Comments on: The End of the Code http://gruntdoc.com/2007/03/the-end-of-the-code.html Ramblings of an Emergency Physician in Texas Fri, 10 Feb 2012 00:40:33 +0000 hourly 1 http://wordpress.org/?v=3.3.1 By: Jim http://gruntdoc.com/2007/03/the-end-of-the-code.html/comment-page-1#comment-21651 Jim Mon, 29 Mar 2010 14:55:12 +0000 http://gruntdoc.com/2007/03/the-end-of-the-code.html#comment-21651 I thought about your approach, and then quickly inventoried the hundreds of codes in which I've been involved since 1965 when I assisted at the first. What comes immediately to mind is that it was the most excellent physicians who ended a code as you suggest; that correlation holds up to this day. The techniques have changed, but the outcomes don't seem to have changed all that much. The best docs are team leaders who keep everyone apprised of what they're doing and what they're thinking. The worst ones seem to think that knowledge is power and it is best shared sparingly. Ironically, it's the ones who keep the team in the loop, share their mental model, and verbalize the thinking process that goes into decisions, who wind up being the best and the ones with whom everyone wants to work. I'm fortunate enough to still work with several who meet those criteria. Jim Former 8404 HM3 '66-68 Former CPT AN '88-98 I thought about your approach, and then quickly inventoried the hundreds of codes in which I’ve been involved since 1965 when I assisted at the first.

What comes immediately to mind is that it was the most excellent physicians who ended a code as you suggest; that correlation holds up to this day. The techniques have changed, but the outcomes don’t seem to have changed all that much. The best docs are team leaders who keep everyone apprised of what they’re doing and what they’re thinking. The worst ones seem to think that knowledge is power and it is best shared sparingly. Ironically, it’s the ones who keep the team in the loop, share their mental model, and verbalize the thinking process that goes into decisions, who wind up being the best and the ones with whom everyone wants to work. I’m fortunate enough to still work with several who meet those criteria.

Jim
Former 8404 HM3 ’66-68
Former CPT AN ’88-98

]]> By: marg http://gruntdoc.com/2007/03/the-end-of-the-code.html/comment-page-1#comment-21138 marg Thu, 25 Feb 2010 02:27:52 +0000 http://gruntdoc.com/2007/03/the-end-of-the-code.html#comment-21138 I have never seen a good outcome from a patient who has come in to ED with CPR in progress. I have seen a few patients who did survive but with profound brain damage to go on to live miserable lives in some nursing home - endless cost to the taxpayer and just prolonging the misery for the family I have never seen a good outcome from a patient who has come in to ED with CPR in progress.

I have seen a few patients who did survive but with profound brain damage to go on to live miserable lives in some nursing home – endless cost to the taxpayer and just prolonging the misery for the family

]]> By: Wendy H. http://gruntdoc.com/2007/03/the-end-of-the-code.html/comment-page-1#comment-20490 Wendy H. Mon, 21 Dec 2009 09:24:09 +0000 http://gruntdoc.com/2007/03/the-end-of-the-code.html#comment-20490 I really wish that even *one* doctor back in my paramedic days had done this. I don't remember it happening a single time. The other thing I wish I'd seen more of was calling the code sooner. We all know, as has been stated repeatedly here, that they are usually futile efforts, and I used to just get so incredibly upset when some idiot of an intern or attending would want to keep pumping everything in the crash cart when there was clearly no more point, and everyone was already completely exhausted. I started my career in Pennsylvania, and we were allowed to pronounce death and call our own codes in the field. When I moved to CA, it was a big shock to no longer have that authority. The indignities perpetrated upon the patients and their families as a result was an outrage. I really wish that even *one* doctor back in my paramedic days had done this. I don’t remember it happening a single time.

The other thing I wish I’d seen more of was calling the code sooner. We all know, as has been stated repeatedly here, that they are usually futile efforts, and I used to just get so incredibly upset when some idiot of an intern or attending would want to keep pumping everything in the crash cart when there was clearly no more point, and everyone was already completely exhausted.

I started my career in Pennsylvania, and we were allowed to pronounce death and call our own codes in the field. When I moved to CA, it was a big shock to no longer have that authority. The indignities perpetrated upon the patients and their families as a result was an outrage.

