Your First code

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Ovationman
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Your First code

Post by Ovationman » Fri Oct 17, 2008 10:50 pm

I just helped work my first code in the ED tonight. We had a old woman coded in the ambulance and was Asystole when they got her in. We worked it for fifteenth mins before we called it. It was really a rush but I am glad it was someone who had lived a long life. I was wondering if anyone else remembers there first code and what impact it might have on anything.

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Re: Your First code

Post by painiac » Fri Oct 17, 2008 11:39 pm

It was my first day of "Critical Care" clinicals in the surgical ICU of a big-city hospital.

There was this big biker-looking dude, probably 275 pounds or so. He'd been shot once in the abdomen. From what little we knew, it was drug-related. He'd just come out of surgery, where they'd discovered that the bullet had transected the inferior vena cava. He had a hematoma on his abdomen the size of half a cantaloupe. They were pushing in units of blood as fast as it would go, and the room was packed to the walls with doctors, nurses, lab techs, respiratory techs, and med students.

They finally decided he was at least stable enough that his family could come in, so all the staff cleared out and the family walked in. One of the nurses looked at a fresh printout of his arterial blood gases and said, "he's not going to make it". Family wasn't in the room for even one minute before he coded.

After a little while, about 20 minutes or so, I heard one of the doctors call time of death. I stood there kind of expectantly, wondering. Would this get to me? I've never seen anybody die before. When would it come? A couple minutes of introspection later and I realized, it wasn't coming. It didn't bother me. I can do this job, and I can apply myself fully to it without having to worry about grief getting in the way.

Being in a code, it does make you face your own mortality. It's something you always *know* but don't really think about. Everyone has their time to go. I don't think it's written in the stars or ordained by fate, necessarily. It's just inevitable: "On a long enough timeline, the survival rate for everyone drops to zero". Memento fuckin mori. Everyone has their time. We do our best, to the very limits of our knowledge and ability. Once in a great while, it's not their time yet and we bring them back from the edge. This rarely happens, though. You can't let it get to you. You can't take it home with you, or it will chew you up and burn you out. It was just their time. You tried to intervene on their behalf, but they were already gone.

I'll never forget the tattoo the dude had on his belly of a smiley-face guy shooting another smiley-face guy in the head, and the smiley-face guy who was being shot had a conversation bubble that said, "Why me?". The entry wound of the bullet that killed the guy was right after the question mark in his tattoo's conversation bubble. That may be the best question I've ever heard.

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Re: Your First code

Post by Bubba Enfield » Sat Oct 18, 2008 8:42 am

I really can't remember my first code as a student. Actually I don't think I can recall the first code I ran on my own once I was hired either. I'll always remember the first time someone coded in front of me, that was weird. Someone goes from talking to you, to falling down dead, and you're the last person to speak with that person, that's something I thought about later. Most codes, I don't feel bad about not getting a pulse back, because the person is old enough to have had a decent shot at life. But when it's a 30 year-old mother, with her kids watching the rescusitation efforts, that truly sucks. And when it's a kid, forget about it. :(
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Re: Your First code

Post by Orestes 21 » Sat Oct 18, 2008 3:34 pm

My first code was back when I was a first responder and 14 years old I was riding with my town fire department at the time for this call I was on the ambulance with a Paramedic (Pat) and an Intermediate (Dan) I forget who was driving but, We were dispatched for the unknown medical, once we had arrived on scene we found a retired member of the fire department (long since retired) in the bathroom in between the toilet and the tub in cardiac arrest. I remember the department toning out for extra personnel to assist. Pat grabbed the tube while the Dan went for the IV and I began compressions.

We extricated the patient to the back of the truck and begin transport Pat was pushing drugs while I bagged and Dan continued CPR. I remember Dan talking to the Patient trying to get him to fight back, I didn’t really find it odd because he was the guy who knew everyone in town and knew their life story for the most part. As we entered the hallway of the trauma center they had me do the hero ride* because Dan was tired from compressions and I was easier to push on the stretcher. Pulling into the trauma room filled with the code team was quite the awesome sight. I wasn’t pushed but I was placed out of the way so the patient could be transferred over and the hospital could take over care, we stood there and watched while Dan explained to me what they were doing.

