November Notes, Day 2

"One Hour"

 You're going to need a drink after this one... I sure did...

It all started with a patient brought in as a transfer from another hospital after being found unresponsive at home, CPR being performed, and concern for a cardiac event.  The other hospital got the patient back and then transferred them to our facility.  Ten minutes out from our Emergency Department, they coded again and CPR was restarted.  When I got the patient, they were still performing CPR, and I ordered various medications, and we got the patient back.

While this was going on, another patient had been brought in by ambulance for some side pain and concern that they missed their dialysis appointment three days prior.  Initially, they were stable, but as my patient was starting to have a pulse again and we were stopping CPR, that patient decided to have a cardiac arrest and another code was called.  The other ED doctor went to take care of that patient, and all of the staff that had been at my code, ran to that code, and suddenly we had two critical patients in the department.

About this time, we got word that two trauma patients were being brought in "lights and sirens" and we prepared for a Code Trauma.  As this was going on, my patient decided to code again, and anyone who wasn't helping with the other code ran to my code.  We got pulses back again, but were now using multiple medications and a transcutaneous (on the skin) pacemaker.  The dialysis patient got pulses back at this time, and the other physician was free for a moment which was good because we were still waiting for the two trauma patients.

Suddenly, an ambulance showed up at the back door with a patient in cardiac arrest, we thought it was the trauma, but it turned out to be yet another patient.  The other ED doc took that patient, and started to run the fourth code of the moment (my patient twice plus the dialysis patient plus the new patient.)  At about this time, the first of the trauma patients was brought in, and the surgeon who had responded to the Code Trauma said they would go look at them as simultaneously, the second trauma patient rolled in the door with paramedics performing CPR on them.

I ran the trauma code with the surgeon who had since returned while my colleague got pulses back on their patient who then proceeded to code again before she'd had a chance to leave the room.  Unfortunately, my trauma patient died, and as I pronounced them, my initial patient started to have worsening vitals requiring adding medications and some more attention.  My colleague's now twice-coded patient got pulses back around the time her dialysis code patient was trying to code again.  She went to take care of that patient while I finally had a chance to sit down and write some orders on my initial code.

One hour had passed.  We haltingly joked that we were running 75% on our codes.  Someone pointed out that our average was better as 7 codes had actually been run, so we were at 86%.  Regardless, still a passing grade.  Then our attention turned to the 15 or so people that had filled the waiting room during that time and were still waiting to be seen;  not to mention the other dozen or so patients that had been in the department when all of this unfolded.  So much had happened in one hour... but there was still a lot of work to be done.