poured out before bed
“I can’t bag him anymore – nothing’s going in.” The sinewy paramedic looks up at John expectantly.
John nods, takes in a sharp breath.
“Place an ET tube.”
“Placing an ET tube.”
“How are we doing on time, Jill?” John watches the resuscitation attempt in progress grimly, glances at the fluids hanging above the patient.
“We’re at two minutes now.”
“Everybody clear, let’s check the rhythm.” Everyone stands back, hands up. The OB/Gyn intern who was performing chest compressions is replaced by a chiseled internal medicine intern,who with the rest of the team stares at the tele monitor.
“Still Vfib, resume chest compressions…charging…everybody clear…all clear… shocking. Back on that chest, Jim. Jill, let us know when 2 min is up. Amy, please draw up 1 mg Epinephrine with a flush.”
“Drawing 1 mg Epi and flush.”
“The ET tube is in.”
“Great, what’s the capno reading?”
“It’s at 7.”
“Jim, faster compressions, please, allow for full chest recoil – excellent, looks like we’re at 12 now. Amy, how’s that Epi coming?”
“Good, administer 1mg Epi with flush.”
“Epi is in…flushed.”
“Great, please draw 150mg of amiodarone with flush. Jill, let me know when we’re at 3 minutes post-epi.”
“Alright, let’s think about causes guys. He’s got multiple risk factors for both MI and PE. He’s post-surgical so hypovolemia is also a consideration. Lytes are always a possibility – have we got those stat labs back from before he coded?”
“Yep, normal BMP, normal tox screens.”
“We’re at 2 min, Dr. Smith.”
“Alright, everyone clear, checking rhythm…asystole…resume chest compressions.”
Carla, a slight family medicine intern with wispy arms and fine straight hair begins vigorous compressions, her blonde locks flailing back and forth like curtains in the wind.
Suddenly, there is a loud POP, followed by a wet sounding slap.
The paramedic managing the airway coughs loudly.
Lying on the floor next to him is the recently placed ET tube. There is a red mark across the bridge of his generous nose.
Jill, begins to giggle.
“Bob, are you ok?! Oh my god, I’ve never seen that…that’s…oh, that’s a new one!” She is laughing hysterically, now.
Bob puts down the ambu-bag and shakes his head grinning at Carla, who has stopped CPR, standing horrified.
“Those were some chest compressions, Miss.”
Carla turns bright red as the other interns begin to laugh.
“Well, they always say, hard and fast…”
Jill tosses the mega-code checklist on a chair, turns off the monitors and resets the controls on the simulator. On the table in front of us, the sim-man’s eyes open and begin blinking again, his chest rises and falls, a pulse now visible in his carotids.
“And they’re right, Carla, you did great. Everyone did great. John, well done running this one. Of course, if that happened in real life, we wouldn’t stop and laugh. We’d throw in a new tube and keep up CPR like it never happened… And now, let’s pretend that this never happened and start a new scenario. Katie, you’re up. This is a 67 yo M who presents to the ED via his wife complaining of dizziness and sudden right sided weakness starting an hour ago. Go.”