Ivermectin for Humans - Buy Online! The ED should be very adept at drips especially in the setting of cardiac arrest and post-ROSC care, and the ICU should absolutely be able to run a code and perform all procedures that would be necessary. Seems like a silly redundancy.

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  • Gravity13


    March 10, 2015, 6:35 pm

    My hospital has the ED MD go to codes, and we only have one on at a time, so, it can be sort of hairy when our doc is stuck on a code on the floor and then it's just nurses and paramedics in the ED, like the patients are running the asylum. 🤣 I've actually brought this up at staff meetings as a potential problem, but they say we can always call the floor to talk to our doc. During the day, we also have a mid-level, but at night the doc is the sole ED provider.


  • Tlide


    March 11, 2015, 8:33 am

    Agreed, running a code in a familiar, controlled setting with providers that can place lines/push meds sounds like heaven in contrast to 0300 trailer with a faulty floor and no other ALS hands where I have to handle airway/access/meds/running the code simultaneously.


  • chromacolor


    March 10, 2015, 7:19 pm

    At my place, ICU doc or Hospitalist runs codes, unless it is in OR / PACU / Pre-op (anesthesiology runs those) or the ER (ER doc runs those). If there’s a second code simultaneously, anesthesiology goes to the floor runs it. If there is a third (has never happened) anyone qualified runs it.


  • UnificationDotCom


    March 11, 2015, 3:51 am

    No, it makes no sense because EM docs don’t do call and I fail to see how being on call would be helpful during a code since it requires rapid response time (unless you mean that you would have an EM physician just hang out in the hospital for just codes which seems like a waste of money.)


  • EmpiresCrumble


    March 10, 2015, 6:47 pm

    I would think anesthesia would be preferable for this role. They’re already in house for anything needed in the OR. Also, if we have a difficult intubation in the department (ex someone with Ludwig’s or something) their expertise is invaluable. I don’t think having an EM physician on call only for codes would be a good use of money. Maybe only if it was also a procedural shift.


  • Gedrah


    March 11, 2015, 12:00 am

    I get a call about once a year, maybe, to come to the ED to help out on an intubation for intrathoracic tumor, submandibular abscess, that sort of thing. If they've called me, they've usually called ENT as well. So I'm doing an awake fiberoptic intubation with a trach tray and surgeon standing by. Depending on the ENT, that can be very reassuring or no help at all.


  • marblelion


    March 10, 2015, 11:07 am

    The worst situation I've been in was when there was a relatively new L&D nurse (new to us, not new to L&D) who didn't know how to set up a Glidescope, or even what it was, for a stat section at night. Thank God I could bag the patient for the length of time it took to show how. I ripped the nurse manager apart the next morning - politely, but viciously. If they don't know what it is, where it is, or how to set it up, they do not belong on this unit until they do.


  • Snorple


    March 10, 2015, 8:13 pm

    Horrible. I’ve occasionally watched like mri nurses and other nurses who don’t do intubations as much try to help (like I wasn’t called, just happened to be standing there) and I’ve had to go in and intervene because they don’t know what a mac 3 is or like you said how a glide scope works. God forbid they have an airway in the middle of the night and we aren’t there. The nurses broke our fiber optic when that happened.


  • megatom0


    March 10, 2015, 6:47 am

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  • mredd


    March 11, 2015, 1:58 am

    No. Have you rotated through an emergency department? Can you imagine the EM doc leaving the department to run a floor code? Our EM docs barely have time for bathroom breaks, let alone the time to be absent from the department for a 30 minute code. Also, in hospital cardiac arrests are a very different game than out of hospital cardiac arrests. Majority of out of hospital cardiac arrests are a shockable rhythm due to ACS. In hospital cardiac arrests are like 95% PEA arrest due to some non-cardiac physiologic disturbance. Intensivists play in this arena all day, every day and should be the ones running in hospital codes. Anesthesia should be running OR codes. ER docs should be running ER codes. While the acls algorithm is the same everywhere, the pathophysiology of the arrest may vary widely based on the setting and that is where one’s medical training really gets put to work.


  • corby10


    March 11, 2015, 5:50 am

    You mention all that stuff but there isn't any data supporting different medications improve outcomes...hence a lot of meds have been slowly getting pulled out of the algorithm because they don't help. RIP atropine. If you ever take ALCS EP then they go over a lot and mention "Yeah you can try bicarb/mag/calcium for longer codes...its a hell mary play". Kitchen sinking isn't exactly a science.


  • backpackwayne


    March 10, 2015, 10:51 pm

    I don't doubt that an ICU doctor running a code on their floor is going to perform better 99/100 times. Its possible that the ER doctor gleans enough relevant history to get a good idea about the etiology of the code, but this isn't optimal and chances are that its more or less going to be ran algorithmically. Then again, in-hospital cardiac arrests have significantly higher ROSC rates and probably should be prioritized.


  • Gravity13


    March 10, 2015, 6:48 am

    Calcium is like glucose: it's rare that it's the underlying issue causing a code, but acutely it's not likely to harm anything to do it. And I have seen two codes that were hypocalcemia, both immediately after removal of a parathyroid adenoma. "Hungry bone syndrome", they call it. Source of PTH goes away -> rapidly degraded -> osteoblasts strip the bloodstream of all ionized calcium rapidly. The first one I saw ended up needing an ungodly amount of calcium - IIRC 25 g IV over three days. Most of that gluconate, of course, but the first two grams were chloride.


  • sonicon


    March 11, 2015, 9:10 am

    As others have mentioned a lot of the studies tend to be negative in this realm, but we still do them when patient specifics deem necessary. Having somebody rock ACLS to a tee isn’t necessary going to help the CCB overdose, or the complicated airway that lead to a code. What if patient needs a chest tube? Or they’ve got a tamponade? Traumatic arrest secondary to trauma??


  • Chaoticmass


    March 10, 2015, 2:21 pm

    We’re the same way, but traumas, and at the medics discretion, still get transported. Not to mention Peds. I’m a big fan of running codes on scene to prevent the risks of transporting a code across town or down the highway, especially with low quality CPR. But that being said that one study isn’t the end all be all and some patients may benefit from an ultrasound probe on the chest, or labs, or more hands on deck.


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