Quote from IsseyM
Hi everyone, i have been on my own for almost a year and i have not been in a code yet (Don't look forward to it either). I was wondering if any of you have been in a code, if so can you go into detail the steps you initiate. I know for sure number 1 we call out to the charge nurse or overhead page all available staff to room ## IMMEDIATELY. I am quite nervous about this and i'm afraid i won't know what to do. I want to be prepared for a code, so any advice or tips are appreciated. Also who does chest compressions in the OR? The surgeon?
You should have a policy and ideally do mock codes so that everyone understands what they are supposed to do.
As far as CPR it depends on where the drape is. If the chest is prepped out then the surgeon or someone that is scrubbed will do it. If chest is not prepped then usually someone not scrubbed in will do it.
There are a couple of roles here. I'll give you what I was taught many moons ago. If you are scrubbed your job is to protect your sterile field and get ready to support the surgeon. This includes anticipating opening the chest or aborting the surgery.
If you are the circulator you support anesthesia until you get help then support the surgeon and the scrub. Once again anticipation is the key. Also police your
OR. Make sure that extraneous personnel are kept out and watch the traffic. Be ready to help move the patient to attach external paddle. Hopefully the charge nurse will help you police the room.
Outside of trauma I've seen 3-4 intraoperative arrests. Our procedure was pretty much as above. One of the PACU nurses would do recorder. Charge nurse directs traffic and delegates more resources. Usually another 1-2 anesthesiologists would come in and help at the top of the table. Scrub would keep field sterile. CS would bring in mini thoracotomy tray and internal paddle.
Worst arrest - moving a TMJ patient to the stretcher when he arrested. Look anesthesia's eyes when he realized we were in a back hall with two dentists and an arrest.
Best (relative) - Anesthesia looks over screen and asks "Can you step back for a minute so I can shock this guy?". Looked up and the patient was in V-tach. Absolutely unflustered. Thats when you know that you have a rock-star anesthesiologist.
David Carpenter, PA-C