First code

Today was another busy day on the adult ID ward.  I started off helping out the interns by doing a couple of lumbar punctures and some blood draws and then the team rounded on all the patients.  Rounds here are a little different than back home.  We start off by seeing the new patients or the ones on the high dependency area.  Also, during rounds the team takes vitals and starts IV fluids if indicated.

Other than the patient with hyperactive delirium who kept saying that the American resident was telling her lies and that I was her white father, the most memorable event of the day was being involved in a code for the first time.  I was just about to draw blood on a patient when an attendant said to me, without any apparent concern in her voice, "She has arrested."  At first I just looked up and asked "She's arrested?  What do you mean? Who?"  The attendant pointed at a patient three or four beds down the row from where I was standing and I looked and tried to make out what was going on.  I couldn't really see the patient breathing so I went over and checked and her chest wasn't rising and she didn't seem to be moving air.  Her hands were cold and I couldn't feel a pulse.

I told the nearest doctor I could find, who was the American resident on the team and he came over and started chest compressions and told me to get the other resident.  Because there was an infant, probably a 1-2 year old, playing on the floor next to the patient, right behind the resident who was doing chest compressions, the first thing I did was try to find a place for her where she wouldn't get stepped on or have body fluids or a needle land on her.  The mother didn't want her on the bed, probably out of fear of getting her daughter sick, so I looked around and thought of putting her on an empty bed but no one was there to make sure she wouldn't fall off.  Finally someone in the room realized that I needed someone to take the infant.

Finally I found the senior house officer and the intern and we all started running a code. For about 25 minutes we did chest compressions and bag ventilated the patient and that whole time we tried to get IV access and failed until we finally got a femoral IV line and gave epinephrine at about 20 minutes.  After 25 minutes without any sign of a pulse or heart sounds, it was pretty clear that continuing was futile, but we moved the bed to another room that had suction to get rid of some of the gastric contents that had come up.

All of this happened in a room full of other patients and the family members watching.  As I was doing chest compressions, I was using the song "Stayin' alive" to keep the right rhythm because I've heard that it's a song that plays at the ideal beat for chest compressions.  It seemed to keep me at the right rhythm, but having an upbeat song running in my head while running my first code seemed to make for a strange combination emotions. 

The American resident, who had rounded on the patient earlier, said that the patient had been responsive earlier in the day.  She was in her 20s and had known ISS (immunosuppression syndrome = AIDS) and had come in with abdominal swelling.  She was in kidney failure and she was acidotic (bicarbonate of 11) so it seems like she likely had a pulseless electrical activity (PEA) arrest due to acidosis.  But, given that there was no EKG, we have no idea what sort of heart rhythm she had.