I'm too old for this shit...

[Jolly]

Got a call from the ED nurse at 1710 yesterday. Code en route, ETA 3-4 minutes, full response.

Guys, this is a rural hospital...One x-raider, one lab rat and one snot sucker at that time of the day. ED is running two RN's, a LPN and a doc. So this kind of code is all hands on deck. Patient hit the back door, is wheeled into the trauma room and presents with a barely discernable pulse, a BP of next to nothing and she's gasping. Occasionally.

We slid her off of the ambulance gurney and people start their jobs. One nurse documents, the respiratory tech is bagging, one nurse starts a saline lock and hands me a blood-filled syringe. Doc is calling for epi, more epi and then atropine and another nurse is getting the telemetry leads on.

I go put my stuff on, glance at my watch for spin and run time and head back. By this time, Doc is jacking in more epi and atropine, pulse is still barely discernable and we're taking turns bagging and doing chest compressions. The thought runs through my head that I rarely ever do this and I stand a good chance of breaking this patient's ribs. During pauses, Doc is getting a better pulse and he's got the patient up to a whopping 30 before it fades and the nurse now has a pacer hooked up.

I've got to leave and finish up my stuff, so I let the rad tech have the compressions, but I come back as soon as I result, with a paper copy of the lytes to give to the Doc. I'll be damned, but they've got a pulse rate up into the mid-forties and the patient is starting to breathe on their own under oxygen. Xray guy is doing a portable on the patient. Other guys are doing their jobs. Doc wants a chopper, but we've got a front coming in and sane people don't fly medevacs in the pouring rain and gusting winds, so they're gong to load her back into an ambulance with a nurse, for a thirty minute ride to the nearest Level 2 trauma center.

Since we Jane Doe'd her upon admission, everybody's trying to get the paperwork right since we now have demographics. The nurses are policing up the trauma room, making sure the empty flotsam and jetsam agrees with the chart count.

Hope the patient made it. Don't know, haven't talked to the ER crew today.

As I said, it's a small hospital and everybody has to pitch in, when needs must. I've done femorals in a small hospital code or drawn ABGs. I've loaded patients into cat scans and pulled a psyche patient off of a doc and fought him down. In some ways, it's a more satisfying form of medicine. In a big hospital, it's just a name and a set of results on a LIS screen for me.

But I'm getting too old for this shit...

[George K]

For at least two decades before I retired, I said the “trauma is a young man’s game. “

I feel the same way about codes.

Should you find out what ultimately happened, let us know! Sounds like everything was done properly, quickly, And with a marginally good result.

[Jolly]

In my old hospital, if we had an afternoon code on the surgery floor (male surgery south wing, female non-gyn surgery north wing, OR in the middle), the lab guys had to respond wit a Burdick for a rhythm strip (ancient medicine, I know). Since it was close to OR, lots of times you get a gasman. Loved to see those guys how up. A) They can stick anybody or darn near it, and B) they tend not to fuck up an intubation.

[Mik]

Too much terror for your truly. I think I would have been good at trauma medicine had I gone that way, but I never had any inclination until much later in life when I began to learn about the medical professions.

[Jolly]

It takes a certain mindset. Some guys are just built different...For instance, take George's wife (no Henny Youngman jokes, please)...ICU nurses are just different. The good ones, the ones who last, can have hearts as big as Texas with stainless steel backbones and an ability to flush the job at the end of the day.

[Mik]

Yep. The patients aren’t the only trauma victims.

[George K]

@Jolly said in I'm too old for this shit...:

ICU nurses are just different

ER nurses are in the same category.

There was a twitter thread posted by some 1st year resident (that's an intern in the old parlance) who was upset when the nurse asked, "Are you sure you want to order that?"

I don't recall what he wanted to order, but the comments were...uncomplimentary toward the attitude of the (as my wife would have called him) "little intern."

I commented by saying, "Suppose you went ahead, and things go south. Try to explain that on AM rounds. 'Well, the nurse did have some concerns.'"

The other extreme (and this happened to me) is talking to the nurse and saying, "What do you think?" That's how you make a friend forever.