Shock

At about 8 a.m. today, the code bells sounded. ("I love the smell of chaos in the morning," said a nurse nearby.) I ran to the code, but because I had to schlep over from the intensive care unit (the ICU), I was late, and I didn't make it into the room. Scowling, I trundled downstairs to get back to pre-rounding.

Half an hour later, the ICU fellow came and tugged on my sleeve. "The code upstairs? She's here, and she needs lines." I jumped up, gathered supplies, and went into the room.

The patient was lying in bed, her eyelids stained violet as if with makeup. I began to announce myself brightly, the way I do with all my comatose patients ("Good morning, Mrs. Smith! Why, your nurple is exceptionally purple today!"), when I realized she was not intubated. This was very nearly alarming: I have never actually witnessed a code where the patient was not intubated.

When I began to lower the head of her bed, she shouted. "Ow!" I stopped and apologized. "It's OK, but girl, they hurt my chest something awful this morning. I feel like I've been beat up."

She had been beat up, so to speak. Her heart had stopped completely, and she had received chest compressions and one electric shock to her chest wall to restart her heart rhythm.

Still, I had to step back and verify that I was in the right room. That she was breathing independently was surprising enough, but that she was completely lucid just seemed improbable. And yet, it was true. For several reasons--among them the fact that her pulseless arrest was witnessed--her resuscitation worked.

I am so used to participating in minimally successful resuscitations of very medically fragile people that I was utterly stunned by this positive outcome. This, of course, speaks more to the population that is both electing and requiring CPR in hospitals than it does to the CPR procedure or practitioners--which, of course, speaks to the need for providers to be brutally honest about how well CPR works.

Otherwise, we just end up being brutal.

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Hey there, Signout.

Great story. You raise an important point: there are mismatched expectations as to the success of CPR. One of the culprits is TV and the movies. I wrote a little about this here, especially a fascinating study quantifying the disparity between CPR rates on television versus those in real life.

Best,

Blog, MD

A code is an inpatient cardiopulmonary resuscitation--but it's also so much more than that. I meant to link to an earlier post that explains this. Sorry to be obtuse.