While I was cleaning the back of the truck Dan came out and said that they had called it and he had died. Once the truck was clean and the guys were getting supplies I stood at the front of the truck and looked out over the Lifeflight helicopter and thought that, that call was awesome (how ever morbid it sounds) I knew that this was what I wanted to do for the rest of my life in one way or another. I knew that yes our patient died but it was explained to me that not everyone makes it, most don’t.

** The Hero Ride is when someone hops onto the side of the stretcher and does CPR while the stretcher is pushed along. I am unable to find a pic, I will post one if I find one.
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Re: Your First code

Post by TravisM.1 » Sat Oct 18, 2008 3:45 pm

My wife took her first coded patient pretty rough, but she's fine with it now.
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Re: Your First code

Post by tails359 » Sat Oct 18, 2008 6:05 pm

Having been in the field for coming on seven years, I cant really remember the first code I ran ever, as an EMT. But I do remember my first code as lead medic. It was my first shift working as a paramedic at the beginning of this year. Second call of the day I think. We got toned out to Lowes hardware for a man down, CPR in progress. I can tell you I was sweating bullets on the ride over, even though I've run dozens of codes before. All those times I was an EMT, and had a medic running things. Its a little different when you're in charge. The buck stops with you.

We got onscene about three minutes after fire did, grabbed our gear ( we could see them working the guy though one of those big bay doors) and headed over. The fire captain met we half way and gave me quick rundown. Middle aged male, pulseless, not breathing, vomit in the airway ( wife said he just ate lunch). They were just getting him on the monitor, and the firemedic was in the middle of a tube attempt when I walked up beside the pt. No dice on the tube, he pulled out and asked if I wanted to try. Hell yeah. So we suctioned his airway, and oxygenated him with a BVM. My turn. Keep in mind this guy was about six foot three, 280. Between the puke, and his size, I couldnt see shit. I pulled out and we put the BVM back on him. The firemedic wanted to try again but I said no, and pulled out a combi-tube. Got that in no problems, good equal chest rise and breath sounds equal bilat. Looked at the monitor and the guy was in V-fib. The pads were on his chest, so I cleared the pt ( they were still working on the IV). The firemedic and I were about two feet behind the pts head when I shocked him. Now, remember all that puke? For those of you that dont know, a combi tube is what is known as a dual-lumen airway. Thats a twenty dollar word for its two tubes in one. That way it works wether it goes in the trachea or the esophagus. 9/10 times it goes in the esophagus, with the extra tube thats not hooked to your BVM going right into it. When I shocked the pt, he jerked hard, launching puke up the CT like a freaking shotgun. Nailed the firemedic and I right in the face. Thankfully I had my mouth shut, so it only went all over my face and into my eye. The firemedic wasn't so lucky, he got a mouthful of puke along with his eye puke. Needless to say, nowadays I wear my fucking eye protection like you're supposed to.

Anyway, we spit, swished sterile water, spit again and got back to work. We got him onto a backboard, by that time the line was started, pushed epi, CPR, shocked him a couple more times while we tried to get his big( and puke slicked) ass onto the cot an into the truck. Lots of CPR, epi, Lidocaine, electrons ( 12 shocks I think was the grand total), and diesel later we arrived at the ER. He was still in V-fib , and they worked him for a while before he finally went into a PEA, then to aystole. Doc called him about twenty minutes after we got there. Did my paperwork, grabbed a set of scrubs from the OR, had to do a exposure report because of the puke to the eye. Went back in service. I was pumped. Aside from the electrically propelled puke, everything went smoothly. It didnt bother me in the least( then again I had been on the truck for six years already), I was too stoked about having run my first code and having it go so well. Unlike some of the codes-from-hell Ive had sense, it was all good. As for things that bother me, kids is really it. Though it sucks when some young parent goes. Anyway, hope I gave you what you were looking for.
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Re: Your First code

Post by Bubba Enfield » Sun Oct 19, 2008 7:14 am

Tails, that's an awesome story. We don't have combitubes here, I didn't know they spew puke.

