CODE BLUE !

"CODE BLUE on 3rd floor. CODE BLUE..." was what the resident, interns, and I heard on the overhead speaker on my 1st night of night call. The resident said "let's go." And we were all running down the hall and up the stairs to the floor where the code came from. The rest of the code team (nurses, techs, etc.) were already there getting the patient prepped and waiting for the resident's orders. We all looked at the monitor which showed electrical activity and then we checked the patient for a pulse. He had no pulse (they even used a doppler to check for pulse). It was PEA - pulseless electrical activity. It was just like what we practiced for ACLS except I don't remember at all what to do. But the Maxwell's booklet had a section on PEA which I looked at while standing there in the room. One intern pulled out his ACLS mini spiral book also. The resident had in her pocket a few laminated cards of the ACLS protocol also (which I wouldn't mind having). In the section about PEA, you had to consider the H's & T's. Of course, I don't remember those at all, but it's in the book. The resident also reviewed the patient's chart, but she already knew about this patient from seeing him earlier. We already knew what the problem was and the family had not expected such a sudden turn of events when his illness (aortic dissection) didn't seem emergent. He was going to be transferred to Houston the next day for surgery. But somehow, it became emergent. He actually coded 2 hours earlier but managed to get a pulse. This was the second code and he was not DNR. So the team took turns doing 2 minute compressions (they were pushing hard & fast), and gave him oxygen with a ventilation bag. The patient was given epi a few times followed by atropine as well as bicarb (they did an ABG that showed acidosis). They continued to do compressions for over 30 minutes and then finally stopped when there was no change (he still had no pulse). The resident announced his time of death that evening.

I was only a spectator when this happened, but I got to see how they handle code blues in real life situations. They had a recorder who recorded the sequence of events - how many times epi was given, etc. They had a chaplain there (who always shows up for a code) to be with the patient and family for support and prayer.

We all then left the room so that the family could grieve. The resident then left a code note in the chart (btw, there's a note for everything - admit note, discharge note, progress note, transfer note, procedure note, consult note, etc.).

3 hours later, there was another code blue. This patient also had PEA. After several minutes of CPR/epi/bicarb...etc, her pulse returned and she survived.

btw, code blues don't usually happen this often. I just happened to be there when it did.