]]> By: Teri http://gruntdoc.com/2007/03/the-end-of-the-code.html/comment-page-1#comment-18744 Teri Sat, 18 Jul 2009 21:21:02 +0000 http://gruntdoc.com/2007/03/the-end-of-the-code.html#comment-18744 Im an EMT/Medical assistant. I had a code a while back that really put me in a balancing act. It was only my third code in my career. The pt was old (80something), multi-system organ failure, just had some kind of abdominal surgery, a question about possible abuse, had prior stroke so was a talking vegtable, was an amputee, just alot of things going against him. He came in complete asystole but we worked him for I think 40 mins. We actually just called it and everyone was cleaning up. I went to start counting and throwing things away, I turned around and I heard a beep looked up at the monitor and sure enough saw sinus brady. You know when they have a rhythem you have to treat them so I yelled for the team to come back. We got him stabalized but later the family let the pt go. At the time I felt 'yes we got the pt back' but now looking back on it, why did I feel that way when the pt was so bad off to begin with. We in the medical field fight with ourselves all the time but to date I have no regrets about the decisions Ive made in my career. I think thats all that matters and that we take care of the patients to the best of our ability and moral character. Im an EMT/Medical assistant. I had a code a while back that really put me in a balancing act. It was only my third code in my career. The pt was old (80something), multi-system organ failure, just had some kind of abdominal surgery, a question about possible abuse, had prior stroke so was a talking vegtable, was an amputee, just alot of things going against him. He came in complete asystole but we worked him for I think 40 mins. We actually just called it and everyone was cleaning up. I went to start counting and throwing things away, I turned around and I heard a beep looked up at the monitor and sure enough saw sinus brady. You know when they have a rhythem you have to treat them so I yelled for the team to come back. We got him stabalized but later the family let the pt go. At the time I felt ‘yes we got the pt back’ but now looking back on it, why did I feel that way when the pt was so bad off to begin with. We in the medical field fight with ourselves all the time but to date I have no regrets about the decisions Ive made in my career. I think thats all that matters and that we take care of the patients to the best of our ability and moral character.

]]> By: Vanessa http://gruntdoc.com/2007/03/the-end-of-the-code.html/comment-page-1#comment-18354 Vanessa Mon, 22 Jun 2009 02:47:06 +0000 http://gruntdoc.com/2007/03/the-end-of-the-code.html#comment-18354 After that successful revival of a 31 min code the other night I will now be referring to you as GruntDoc, the Death Destroyer! After that successful revival of a 31 min code the other night I will now be referring to you as GruntDoc, the Death Destroyer!

]]> By: Judd Bailey http://gruntdoc.com/2007/03/the-end-of-the-code.html/comment-page-1#comment-18290 Judd Bailey Tue, 16 Jun 2009 06:25:13 +0000 http://gruntdoc.com/2007/03/the-end-of-the-code.html#comment-18290 Just retired from 35 years as a fire service EMT/PM. Truths I hold self evident based on those years: (1) Every code in the field is a cluster****. (2) If the present code has not yet turned into one, you are overlooking something. (3) Light/siren trips to the ER for code pts. postpone the familys confrontation with death, sometimes by years, but usually by just 15 minutes.(4) I worked every infant and pedi code like it was my own, no regrets. (5) I would rather face 100 families to tell them their loved one has died than listen to 1 more ER Nurse who feels a duty to loudly advise me she could have run the code better in some respect. She has no idea how close she is to "witnessing" workplace violence at that moment.(6) 97% of medics think the usual code due to chronic bbq overdose is a purely mechanical process, no more exciting or critical than baking a cake, but the moment we perceive a chance to win one, the search for and interventions against reversible influences becomes an art form. (7) Traffic is more dangerous to EMS crews than all the mean dogs, mad mommas and "harmless" drunks combined. (8) "Critical stress debriefings" are an embarrasment to the field of psycology. Nobody hopes for a CSD after "that" call. We want to (a) hear our spouse/kids voices, (b) be with our peers, (c) abuse adult beverages and fried foods at the Missing Cat Chinese Buffet ("Open 24 hours, except Sundays when we close at midnight."). Maybe if you came there we'd talk to you. (9) Less than 7% of all physicians have any business stopping at a trauma scene. Most of the other 93% never make this mistake twice. (10) Nice guys may finish last but at least we don't get sued by pt. families. Just retired from 35 years as a fire service EMT/PM. Truths I hold self evident based on those years: (1) Every code in the field is a cluster****. (2) If the present code has not yet turned into one, you are overlooking something. (3) Light/siren trips to the ER for code pts. postpone the familys confrontation with death, sometimes by years, but usually by just 15 minutes.(4) I worked every infant and pedi code like it was my own, no regrets. (5) I would rather face 100 families to tell them their loved one has died than listen to 1 more ER Nurse who feels a duty to loudly advise me she could have run the code better in some respect. She has no idea how close she is to “witnessing” workplace violence at that moment.(6) 97% of medics think the usual code due to chronic bbq overdose is a purely mechanical process, no more exciting or critical than baking a cake, but the moment we perceive a chance to win one, the search for and interventions against reversible influences becomes an art form. (7) Traffic is more dangerous to EMS crews than all the mean dogs, mad mommas and “harmless” drunks combined. (8) “Critical stress debriefings” are an embarrasment to the field of psycology. Nobody hopes for a CSD after “that” call. We want to (a) hear our spouse/kids voices, (b) be with our peers, (c) abuse adult beverages and fried foods at the Missing Cat Chinese Buffet (“Open 24 hours, except Sundays when we close at midnight.”). Maybe if you came there we’d talk to you. (9) Less than 7% of all physicians have any business stopping at a trauma scene. Most of the other 93% never make this mistake twice. (10) Nice guys may finish last but at least we don’t get sued by pt. families.

