Roles in a Code

When a patient is coding, everyone works as fast as they can to save the life of the patient on the stretcher. While doing clinical rotations in nursing school, watching the ER nurses work together during a code is what enticed and enthralled and sucked me into this specialty. So, here's a list of the roles/responsibilities (in my opinion, of course) that seem like just the right amount of people to be in the room during a code situation. (When it's my patient, I like to do the things marked with a *)

As the ambulance crew is rolling the patient into the room: 

RN*: Write down the story from the medics, any medications they gave, what size ETT they used, etc., along with any known patient history and medications. WRITE IT DOWN, you will forget it otherwise. 

Tech 1-2: Place the patient on the monitor. Obtain an EKG and a blood sugar. Grab another tech or two if CPR is in progress.

RN 1-2: Get an IV. Two if possible. Tape them suckers down, and draw labs, a whole rainbow, blood cultures, lactic acid, ammonia.

So the patient is now on your stretcher, connected to your monitor/code cart. Docs are doing their thing. And the patient is pulseless.

Techs: CPR, hard, fast and deep. Having two or three techs in the room helps so at pule checks they can trade out.

RN1: Give the medications and guard that IV. If someone accidentally rips the line out, everyone is screwed. When giving a medication, make sure to clearly communicate what you're doing. Saying "1 mg epi is in" loud enough for everyone to hear is key.

RN2: Draw up the medications, and work the code cart monitor. Get those epi bristojets ready. Spike a fluid bag. Be prepared with extra flushes to hand to the med-giving RN. Know how to set the monitor to the correct amount of joules to shock the patient. And MAKE SURE everyone is clear of the patient before hitting the shock button.

RN3*: Watch the clock, take notes, and be the communicator for the team. Make sure everyone is aware of what medications have been given. Know the ACLS algorithm and when it's time for a pulse check or another round of epinephrine. Position yourself by the door, so you can watch the entire team working, and so you can call out for supplies if something is needed.

It's so helpful in situations like this if you can have another nurse or tech standing right outside the door, so if your code cart runs out of epi, or if you forgot to grab an OG tube, they can grab it without taking people away from the room.

It's also important to have a nurse watching the rest of the pod while this is going down. If you look around and realize that you don't need to be in the room, GET OUT. You are probably in the way, and can be so much more useful going out to the desk and seeing what you can do to help everyone else out. The department doesn't come to a halt just because a sick patient comes in. Everyone else still needs IVs started, pain medications and those delicious chicken sandwiches. 

*Disclaimer* I'm not trying to say this is the ONLY BEST way to run a code, just how I've observed to make things run as smoothly as possible.

TL;DR: Know what needs to be done while a patient is coding, & if you're not doing anything productive.. GET OUT!

-K