One time I was running a code in a trailer, in a bedroom that's basically a bed with a foot or so of space around three sides. When we shocked him the first time, a cat came SCREAMING out from under the bed, right overtop of the patient, between me and my partner. We nearly shit bricks.
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Re: Your First code

Post by tails359 » Sun Oct 19, 2008 4:48 pm

^ ROFL! Yeah, I would have shit a brick myself.
Yeah, usually it just kind of seeps out of the extra tube, with maybe a light pumping action with compressions. That was the only time Ive ever had it fly out. Now I usually bend the extra port over and tape it, to avoid any surprises.
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Re: Your First code

Post by posie » Sun Oct 19, 2008 9:42 pm

Heh!! This is a great thread. I love hearing other medics' crazy stories. The combitube puke story is just awful...it could've been worse: http://randomreality.blogware.com/blog/ ... 28325.html. Any of y'all had to take PEP, Post Exposure Prophylaxis? Hopefully not. My code story is pretty tame in comparison.

My first code was in a rural Alaskan town. I had been a volunteer firefighter/EMT for a couple of months. It was about 1AM on a Friday or Saturday night and I was on call. I had just gotten home from a night out with friends (obviously, no drinking while on call). I had my radio set to scan and I heard a bunch of crazy radio traffic, so I ran out the door with my bunker gear and drove hard to the station. I pulled into the station when the call was toned out.

Our dispatcher was a totally useless brat who had gotten her job because her Mommy was the HR director, so we ended up dispatching the call ourselves. Really professional, thanks. Anyway, a 23 year old drunk had been speeding and then rolled a 15-passenger van down an embankment, and at the time of tone-out nobody was sure if there were any people in the water. As personnel got the scene secured, we realized that there were 4 people in the van, and thankfully nobody was in the water. Although we got the first three out of the van relatively easily, we had a hell of a time getting the last one. The van was overturned/upside down and the guy was pinned upside-down in the crushed van.

It took us 45 minutes to extricate him. Our smallest firefighter/medic tried to ferret her way into the van and reach the victim to assess him while he was pinned, but she couldn't find a pulse -- not femoral, not carotid, and he was totally unresponsive. Bad sign. When we finally pulled him out, he was blue and floppy, and I thought, "Oh fuck, he looks pretty dead." We quickly put him on the gurney, started CPR, and loaded him as fast as we could for transport. As we did compressions and ventilations, it was pretty obvious to me that he was already dead.

I remember feeling so helpless when he was pronounced dead by the doc - we did absolutely everything we possibly could to get him out quickly. Another medic and I stood by while the police photographed his body, and then we loaded his body into a body bag. It was surreal for me to go on my first dead call, and then to see him on the table in full light, and then load his corpse for transport to the medical examiner.

We loaded the body bag back onto the gurney, covered it, and took him to the morgue at the police station. A few hours later, when the next plane was set to leave, we loaded the patient's body into a locked coffin and drove to the hangar for plane transport to the Anchorage medical examiner. I think that his cause of death was eventually determined to be traumatic asphyxia.

It took me a long time to go to sleep after that. It was very overwhelming and the first dead call is typically pretty rough. The whole accident happened because of drunk driving, and it was such a tragedy. The other men in the van were badly injured - one had both his femurs broken. Looking back, it was amazing that only one of them died.

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Re: Your First code

Post by tatersalad » Mon Oct 20, 2008 12:40 pm

Thanks for posting guys. I'm set up to start the EMT-B class in January, helps to be exposed to others experiences...

