what you do to void a code, and during the code?

emtb2rn, BSN, RN, EMT-B · Oct 17, 2008

Not sure I really understand your question.

Are you asking how to avoid calling a code? If so, then being aware of your pts and proactively managing any deterioration in condition before they arrest is the best way to avoid a code. Does your floor have protocols? Find out what they are. If you have a RRT (rapid response team), initiate them if your pt goes suddenly hypotensive, has resp distress, develops chest pain or has acute onset AMS (probably wanna do a quick fingerstick on that one first).

Plus, you can always cancel a code. The code teams in my hospital would rather the floors err on the side of caution if they think the pt does or might need advanced life support.

Have you taken ACLS? Strongly recommend it if you haven't as you'll learn the textbook way to manage a code. Real life can be different....

Hope this helps.

Pediatric Critical Care Columnist · Oct 17, 2008

With the development of rapid response or medical emergency teams, the number of patients who progress to cardiac arrest has dropped dramatically in most hospitals. Of course, as emtb2rn has said, awareness of what's going on with your patients is key. At the risk of tempting fate here, I've worked in a high-acuity PICU for 11 years and have never had a patient code on me yet. I watch for those subtle changes in condition that might suggest a deterioration and fix it before it worsens. I've even had patients who had already coded more than once on the previous shift who were still ticking along at the end of mine. Be aware, call the doc if something just doens't seem right, don't worry about being wrong because s/he who hesitates often is getting the cart. It's much better to say something like, "I can't put my finger on it, something has changed and I'm concerned. I might be wrong, but I want you to check it out." Then tell the doc what you've observed, what you've already done and anything else that might be important. If you're wrong, oh well, the doc is still being paid for the time.

patwil73 · Oct 18, 2008

my coworker says nothing is worse than calling a code.

I would disagree. Nothing is worse than explaining to a sobbing family member that the patient died because no one called a code.

I am scared of code.

Most people are. You are dealing with death. There is a lot of increased adrenaline. A lot of people tend to blame themselves (if only I had. . .). However, understanding your role in a code will do a lot to decrease that fear, since you have a specific job to do.

wondering what you do to void a code?

Sometime you can't. A massive PE or MI from a mainstem blockage will kill someone almost instantly. However, for the others look at trends in the vital signs. If the patient has been moving along with a HR of 100 for the last 3 days and BP of 130/60 and suddenly go down to 62 HR with a BP of 100/45 you might call for some help. (Note that even though both sets of vitals could be considered "normal" it is the change in trend that indicates a problem.)

and what you do during?

Depends on your hospital. At mine my responsibility is to "run" the code with the residents. I keep the algorithm flowing, make sure CPR performers are taking turns, record the events and work on differential diagnosis with the residents.

At your hospital your job might be to perform cpr, get equipment, take vitals, adminster meds. You would only be asked to do one thing from the list. It is a good idea if you have a fair number of codes to get used to the different roles so you can help out - and by becoming familiar you will lose a lot of that fear since you know what is going on.

I would also suggest taking an ACLS class. You will learn that codes run by a cookbook approach. You do pretty much the same thing every time, and once you learn those steps it becomes much easier to handle.

I hope this helps

Pat