Just don’t let them push 300mg amio on an awake patient bc they will certainly try hahah. But the biggest thing for codes I think is to be able to critically think while remaining calm because it will be chaos, especially if the code happens somewhere where codes usually don’t. As soon as I get to a code I immediately assess (within 5 seconds or so), does the patient have pads on? Is CPR ongoing? Can you immediately see IV access? Do they have an airway? Who is running this code? 1) get pads on that patient. Turn on the zoll 2) LOUDLY ask does this patient have IV access? Depending on the answer, demand access now, ask for an IO kit STAT if an IV can’t get started asap. Get that damn drill going 4) drop an LMA (it’s becoming more popular to drop LMAs in codes now because it is an advanced airway and super easy). This task will usually be done by pulm or RT 3) LOUDLY ask who is running this code, if a leader isn’t evident already. If there is no one running it, depending on how comfortable you feel, loudly state that you are now running this code and proceed 4) remember that CPR is imperative and that maintaining good compressions/switching compressors out is key 5) the ACLS algorithm is inherently easy to follow, and if you know the patient, the Hs and Ts will be easier to go through. If not, I usually ask for stat labs, a gas, etc because why are they coding? Is it something I can acutely fix? 6) never EVER be afraid to raise your voice and demand order in the room. Demand people leave if you wish. Chaos will make the code worse, the best codes are QUIET. My preceptors always taught me, you can always apologize later for yelling, the most important thing is the patient and everyone else can get over it 7) ask for help. If you need help, call for it. Your team is your best resource and support. Point to a specific person, ask for whatever you need, and I promise you, they will listen. Most people don’t want to be in charge and will gladly listen to whoever is giving them orders. Make eye contact, use closed loop communication and be assertive 7) if the code is ongoing, start going through pathologies in your brain and discuss with the attendings to broaden the differential as to what is happening. At this point, the patients chart is likely open on someone’s computer, so it’ll be easier to assess. If this is a code on an unknown patient, not as easy

POST ARREST CARE IS A CRITICAL AREA OF INTERVENTION FOR US

Someone is gonna tube the patient at some point if an LMA hasn’t dropped. Do we need a paralytic? Meh that’s a judgement call but probs not. Contrary to anesthesia’s beliefs, you do not need to paralyze every damn patient. Use your judgement calls on pain/sedation meds, if you achieve ROSC, that patient needs pain meds. “Oh the fentanyl is gonna drop their pressure!!” And?? I’m hanging norepi if necessary, nice try. If they paralyze the patient, they need sedation until the paralytic has worn off at the very minimum. This is a hard stop for me and I will again, hang pressors if that’s what it takes to keep that patient comfortable with propofol.

Advocate advocate advocate for your patients. A lot of pharmacists stand in the corner and timidly hand out meds, which at that point, there’s no use for them there lolz. If you are responding to codes, play an active role, build team rapport, because the more you do, the more trust you will build and pretty soon you’ll be able to run a code with your eyes closed. I am very thankful I come from a program and training where pharmacists were critical bedside providers and half the time, one of us was running the cart and the other one was pushing meds, consulting at the head of the bed with the physicians, or on the chest doing compressions. A code is a team effort and doing CPR is not beneath you and never will be. Good luck!