to get to the guy to help him targeted my family and I first out of everyone there cause guess what? We're all Korean Americans! I figure she thought "here's a bunch of Asian geniuses, one of them has to be a doctor." This was in a packed restaurant with dozens of tables in it and she comes to my table first.
2-I hadn't had a date with a woman for over a year and well heck the cobwebs were there in that regard. Just a few days later I had a date with the woman that would become my wife and we hit it off from that date onwards. After our first makeout session I told her that my last one was with a man so I was real real desperate for that date to be a success.
3-Some idiot ER attending was at the table next to the guy the entire time, knew what was going on and just ignored him. Then after the EMTs arrived, she got up approached me and told me I was doing some of the CPR stuff wrong. Now this was back when I was a medstudent and still in kowtow-to-attending mode so even though I felt like biting her head off and asking "Why the eff didn't you help or say this when I was doing CPR?" I double checked all my BCLS stuff right when I got home and I didn't do anything wrong. Had the same thing happened today I would've given her some real real punch in the gut comment like "glad to see you're living your Hippocratic Oath.....NOT," or "No wonder why you're so fat. You'd rather eat than help a dying man." (and she was overweight).

 

[FlowRate]

we now know it doesn't make a difference

Breaths are still recommended for healthcare provider CPR. It's just that laymen should focus on appropriate compressions (between the lines: people should do something instead of freaking out about the mouth to mouth part and doing nothing.)

 

[whopper]

OK learned something new. Last time I checked they mentioned it didn't make a difference.

 

[Ceke2002]

I did it a few times and the first one was back in the day when they still thought mouth-to-mouth was needed. I was in a restaurant, an older man stopped breathing starting turning blue and didn't respond to me pinching him real hard (to the point where he could've bled).

I did CPR and two guys came out of the woodwork to help. I remember 1 was a fireman. I took command of the situation and I asked if anyone wanted to do mouth-to-mouth and they both nodded no. I thought to myself "cowards" and went at it giving him the full on kiss, our saliva mixing.

Well I'm sure my mouth-to-mouth didn't help given that we now know it doesn't make a difference but the CPR did work. EMTs didn't arrive for about 12 minutes and he lived to the point when they got there and they were able to send him to the hospital.

Some entertaining points (despite this was a terrible situation cause I'm sure the guy had brain damage from anoxia).
1-The waitress that alerted me to get to the guy to help him targeted my family and I first out of everyone there cause guess what? We're all Korean Americans! I figure she thought "here's a bunch of Asian geniuses, one of them has to be a doctor." This was in a packed restaurant with dozens of tables in it and she comes to my table first.
2-I hadn't had a date with a woman for over a year and well heck the cobwebs were there in that regard. Just a few days later I had a date with the woman that would become my wife and we hit it off from that date onwards. After our first makeout session I told her that my last one was with a man so I was real real desperate for that date to be a success.
3-Some idiot ER attending was at the table next to the guy the entire time, knew what was going on and just ignored him. Then after the EMTs arrived, she got up approached me and told me I was doing some of the CPR stuff wrong. Now this was back when I was a medstudent and still in kowtow-to-attending mode so even though I felt like biting her head off and asking "Why the eff didn't you help or say this when I was doing CPR?" I double checked all my BCLS stuff right when I got home and I didn't do anything wrong. Had the same thing happened today I would've given her some real real punch in the gut comment like "glad to see you're living your Hippocratic Oath.....NOT," or "No wonder why you're so fat. You'd rather eat than help a dying man." (and she was overweight).

Wait, you mean you didn't have the ability to perform open heart surgery on the restaurant's floor, whilst simultaneously calculating complex equations and fighting off multiple attackers with a set of nunchucks? 😱

Breaths are still recommended for healthcare provider CPR. It's just that laymen should focus on appropriate compressions (between the lines: people should do something instead of freaking out about the mouth to mouth part and doing nothing.)

This was my understanding as well. The senior first aid course I originally trained in has now been rolled into an advanced first aid certificate, which covers more than what I was originally taught (including the operation of resuc equipment), but still includes training in rescue breathing alongside compressions.

 

[strangeglove]

You should be no more worried (and no less skilled at running a code) than a PGY-1 medicine intern. That said, I agree with previous posters they interns - medicine or psych interns - rarely "run" the code. They do participate and are expected to learn.

 

[jettavr6]

lmao.....is this the stuff interns to be worry about? As a psych intern on a medicine service you will be expected to:

1) keep a positive attitude
2) help out the team when needed
3) try hard and be open to learning when it's the appropriate time
4) don't get in the way

You do these four things and your few months on medicine will go just fine. On 'paper' you may(or you may not) have the same responsibilities as the categorical medicine people and mediciney pre-lim types, but in reality you won't. And they may tell you you have the same responsibilities and expectations as them, but you won't.

Completely wrong advice, but given the source - pretty much expected.

A few of us took a lackadaisical approach on our medicine rotation in residency only to be quickly corrected by our superiors and set on the right path. Granted, none of us was expected to run a code, but we were expected to perform like any of our first year medicine peers. It boils down to the fact that ultimately, residency is a job - you are there to not only learn, but also perform.

Another thing we learned is that if you performed well and worked as hard as your medicine colleagues, then that respect earned goes a long way when you need a medicine consult at 3AM.

 

[jettavr6]

OK learned something new. Last time I checked they mentioned it didn't make a difference.

They are always changing this which makes it more confusing

 

[NickNaylor]

When on call and on night float for medicine, we carried the code pager. I only went to one actual real code which was in the MICU and well underway by the time I actually got there.

The advice I got from one of my seniors would probably be applicable: "your only job if you actually get there first is to start continuous cardiac monitoring, get a nurse to find an attending or senior resident, and start chest compressions. By the time you do that someone else will already be there to help."

Despite carrying to code pager, I didn't do a single round of chest compressions nor did I do any actual code management. I agree with the ACLS cards if you're concerned and want to be prepared, but the reality is that you likely will not be running any codes.

 

[Guyton]

The cornerstone of an effective code is timely, high quality CPR. Despite the millions of dollars invested into advanced resuscitation care that has led to an eye popping array of advanced airway tools, increasingly radical vascular access devices, and a plethora of pharmacologic agents- studies continue to suggest these "advances" actual lead to less favorable outcomes as compared to Basic Life Support. This is especially the case if one considers survival to discharge as being the more favorable outcome compared to the standard Return of Spontaneous Circulation measure ACLS proponents tout.

A recent study, published by Sanghavi et al in JAMA Internal Medicine, upset the prehospital community by claiming basic life support may lead to better outcomes than advanced life support. The article drew criticism from the Journal of EMS, The New York Times, and even JAMA itself. There appears to be significant reluctance by those vested in the "reinvention of the resuscitation wheel" funding loop to grasp the concept that in an emergency setting, complexity invites chaos.

My recommendation to the OP would be to focus on the basics of resuscitation. And remember, when the code pager goes off, the first person's pulse to check is your own.