Friday, September 25, 2009

Keeping A Cool Head

Posted by Kendra Yum at Friday, September 25, 2009

Today started out like most other mornings in the Surgical Intensive Care Unit (SICU) at University Hospital. My classmate, Karen, and I arrived early to review patients’ medical profiles. We then discussed our findings of medication-related issues with our preceptor, a clinical pharmacist in critical care and nutrition support. At 8 a.m., we joined the rest of the SICU team, made up of residents, medical students, nurses, a dietitian, pharmacists, and an attending physician. With the group assembled, we began the morning rounds.

On rounds, we stopped at each patient’s bedside on the unit. The team was huddled around a patient with all of us scribbling notes as we listened to an update of the patient’s status.

Suddenly, an overhead alarm began to beep in rapid succession. Team members stopped writing and looked at each other. Then we heard someone cry out: “We have a code in room number 20!”

The entire team rushed toward room #20. Karen and I looked at one another, each gauging the other's response as we accompanied the group. A code blue had been initiated, meaning that a patient was in cardiac arrest.

The team of doctors and nurses instantly gowned up and surrounded the patient to perform defibrillation and apply chest compressions (CPR). My preceptor immediately pulled open the medication drawer of the crash cart and began rapidly assembling syringes of epinephrine and atropine, so that they were ready for use, on command. (A crash cart is a set of trays/drawers/shelves on wheels used in hospital emergency rooms and containing the tools and drugs needed to treat a person in or near cardiac arrest.)

The attending physician called for multiple doses of epinephrine, followed by a bolus of amiodarone. The room was abuzz and bustling as commands were shouted across the room. The tension in was palpable, and remained that way until the patient's heartbeat stabilized.

After the crisis, our preceptor described the role of a pharmacist during a code blue and the pharmacist's responsibility for monitoring the correct administration of medications during emergency response.

Easier said than done... Experiencing the code today demonstrated how overwhelming an emergency response could be. The literal life-and-death urgency of an emergency situation could easily overwhelm clear and rational thought, and interfere with informed decision-making, including decisions about medication use. As a pharmacist responding to a code blue I could see the absolute need to keep a cool head in a heated crisis. Hopefully, I’ll get there.

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