]]> By: Beth http://gruntdoc.com/2007/03/the-end-of-the-code.html/comment-page-1#comment-9307 Beth Thu, 10 Jan 2008 00:58:15 +0000 http://gruntdoc.com/2007/03/the-end-of-the-code.html#comment-9307 I'm not a medical professional of any sort, nor have I ever been. However, this still made me get a little weepy. I would want you, or doctors like you, there in the case of myself or my family coding. It's such a little thing, really, but it truly does mean a lot to have every professional in the room be treated as a.) a respectable professional and b.) part of the team, making that decision AND not being the sole person to bear the weight of that decision. With my parents starting to age and with multiple health issues on both sides, I pray that when their time comes, they have such caring professionals at their bedsides. Thank you. I’m not a medical professional of any sort, nor have I ever been. However, this still made me get a little weepy. I would want you, or doctors like you, there in the case of myself or my family coding. It’s such a little thing, really, but it truly does mean a lot to have every professional in the room be treated as a.) a respectable professional and b.) part of the team, making that decision AND not being the sole person to bear the weight of that decision.

With my parents starting to age and with multiple health issues on both sides, I pray that when their time comes, they have such caring professionals at their bedsides. Thank you.

]]> By: er mom http://gruntdoc.com/2007/03/the-end-of-the-code.html/comment-page-1#comment-8656 er mom Thu, 29 Nov 2007 02:51:17 +0000 http://gruntdoc.com/2007/03/the-end-of-the-code.html#comment-8656 If i ever code,I hope Alex D isn't the paramedic that comes to get me. If i ever code,I hope Alex D isn’t the paramedic that comes to get me.

]]> By: SG http://gruntdoc.com/2007/03/the-end-of-the-code.html/comment-page-1#comment-8654 SG Wed, 28 Nov 2007 18:19:44 +0000 http://gruntdoc.com/2007/03/the-end-of-the-code.html#comment-8654 I've been having a bad week. So far three codes, and all went bad. And I'm a paediatrician, and often our in-hopsital resus situation has a favourable outcome. Reading this put things back into perspective for me. Thanks. I’ve been having a bad week. So far three codes, and all went bad. And I’m a paediatrician, and often our in-hopsital resus situation has a favourable outcome. Reading this put things back into perspective for me. Thanks.

]]> By: Zoe Brain http://gruntdoc.com/2007/03/the-end-of-the-code.html/comment-page-1#comment-5669 Zoe Brain Wed, 23 May 2007 15:42:51 +0000 http://gruntdoc.com/2007/03/the-end-of-the-code.html#comment-5669 I remember the day my father came back. I was there as the code team arrived, I held his hand, backed off when the paddles came out, told him firmly to breathe (he was semiconscious) and soon his heart started beating again. 12 hours later, 2/3 of his heart was akinetic, and I held his hand as he went after drinking a final cup of tea. A few sips, anyway, as he was taken off the ventilator. My Thanks go to the cardiac unit, they did everything they could, including the doses of morphine which meant he didn't feel it when he choked to death again. That was 13 years ago. But my heart, and my thanks, go out to all code teams everywhere. Sometimes you win, sometimes you lose, but you have to be in it to win it. I remember the day my father came back. I was there as the code team arrived, I held his hand, backed off when the paddles came out, told him firmly to breathe (he was semiconscious) and soon his heart started beating again.

12 hours later, 2/3 of his heart was akinetic, and I held his hand as he went after drinking a final cup of tea. A few sips, anyway, as he was taken off the ventilator.

My Thanks go to the cardiac unit, they did everything they could, including the doses of morphine which meant he didn’t feel it when he choked to death again.

That was 13 years ago. But my heart, and my thanks, go out to all code teams everywhere. Sometimes you win, sometimes you lose, but you have to be in it to win it.

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