Code Blue!

We have all seen CPR done on a dummy - "CPR Sue" or whatever your instructor called the plastic dummy whose chest moved when you directed air through the mouth.

Today, however, I saw CPR done for real on a patient who "coded" (medical jargon for died - well, coding means we are going to try our darndest to bring you back unless you are DNR/DNI...more medical jargon for Do Not Resuscitate and Do Not Intubate). Anyway, this patient basically stopped breathing and despite the advanced age, the family did NOT have a DNR/DNI which means full court press to bring the patient back - CPR, cardioversion (that's the one where they yell "CLEAR!" before you see the patient fly up on TV...and no, in real life, the patient doesn't necessarily jump up that high!), intubation, ventilator, all sorts of heart medications that will bump up your heart activity and restore the beat.

For the most part, a room where a patient has coded is controlled chaos. There is an MD in charge, several other first year residents who rotate doing compressions on the patient (which can be extremely tiring), and a nurse who is preparing the meds and documenting how long the code has been progressing, etc. Oh, there are also several med students who are trying to observe a piece of the action. Overall, the process is quite controlled even though stuff is flying around in the room.

Seeing the chest compressions during CPR on a patient really put me in awe. I mean this patient was just like a rag doll. And in fact, if you are ever in the position to do CPR, they say you need to push down on the chest about 2 inches...and if you are doing it correctly, you will probably break a rib or two in the patient. It is quite unpleasant, actually. Seeing it in person just totally blew me away.

In the end, we brought this patient "back" - though we suspect brain damage due to lack of oxygen. This brings another point up - make sure you discuss with your family and your doctor your wishes and desires if you are ever, God forbid, incapacitated and can't make your own decisions. What would you want done if you ever "coded" - your family should know exactly what you want done so they don't have to make the emotionally gut-wrenching decisions on their own if ever put in that position. And PLEASE, if you have a family member who is older, think about THEM when deciding whether to authorize a DNR/DNI. The process of CPR and intubation and ventilators, etc, is extremely painful. In fact, it can be downright torture in older patients. So please, for their sake, discuss their wishes with them if you can and don't put them through iatrogenic torture unnecessarily.