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Re: Your First code

Post by claren » Mon Oct 20, 2008 4:30 pm

tatersalad wrote:Thanks for posting guys. I'm set up to start the EMT-B class in January, helps to be exposed to others experiences...
When it comes to encountering death, context is everything. Death in the ER itself is generally less of a big deal than death in the back of the truck, which is generally less of a big deal than death out on the street with bystanders around, which is generally less of a big deal than death in the home, with the family standing around watching the resuscitation efforts.

Trauma death is often harder than medical death, although medical death can be ugly too (although, I'm thinking more of an ICU/tubes-in-every-orifice-and-they-still-crack-the-chest kind of scene, which you aren't likely to see on your clinicals).

My first code was a 60's male. His entire head was cyanotic, as blue as my scrubs; he obviously wasn't going to be a save. He had been CPR in progress for 30 minutes by the time he got to the hospital. We worked him for 6 or 7 minutes, then the doc called it. Washed my hands, ate lunch, didn't think about the fact that I wasn't thinking about it until over two hours later.

Yes, there are people who are not cut out to see death for a living. However, I don't think most folks that want to be EMTs (or nurses or doctors) will have a problem with "normal" death, at the clinical observation level (from what I've seen/heard, it becomes more difficult when -you- are the provider).

Just don't worry too much about it, and I think you'll do fine.
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Re: Your First code

Post by MJS8725 » Mon Oct 20, 2008 8:37 pm

claren wrote: My first code was a 60's male. His entire head was cyanotic, as blue as my scrubs; he obviously wasn't going to be a save. He had been CPR in progress for 30 minutes by the time he got to the hospital. We worked him for 6 or 7 minutes, then the doc called it. Washed my hands, ate lunch, didn't think about the fact that I wasn't thinking about it until over two hours later.

Dude, you never worked at Sierra View Hospital in Porterville CA, did you? You described my first code exactly. We found him in his room cyanotic and worked on him for about 5 min on scene and then for the 25 min transport to the hospital. When we arrived the ER staff took over and called him about 5-10 min later. Creepy. I wasn't even an EMT yet I had gotten my CPR card THAT DAY during our volunteer training.
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Re: Your First code

Post by 19kilo » Wed Oct 22, 2008 3:27 am

I don't remember my first code at all. One code I do remember was a three year old and his mother. He had some sort of genetic illness and his mother knew about it and she told us but still wanted us to work on him. And course we did. me and and a nurse took turns between compressions and bagging for a half hour before the doc asked the mom what she wanted him to do. She just said " let me hold him". I have since forgotten their name but I won't forget their faces.
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Re: Your First code

Post by thorian » Wed Oct 22, 2008 4:10 pm

You know the first real code I have ever worked on was a old guy. I still remember his name however due to HIPPA I wont repeat it. He was a stubborn old farmer that had a history of heart problems. Every time he was having an issue we would monitor his vitals until his nitro took effect and then he would go back to his day. One day we get a call that he was unconscious and had fallen into the bathtub. It was pretty obvious that he was gone at that point. Body was cold and blood was starting to pool in his hands and knees. We performed CPR for the hysterical wife until the paramedics arrived and got her calmed down enough to say that he was a DNR. I was out of work that day and I recall it was a sunny April morning it was cool jacket weather but it was calm and peaceful. Another guy and I volunteered to stay and assist the funeral home with body transport. While waiting for the funeral director I literally watched 4 generations of that man's family arrive to pay respects to their father grand father and great grand father. I also noticed that he had a bunch of humming bird feeders around his porch and looking in the living room his chair looked out on them and not at the TV as one would expect.

So I sat there in the rescue squad for 3 hours watching the humming birds just enjoying life.

His grandsons and the 2 of us placed him into a body bag and then carried him out to the hearse. I didnt say anything was thanked for my service and left with a different outlook in life. And then put a humming bird feeder out by my kitchen window.
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Re: Your First code

Post by leadpulaski » Wed Oct 22, 2008 4:40 pm

My first code was on my first day on the FD and was my first time running code. 50-60 y/o male. Heart attack. CPR in progress. Nothing we could have done really, tubed him, shocked him, nothing all around. We waited for the funeral home and helped load him up. What sucked was one of the other firefighters knew the family.
Afterwards the Captains wife brought some bitching mexican food for dinner.

