Codes in OR

[TennRN2004]

In the famous GI/Diprivan thread here, a poster mentioned that anesthesia runs the codes in the OR, while the surgeon stays sterile and steps out of the way. Is this what you who are in the OR see? I've only seen one code situation from an OR patient, but it was an open heart pt who had just been transferred to the SICU ten/fifteen minutes earlier. In that situation, they paged the surgeon stat and he came running to call the code. It makes since to me for anesthesia to run the code in the OR since they have/can establish airway, have lines/meds to push quickly. I was thinking though if you don't do codes often, do you have to think for a minute to start one, or is this part of nurse anesthesist school to anticipate and respond to emergencies in the OR? Of course, I'm sure there's a system in the OR to call for help and have other people come in to assist.

[pigtails]

If any anesthesia professional is present, then thank god!

If you like to run the show, then this is your chance. CRNA's and MDA's take you where should not be and bring you back. What a weird profession, but again, thank GOD. One thing I fear the most is FEAR, and I like the idea of rendering a person insensible to pain and fear. This is a humbling and rewarding profession.

Follow your heart.

[loisane]

Codes in the OR are just an entirely different sort of beast than in any other environment. The picture you might have from floor or ICU nursing is going to be a different image than from the OR.

In anesthesia we often manage unstable patients, than in another situation might be "coded". The scenario of a respiratory arrest is pretty meaningless during an anesthetic. Of course you can have unanticipated apnea, that is one of the main reasons for our continual hyper-vigilance. But when it occurs, it is recognized and managed. Usually without the need to sound any alarms, or even be noticed by anyone other than anesthesia. And if airway management is challenging, a colleague from your own department will come assist.

Hemodynamic instablity and dysrhythmias are managed similarly. So much of what you might think of part of code, is just part of the job description for anesthesia.

So the only time there would be a need to "call a code" would be if you need to ask for defib/pacemaker or CPR. When it gets to this level, the OR team is assisting with the resucitation effort. But you don't need help from outside the OR. The surgeon, CRNA and anesthesiologist (if one is part of the team) are capable of making the decisions required. Not to say you don't call for a consult when appropriate-for a cardiologist, or a pulmonologist, or some other specialist.

In most cases it makes sense for the surgeon to stay sterile. There are plenty of people in the room who can do chest compressions but he is the only one who can operate. His role is to either fix the problem that caused the arrest (like in your emergency heart case), or wrap up the elective case at turbo speed by doing the essentials and closing post haste. Either way, there is no time for him to break scrub, and then have to go re-gown.

is this part of nurse anesthesist school to anticipate and respond to emergencies in the OR?

This is job #1 in anesthesia. So yes, it is one of the primary objectives during nurse anesthesia education-while in school, and life long.

loisane

[stbernardclub]

Good post lousane...sums it up well...

Codes in the OR are just an entirely different sort of beast than in any other environment. The picture you might have from floor or ICU nursing is going to be a different image than from the OR.

In anesthesia we often manage unstable patients, than in another situation might be "coded". The scenario of a respiratory arrest is pretty meaningless during an anesthetic. Of course you can have unanticipated apnea, that is one of the main reasons for our continual hyper-vigilance. But when it occurs, it is recognized and managed. Usually without the need to sound any alarms, or even be noticed by anyone other than anesthesia. And if airway management is challenging, a colleague from your own department will come assist.

Hemodynamic instablity and dysrhythmias are managed similarly. So much of what you might think of part of code, is just part of the job description for anesthesia.

So the only time there would be a need to "call a code" would be if you need to ask for defib/pacemaker or CPR. When it gets to this level, the OR team is assisting with the resucitation effort. But you don't need help from outside the OR. The surgeon, CRNA and anesthesiologist (if one is part of the team) are capable of making the decisions required. Not to say you don't call for a consult when appropriate-for a cardiologist, or a pulmonologist, or some other specialist.

In most cases it makes sense for the surgeon to stay sterile. There are plenty of people in the room who can do chest compressions but he is the only one who can operate. His role is to either fix the problem that caused the arrest (like in your emergency heart case), or wrap up the elective case at turbo speed by doing the essentials and closing post haste. Either way, there is no time for him to break scrub, and then have to go re-gown.

