I was just finished my bowl of cereal, my start to the night shift when the code pager went off. It sounded sort of sickly and as I checked it I was puzzled by the numbers displayed. It is supposed to be a code telling us where the code is….unfortunately it is one of those things I always have to think about to decipher the code, but this one I knew made no sense, the numbers were all wrong.
Fortunately switchboard always follows up the page with an overhead anouncement of where you are supposed to be heading.
I sprint out the door with the herd of staff at my heels. Half way down the hallway I get passed by the much taller and much younger code team members. By the time I reach the stairs there is just me and some other out of shape staff labouring up the 2 flights and then wheezing our way down the hall to the unit.
The room is full of people, most of them standing looking on. I may be old and slow but I can still push my way to the front, which I do.
"someone tell me what happened", I yell over the din. I get a garbbled story of coughing, possible choking spell and take a look at the small mottled infant on the bed with a bagger and mask pressed to his face. He is showing some signs of struggling.
"get some leads on him, we need a BP", I demand and many hands are trying to accomodate my wishes.
The intensivist arrives and asks me to notify the unit that we will be bringing the patient down and to get some intubation drugs up.
I call down and relay the information I ahve about the child then head back to the room. I spy the mum sitting in the ahllway with one of the floor staff wiping tears away. I stop and tell her what we will be doing and get the story form her. Much more cooherent than the one I got from the nursing staff, she had been feeding the baby and he was fussy so she tried just a bit more and then he became apnic.
I relay the new information about feeding, full belly, coughing and probably aspiration and a child admitted for an Acute Life Threatening Event (new term for almost a sids)
Much confusion and disorder later I am trying to draw up intubation drugs for our trip downstairs – just in case. The resident is looking for the larygescope blades – the intubation tray seems to be missing from the cart. Suddenly he and the transport nurse are sniping at each other each one insisting that what they are getting ready is more important.
"knock it off", I tell them, "No one is dying"
And yet the tension level in the room would make you think we were opening his chest. Honestly, I think we need more codes so people learn to relax.
We set out down the hall with the small child attached to monitors and IV pumps. Moving way too fast I drag on the end of the bed trying to slow the train running out of control down the halls. People really need to learn to manage their adrenalin.
We get him in the unit and admitted and everyone disappears. During the course of the night he needs frequent fluid boluses and has difficulty accepting the ventilator settings. Once again we are left with a doctor who has limited experience with this kind of thing. We suggest paralyzing the child to facilitate ventilation, we suggest dopamine to facilatate blood flow. Six hours without urine and 40ml/k of fluid later I make up a dopamine infusion anyway and start on a norepinephrine infusion as well. It is obvious that he needs the inotropes and yet the resident wants to wait until the staff man comes in.
God help us.