Running a Code (in Tight Quarters)

How many hands does it take to run a code?   Think about that for a bit...

In the SRU, the available hands seem essentially limitless.  There's a train of PCAs and medical students lined up to perform CPR, a nurse to run the monitor and defib, a nurse and/or pharmacist pulling up meds and mixing drips, a nurse charting, a MD dedicated to the airway, a RT to help with bagging, not to mention the MD running the whole show.  At a minimum you probably have 10 hands ready to ensure compressions are as uninterrupted as possible, to keep a check on the respiratory rate, to hook up monitors, push meds, defib, and all the other tasks that are necessary to code a patient.

Now what do you do in the back of the helicopter when a patient loses a pulse?  What do you run a code when you only have 4 hands to do what you need to do?  If you've never experienced that scenario, it looks a little like this:

Needless to say it's a little different than the SRU.  As you see, it's possible to run a code in the back of the helicopter, but it's far from easy (despite having 2 experienced flight nurses running the show, on a helicopter that isn't in flight, and a plastic manikin that you know is going to code instead of a real patient).  This situation will undoubtably come up at some point in your career as a flight physician.  And, when it does, the thing that will help the most is proper preparation.  Let's hear from Air Care flight nurses Susan Walker and Joseph Gucwa on their tips for successfully coding a patient in flight.

As you heard it comes down to preparation and communication:

  1. Always talk with your flight nurse on how they would want to run a code if the patient loses a pulse in the air
  2. Pacer/Defib pads should be on cardiac patients for every flight
  3. Think how you will manage the patient's airway and be prepared do so quickly and in a way that frees you up to help draw up and administer meds
  4. As a flight MD, know how to draw up and/or administer meds