"We're In a Code"

Go ahead and turn your caps lock on now, butthurt commenters. Here we go.

So, as I may have mentioned before, last night sucked. Hard. I think we had about 4 intubations and 2 codes in the first 2 and half hours in addition to a bunch of other train wrecks and ICU holds that were already down in the ER at this point. At some point in the midst of all the madness, we hear them call a code blue to one side of our ICU (it's split into 2 big hallways) and think little of it. Even procedure whore doc, who usually is calling upstairs to see if they need intubation before the operator is even done announcing the code, payed little mind, as he's already intubated half the patients in the ER at this point and was over it. About half an hour later, they assign me an ICU bed on the hallway where the code isn't happening. I get my stuff together and call up there, and some chick answers the phone and is like, "Um, did you NOT hear the operator? We're in a code right now. Yeah. I think your report's gonna have to wait for a little while." Generally trying to be understanding, I ignore the fact that this woman is talking to me in the same way one would speak to a child who is interrupting the grown ups talking and say, "Oh, I'm sorry, I thought that was the other hallway." I swear I can hear her roll her eyes over the phone as she responds, "Well, up here we all come help", after which the B hangs up on me. Oh hell naw. Let me break this down for you, girl.

One, is it really necessary to act like that? If you'd just been like, "hey, we're all in this code, can the nurse call you back", this would not be an issue and I wouldn't have to make fun of you anonymously over the internet. But now I do. You brought this upon yourself. But seriously. I'm so sorry, I didn't realize the important ICU nurses were still in a code, which I wouldn't understand, because we don't do anything down here besides sew up boo-boos. Let me just get back to handing out ice packs and Norco until the real nurses can call me back and bestow upon me the honor of taking report. Meehh.

But the real point of the post is, how many of you does it take to code a patient? I'm gonna drop a hot opinion on y'all right now and say if it's more than 5, you're probably doing it wrong. I apply that rule to us, too. Okay, if you're coding a patient you need a nurse to record what's happening (1), a nurse to push meds (2) two to alternate between compressions and code gopher (3 and 4) and I'll throw a 5th in there to do other procedures or whatever or to bag if RT isn't there (which they are). Really four is enough, and we've coded patients many a time with three with no problem. If we're really in a bind, I've had days where it's me, super medic and a doctor where I push drugs and record and super medic and the doctor switched off compressions while the doctor ran the code. It's not ideal, but you know what? I would rather have that any day than 10 people in the room. Why? Because if there are 10 people in there, half of them are just standing around anxiously getting in everyone's way, and that is the most annoying shit in the world. If you are standing around in a code, your presence alone is not helping. You are making it worse because you are limiting flow in and out of the room, and you are sucking up everyone's oxygen and making it hotter in there. Get the F out.

If I am the recording nurse, I will actually tell people to get the hell out. If I am helping and a bunch of people come in, I will switch with someone and go take care of my teammates' patients while they're in the code while announcing loudly on the way out that the room is at capacity and the fire marshall is going to come and write us a ticket. In the ICU, I would think this is probably even more true because you often already have lines and an airway established. So you're doing compressions, pushing drugs, and recording . It shouldn't take that many of you. Plus the house supervisor, the chaplain, and everyone else and their mama is up there in your business once that shit gets called overhead. To quote my ICU buddy nurse XY, "It's an ICU room, not a clown car". Leave.

My second point is, that shit must be nice. It would be rad if we were coding one patient down here and if EMS showed up with another super sick patient we could be like, "Nuh-uh! We're in a code! You keep that out in the ambulance bay until we're done! What's wrong with you?" But it doesn't work that way. Sometimes we just have to bag with one hand and do compressions with the other and push drugs with one foot while hoping we remember all this crap, because every patient down here is crashing at the same time. It happens, and I don't feel sorry for myself about it because this is what I signed up for. But do I feel sorry for you when you are asked to step out of a code 15 people are standing around in to take report from the mean, ugly ER nurse so I can fill my room with the next code coming in down here? Nope! That's the way nursing goes. Dry your tears with your fancy cellulose dressings and pull up your disposable one use big girl panties that we don't stock down here and deal with it.