This is job #1 in anesthesia. So yes, it is one of the primary objectives during nurse anesthesia education-while in school, and life long.

loisane

[stevierae]

I am the one who posted that, and, yes, the surgeon usually stays sterile--or, if he chooses to break contaminate his gown and gloves, he can get into a new set very quickly--whatever, he pretty much stays out of the way until he is needed up at the surgical field again.

I agree with loisane--it always cracks me up when someone comes into a room where we are starting to run into troubles with a patient, and, unasked, freaks out and yells out into the hallway, "CALL A CODE!!!!!!!"

First off, we are perfectly capable of handling our own room--we've encountered these situations before, and will encounter them again. The circulator is perfectly capable of starting IVs, hanging blood, setting up and calibrating vasoactive drips, art line, CVP etc. If she is not, she should not be in the operating room circulating. In any case, if she needs more help (someone to run blood gases, check blood etc.) she can call out for it.

Secondly, as I pointed out, it almost always occurs once we already have a protected airway--and, if not, we soon will.

PEA tends to be a common denominator in most "codes--" find the cause of the PEA, (often tension pneumo) fix the problem, and voila!! No more "CODE--" and no more drama.

I freakin' hate it when all the drama queens--every operating room has them-- show up to "help-" all they do is get in the way. And, yes, most surgeons--unless they are trauma surgeons--tend not to do CPR very well, and they are more than happy to stay out of the way.

Honestly, when the drama queens show up, I just want to yell out "Nothin' to see here, people...show's over...."

[TennRN2004]

I am the one who posted that, and, yes, the surgeon usually stays sterile--or, if he chooses to break contaminate his gown and gloves, he can get into a new set very quickly--whatever, he pretty much stays out of the way until he is needed up at the surgical field again.

I agree with loisane--it always cracks me up when someone comes into a room where we are starting to run into troubles with a patient, and, unasked, freaks out and yells out into the hallway, "CALL A CODE!!!!!!!"

First off, we are perfectly capable of handling our own room--we've encountered these situations before, and will encounter them again. The circulator is perfectly capable of starting IVs, hanging blood, setting up and calibrating vasoactive drips, art line, CVP etc. If she is not, she should not be in the operating room circulating. In any case, if she needs more help (someone to run blood gases, check blood etc.) she can call out for it.

Secondly, as I pointed out, it almost always occurs once we already have a protected airway--and, if not, we soon will.

PEA tends to be a common denominator in most "codes--" find the cause of the PEA, (often tension pneumo) fix the problem, and voila!! No more "CODE--" and no more drama.

I freakin' hate it when all the drama queens--every operating room has them-- show up to "help-" all they do is get in the way. And, yes, most surgeons--unless they are trauma surgeons--tend not to do CPR very well, and they are more than happy to stay out of the way.

Honestly, when the drama queens show up, I just want to yell out "Nothin' to see here, people...show's over...."

Stevierae,

I wasn't trying to imply you weren't right or anything by asking my question. Hope you didn't take it that way.:) I want to apply to anesthesia school soon, and your post on the other thread made me wonder about how codes are run in most ORs. I was exposed to the OR setting as a BSN student, but I didn't grasp the full extent of the OR being a world of its own the way I am starting to now. Thanks for everyone's replies. Nothing like learning from the ones who actually do it everyday.

[stevierae]

Stevierae,

I wasn't trying to imply you weren't right or anything by asking my question. Hope you didn't take it that way.:) I want to apply to anesthesia school soon, and your post on the other thread made me wonder about how codes are run in most ORs. I was exposed to the OR setting as a BSN student, but I didn't grasp the full extent of the OR being a world of its own the way I am starting to now. Thanks for everyone's replies. Nothing like learning from the ones who actually do it everyday.

Don't worry--it's all a learning experience. I am continually learning from new RN and OR techs and students, and via this BB. :)

One day soon I will be learning from YOU--both when you are accepted to anesthesia school, and via this BB!!!