During my Emergency Department rotation in school, I enjoyed it so much that I asked my instructor for more days in the ED. As I had hoped for, I was back in ED this week and my god was it amazing!
In one of the rooms, I was hooking up a patient who had complained of chest pain since the night before to the ECG machine. After I had placed the leads on and did a reading, I printed out a strip that led to a whole bunch of medical folks barging into the patient’s room. You see, the strip had shown a STEMI (ST Segment Elevation Myocardial Infarction). Aspirin was given, IV lines were started, Nitro drip was started, and tPA given.
As a side note, I tend to use a lot of medical/nursing acronyms that are used on a daily basis and sometimes I will forget to explain what certain acronyms stand for which may confuse my readers. I apologize for this and highly encourage you to put the good old Google to good use! 🙂 You just might learn something new! 🙂
Near the end of my clinical rotation, I got to experience my first code blue ever! A patient was wheeled in on a gurney into the ED with very little history and information to go by, but everyone on the team had their role and knew what to do. One of the nurses had already started doing chest compressions and then I jumped in to relieve her. I’m telling you, doing CPR on a real person versus a dummy that you practiced on to get certified is completely different as anyone would expect. It’s so much more easier to do chest compressions on a dummy. The only thing that is remotely accurate about the simulation versus a real person is the fact that CPR gets extremely exhausting! Altogether, 6 other team members and I took turns doing chest compressions and bagging the patient. The whole code lasted over an hour long. While doing the compressions, I was surprisingly calm. The only thing running through my mind was, keep focus on doing those compressions and I was also rooting for the patient to “recover.” We were watching the monitor and the resident doctor was feeling for the femoral pulses to decide whether or not he wanted us to continue with the compressions. Like I said, the whole thing lasted over an hour and some of the medical folks were telling the doctor to let the patient go. I was a little shocked by that just because when it comes down to it, it really is up to the doctor to decide whether to continue on trying to bring someone back or to just let him/her go. He is the one running the show and telling everyone what to do! I can’t imagine having to make that decision! The doctor refused to give up and told us to continue with the chest compressions and so we continued. It was my turn again to do the chest compressions. This time, they had lowered the bed and had a stool there for me to step on so I could put my full weight into every compression. I heard and felt some crunching/popping sounds while doing compressions which made me think I probably cracked the ribs or at least dislocated something. The nurses and techs were saying how I surprised them because for a petite girl, I did some really good and strong chest compressions. After a while, the doctor told me to stop the chest compressions while he felt for the femoral pulses. He confirmed that he could feel a pulse. While this was going on, nurses were trying to start IVs on both arms, but this patient was a hard stick. Multiple attempts were made and finally we were able to get one in the hand as well as the antecubital. We were then able to get fluids, dopamine, epinephrine, bicarb, and etc. into the body. As the drugs took into effect, you could see the blood pressure and the heart rate start to increase a little bit. However, as soon as the drugs started to wear off, you could see the vitals start to dwindle and the doctor would tell us to start the chest compressions again. If you’re curious as to the mechanism of action or how each of the drugs I just mentioned works, please do your own research. I don’t want to bore anyone explaining what each drug does to the body and this blog entry is already long enough. After the doctor felt that the patient was “stabilized” enough, he opened up a kit and started a central line in the right groin (For those who are curious about the procedure, look for it on YouTube or something). 🙂 It was so cool! To make a long story short, we were able to resuscitate the patient “successfully.” I put successfully in quotes because you have to keep in mind that this doesn’t necessarily mean that the patient will recover or will function the same way again. They may suffer from brain damage due to the lack of oxygen to the brain. There are also no guarantees that the patient will be able to be weaned off of the ventilator aka “breathing machine” or off of drips that are supporting his/her life. The family may have to make the difficult decision of pulling the plug eventually. It is sad, but that is also reality. Life is too short so live it to the fullest!
Until then, stay safe, learn CPR, fill out an advanced directive, and take care of yourself and your loved ones!
