Nothing is scarier than a coding patient. This is especially true if you are a medical student or resident. I mean when a person is coding they are dead. That is terrifying and as so the scene will usually devolve into chaos as everyone is scrambling to do whatever they can to get a pulse back. There is a scene in Scrubs where JD is running to a code blue when he suddenly realizes what he is doing and ends up hiding in the janitor closet. I think this is a common feeling for most med students and residents when they are called to his or her first code. Another thing that is really easy is to stand in the peanut gallery. Instead of just standing in the background try to figure out a way to get involved. Don’t just wait to be told what to do. Be proactive and take charge of one of the 5 interventions below. How you respond in a code is one of the main ways your attendings, nurses, and peers will evaluate you. it is important to be calm, collected and decisive with your actions.
Given how scary it is to be in a code it is easy to forget the simplest steps but if you can remember a few things in that chaotic environment you will be able to significantly help the team. So let’s simplify everything so that all you have to do is think about a couple of things. As you get more advanced you can start adding to the complexity of your actions during a code
Start Compressions:
It is your job to do compressions. If you are the first person that identifies that a patient does not have a pulse start compressions. If you get to the code after CPR has started, get in line to do compressions. There may be techs, nurses and other people lined up to do compressions but you should jump on the bandwagon. Make sure the compressions you do are the highest quality. Do 2 minutes straight and don’t stop until your two minutes are up, no matter how much your arms burning.
Cut the Clothes Off:
Make sure you have shears and cut off the patient’s clothes. It’s not the most glamorous job but someone has to do it. You want the patient do be fully undressed in a code so that you can begin working on access or other life-saving procedures.
Get the Patient on the Defibrillator:
Grab the defibrillator from the code cart and help get the pads on during a pulse check
Be the Pulse Checker:
Have your hand on the fem pulse and don’t let get. During compressions make sure you feel a good pulse. If the person doing compressions starts fatiguing and performing crappy compressions call them out. During pulse checks, people will rely on you to determine whether the patient has a pulse.
Help Get Access:
This means either putting in a central line or an IO. If you do not know how to put a femoral line in, now is the time to learn. Femoral lines should be your go-to in a coding situation. If the patient is a trauma go for the subclavian. these are not taught as much as they used to so figure out how to learn these procedures. If you have no idea how to put in a central line at least throw in an IO. These are really easy and fast to put in and can be learned on the fly.
If you can do one of the above 5 interventions you will be able to significantly contribute to a code. You won’t be one of the wallflowers that just stares in. Instead, you will be an active member. Your team will remember you. The more codes you become involved with the more at ease you will feel with them. Next thing you know your attendings will be teaching you more advanced skills and will give you more responsibilities.
Hopefully, this simplified approach to the code will help you. Take a deep breath and just simplify in your mind what is going on.
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