Since I was at the Pyxis med station refilling, I immediately logged out knowing full well that meds would be pulled left and right for the code. In addition to the ICU clinical pharmacist, one of the staff pharmacists from downstairs also arrived, as well as one of the pharmacy residents. While I had previously witnessed code blues before, I had never actually taken part ... until today.
The clinical pharmacist immediately printed a list of emergency medication that I needed to pull, and I began handing everything over ... most notably, epinephrine (aka adrenalin, in the form of 250cc in D5W IV drip bags, 1:10,000unit blunt syringes, etc) and atropine. I ran, literally, to two floor satellite pharmacies to help coordinate with mixing emergency IV drip medication that was needed.
All the while, the patient was being given CPR by teams of nurses and doctors who kept rotating. For those who have never witnessed real-life CPR, it is WAY more rough than one would imagine - and much more exhausting to do properly (which is why there must be teams of people to switch every round). Pharmacists began to draw up doses while I prepped more meds ... I was less than 3 feet from the patient undergoing CPR with at least 15 other people (doctors, nurses, respiratory therapists, etc) all around.
30 minutes later, the doctors and clinical pharmacists decided that the only thing keeping the patient alive was CPR and pushing epinephrine ... they considered calling off the code since all attempts to resuscitate were not yielding any good results. The patient's family members, who had arrived 10 minutes previous, became hysterical and were restrained by security who had also been present. The doctors decided to continue with the code for a little while longer. 40 minutes later, despite the best efforts of everybody involved, the code was called off and the patient passed away.
My arm/hand after the code ... had to take note of emergency meds needed immediately - no time for paper
Having been involved in my first code blue, I realized quite a few things that I never fully "understood" until now. First, we tend to have this TV image of "emergency medicine" and look at it as "fun" and "exciting". In a way, it most definitely is ... it's incredible to see that kind of teamwork come together and the sense of urgency is contagious. But I have to say that watching a code or emergency is one thing - actually being involved is a completely different feeling. When the patient's family is standing outside and you hear their screams and wails from crying, you can't help but feel their pain ... this wasn't a TV medical drama anymore ... it was real life. And yet on the other hand, you have to try to block it out and concentrate on your job at hand - your role within the team responding to the code. There is no margin of error in an emergent situation, and I've never concentrated so hard on working incredibly quickly but even more importantly, extremely carefully - you check, double check, triple check your volume, drug dose, etc, and then you try to not second guess yourself. I've never felt that kind of pressure, surrounded by so many other healthcare professionals.
Hours later, my heart was still beating fast ... it was exhilarating and amazing to be a part of that. Unfortunately, the result of our efforts was not what one would have hoped for ... sometimes I am equally amazed at how crude and even barbaric medicine can be, even with today's technology, innovation, and knowledge. Still, I want more ... to study pharmacology and to be a resource like today's clinical pharmacist was to the doctors and nurses responding to the code ... immediately calculating dosage of emergency meds, thinking about drug interactions, adjusting dosing for a myriad of other factors, in what order the drugs should be pushed, , etc. Hopefully that dream will be fulfilled sometime in the near future.
Until then, who said being a pharmacy technician or a pharmacist was only about counting pills?
And it all starts again tomorrow ...
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