Thursday, January 23, 2014

We have different definitions of "code"

So I was working the other night when I heard the code bongs going off. The code was in the surgical observation unit, which I literally don't think I've ever heard before. (Basically overnight observation for routine procedures where you're expected to be discharged in the am. Things like biopsies, some laproscopic ortho and abdominal procedures, lots of plastics and ENT stuff, etc, etc...)

Much to my fortunate luck, I got a call a few hours later that I need to take that patient in my lonely one remaining ICU bed. Reasonable, I think... resuscitated codes should probably take the last ICU bed in the house.

And then I got report.

Obs RN: "So Mr. S is 83 years old, day of surgery from a lap hernia repair. No complications. He's voided after his foley out and all that good stuff. So I put him on his home CPAP and put him to bed at like 2100."

Me: "Mhmmm... yea... mhmmmm." Thinking: "I bet he got overnarc-ed and forgot to breathe for awhile. 

Obs RN: "Well then when I went to take his vitals at like 2330 his SBP was in the 70s!" pause for dramatic effect

Me: "Mhmmm... yea... mhmmmmm..."

Obs RN: "So then I called the code, of course."

Me: "Mhmm... wait, what?"

Obs RN: "He got hypotensive so I called the code."

Me: "Oh so that's when he arrested? It was like a hypotensive/PEA kind of arrest thing?"

Obs RN: "Oh no, just that one pressure of 70 systolic. The next one was 130/80 once I woke him up."

Me: "I'm sorry I'm confused. So he didn't stop breathing or anything?"

Obs RN: "Oh of course not. So anyway, neurologically he's a 15, moves everything, ambulatory, pupils equal and.........."


Apparently "code" doesn't mean pulseless/apneic to everyone...?

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