The Anatomy of a Code
The world of critical care is often a chaotic place … one of the keys of working with patients is taking control of the chaos, especially when a patient has lost a pulse.
ACLS is well known to most providers; but the thing that is difficult, even to seasoned providers, is taking control of the room.
We’re back with.. Mike! Just in case you forgot -
MICHAEL BURTON, BA, MS, PA-C, MMS
Mike is a fellow critical care PA in Atlanta, GA. He has extensive former EMS experience in the field and brings these skills to critical care arena. In our practice he is part of the difficult airway faculty and is the main airway guru; he runs our sim program and mock code program for both our new trainees and established PAs. He is passionate about airway and patient assessment and is the main source for all things first, second and third assessment.
Often, the transition from near code to code can be difficult to recognize (especially if a patient is intubated and sedated). What is the first thing you should do when you come across this patient?
Have someone checking a pulse frequently or continuously
Watch the pulse oximeter - a good pulse ox waveform with good pleth
Once you transition to code? You transition from treating certain numbers - such a blood pressure, SpO2 - and titrating meds to those numbers - to following a protocol, ensuring your are keeping perfusion to vital organs and very quickly reverse cause of arrest. It’s a little more barbaric and rough around the edges
General Code Opportunities
30 to 2 vs continuous -
hands only CPR is okay for the provider outside the hospital - the public was scared to do mouth to mouth. It allows them to continue perfusion while EMS is on the way
Continuous compression w/breaths every 5-6 seconds is okay if you have an advanced airway
If someone seals BVM and delivers tidal volume during continuous compressions, most of that volume is going to the stomach. There is no effective way to ventilate without an advanced airway if continuous compressions are being done
Pad Placement A/P or A/L -
new pads for zoll monitors allow us to see depth, give verbal feedback; to utilize this pads must be A/P
effective defib can still be done A/L if you can’t effective place pads posterior
Don’t assume pads are appropriate position when “pads are on”
ETT vs LMA: It can be difficult to intubate during chest compressions and can create more chaos
cardiac arrest #FOAM
Mock Code Sounds by Pulmcast