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Re: Your First code

Post by exon111 » Thu Oct 23, 2008 2:05 am

tails359 wrote: When I shocked the pt, he jerked hard, launching puke up the CT like a freaking shotgun. Nailed the firemedic and I right in the face. Thankfully I had my mouth shut, so it only went all over my face and into my eye. The firemedic wasn't so lucky, he got a mouthful of puke along with his eye puke. Needless to say, nowadays I wear my fucking eye protection like you're supposed to.
The paramedic who teaches my EMT class told the exact same story. He and another medic got a mouthful of puke from a combitube during a code, so now he is really into stressing the importance of eye protection and a mask when dealing with any kind of intubation.

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Re: Your First code

Post by painiac » Thu Oct 23, 2008 6:08 am

exon111 wrote:
tails359 wrote: When I shocked the pt, he jerked hard, launching puke up the CT like a freaking shotgun. Nailed the firemedic and I right in the face. Thankfully I had my mouth shut, so it only went all over my face and into my eye. The firemedic wasn't so lucky, he got a mouthful of puke along with his eye puke. Needless to say, nowadays I wear my fucking eye protection like you're supposed to.
The paramedic who teaches my EMT class told the exact same story. He and another medic got a mouthful of puke from a combitube during a code, so now he is really into stressing the importance of eye protection and a mask when dealing with any kind of intubation.
"Keeping your mouth shut" is a good policy all-around, not just in social interactions.

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Re: Your First code

Post by tails359 » Thu Oct 23, 2008 1:01 pm

"Keeping your mouth shut" is a good policy all-around, not just in social interactions

+1

At least I know Im not alone. That somewhere out there, someone else got a face full of puke from a combitube.
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Re: Your First code

Post by JIM » Thu Oct 23, 2008 1:12 pm

Heared a tip from a paramedic (back when they still used combitubes here) that once they established the 'good tube' with a Positube, they left it on the 'bad tube' to prevent any vomit from blowing out of the tube..
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Re: Your First code

Post by tails359 » Thu Oct 23, 2008 4:22 pm

JIM wrote:Heared a tip from a paramedic (back when they still used combitubes here) that once they established the 'good tube' with a Positube, they left it on the 'bad tube' to prevent any vomit from blowing out of the tube..
Hmm, good idea there. Though Ive never heard of using a positube with a combitube. I suppose you could do the same thing with a disposable CO2 detector, though I wouldnt use one with a CT, seeing that combitubes are verified with chest rise, bilat breath sounds and epigastric sounds.What I do these days is bend over the spare tube end and tape it, problem solved. At most you have a slow trickle of puke, not flying puke streams of doom.
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Re: Your First code

Post by painiac » Thu Oct 23, 2008 6:39 pm

tails359 wrote:"Keeping your mouth shut" is a good policy all-around, not just in social interactions

+1

At least I know Im not alone. That somewhere out there, someone else got a face full of puke from a combitube.
Haha
You two should meet up and start a support group :lol:

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Re: Your First code

Post by tails359 » Thu Oct 23, 2008 7:51 pm

painiac wrote: Haha
You two should meet up and start a support group :lol:

Yeah, I can see it now, the ultimate medical support group.

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Re: Your First code

Post by arrowolf » Fri Oct 24, 2008 10:02 am

My first code was an old guy who had a heart attack and wrecked his car a block from what was then Knollwood Hospital (Mobile, AL). When we rolled up, the guys on the pumper truck had gotten him outta the car and were doing CPR. As this was back in the Dark Ages of EMS in the City of Mobile, me and the firemen present were all just basic at the time. We figured to load him and drive across the street to the hospital doing CPR and let them handle it. When we were about to shut the doors and roll off the scene, the city paramedics showed up. In the time it took them to intubate and IV and shock and all that stuff, he woulda been him in the ER with the real docs.
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