9.13.2007

Return of the megacode


Well needless to say I feel sooo much better this afternoon than I did last night! Phew! I've been so stressed with all the "marriage stuff", bills and kids, etc. The last few days my stress sky-rocketed with studying to renew my ACLS certification on top of everything else. If you've never been certified for it let me fill you in...it's nerve-wracking! lol ACLS and irritable bowel syndrom should be synonymous! lol

ACLS stands for "advanced cardiac life support" and it means being able to do all the "code blue" stuff. You have to know meds, cardiac rhythms, and how to run the code and tell everyone what to do. The other times I recertified it was plenty nerve-wracking, but it wasn't that bad. You would take a big written test and have to interpret different EKG strips (which still is the same) and then they had different stations that you went to. Each station was a different theme and you went and sat at that station for a half-hour or so with a group of people and you were questioned (as a group mostly) on that particular subject or rhythm. It was never as horrible as you thought it was going to be and you left thinking "that wasn't so bad!". The "old-timers" would sit around and talk of the horrible, dreaded days of the "megacode" where they had to run a code blue from start to finish and if you got anything wrong you failed. YIKES!

So I studied a little bit last night and took my pretest. I got a 97% and so I was worried, but not too worried. I figured I've done this plenty of times before so it would be ok.... and I SKIPPED right over the part in the book about the megacode because we never have to do that right? I mean they haven't done that for like 20 years!

What do you think the first thing everyone is whispering about when we first get there? "Where are all the stations? What's going on?" Yep. *DUM-DUM-DUM!* (queue dreadful music) THE RETURN OF THE DREADED MEGACODE. We all must've looked like deer caught in the headlights! We just sat there bug-eyed and shaking in our seats when we were told that there were no more stations because they felt that some people might be slipping through without totally knowing everything so now each person has to be 100% on their own and graded accordingly. *GULP* We were all sweating bullets! I laughed inside when the first girl called reacted the way I would've wanted to but would've been too afriad to. She nervously yelled and almost started crying "NO! DON'T PICK ME FIRST! PLEASE, PLEASE! DON'T MAKE ME DO THIS FIRST!" lol So they let her off the hook. :) And then they made ME go first. (*cynical stare into the camera*)

They divided us into teams of 5. It was my job to direct these other 4 people in running this code. My case study was a 56 year-old woman who just had a hip replacement and I now walk into the room to find her unconscious and unresponsive..."GO!"

I have to say that I actually did A-W-E-S-O-M-E! *doin the cabbage patch* woot woot! Thinking I'm totally off the hook and that "I don't know what everyone's so scared about!"....until she says "see how smoothly she ran that? Too bad this is only PRACTICE and the real test will be a DIFFERENT case study this afternoon." Jigga-what??? Scuse me??? Awwww mannnn!!!!! They tricked us!! That was so mean. lol I'm sure I was looking totally deflated and suddenly I started to feel something coming on....FEAR. Satan had all kinds of demons whispering in my ears telling me that it could never go that smoothly again...I just got lucky! lol I was so nervous. I went to the bathroom like 10 times and I was having palpitations. lol We took our written test and I only missed 1!! Sweet! Not bad! I was beating myself up over the fact that it was a STUPID question that I missed but overall a little encouraged.

It's time for our megacodes again. We're standing around our makeshift hospital bed (a table), our manequin, crash cart and defibrillator. Someone's called...it's not me. They did ok. They stumbled a little bit, but not bad. They next lady goes and really bombs. Bless her heart she really did. We're all getting more nervous thinking we could be in her shoes in a minute. It's one thing to know what you're doing on paper, but to be in the pressure of the moment knowing someone is dying and the race is on and you're in charge...you tend to panic a little sometimes. After each person gets done someone takes her aside and critiques her. We can't hear anything they're saying...bummer.

Wouldn't you know that those dirty dogs saved me for LAST this time??? I don't want to be first, but I don't want to be last either!!! lol It's finally my turn and I hear, "You're in the e.r. and triage brings you back a 68 year-old gentleman who is pale, cold and sweaty. He says 'I feel like I'm going to pass out.' GO!" So I assign my team..."You please put oxygen on him, you start an i.v., you get a monitor on him and you take notes." I see that his heart rate is really slow and so I tell one of them to feel for a pulse. "NO PULSE, he's unconscious now". I point to two of them and ask them to begin CPR, point at another one and tell her to draw up a milligram of epinepherine and one of atropine.

"Push epi"

"Epi in"

"push atropine"

"atropine in"

"hang normal saline bolus. stop cpr and check rhythm"

The rhythm is now vtach....you don't want to see that. CRAP!

"shock with 200 joules. draw up another milligram of epi."

"shocking...CLEAR!"

"epi in"

"resume CPR. 2minutes of cpr complete. stop cpr, change positions (to give them a rest). still in v-tach shock again at 200 joules. draw up another mg of epi and 300 of amiodarone."

"shocking...CLEAR!"

"resume cpr"

"epi in. amiodarone in."

The rhythm changes to look like a normal sinus rhythm. (finally! I think. they've ALWAYS changed it to sinus rhythm when we are done)

"stop cpr. we have a regular rhythm, please feel for a pulse."

"NO PULSE!"

(what? what the frick??... see there's a heart rhythm where the person is dead and they have no pulse but there's still electricity flying around that shows up on a monitor like a heartbeat...so you have to actually check for a pulse...and my guy didn't have one. dang!)

"resume cpr, switch places if you need to. give 1 mg of epi and 1 mg of atropine"

"epi in. atropine in."

This goes on and on and on for what seems like FOREVER. Same routine. They would NOT get a pulse back. What did this instructor want from me???? BLOOD??? lol Then it comes to me.

"Have we gotten labs back yet? What's this guys blood sugar?"

"Blood sugar's low at 38."

"Push glucose."

"Glucose in"

My patient suddenly returns to sinus rhythm with a rate of 70.

"Stop CPR. Check for a pulse"

"YES, THERE'S A PULSE"

"(*sigh*) continue oxygenation and transfer patient to intensive care unit."

HOLY CRAP!!! lol My instructor then pulled me aside to critique me. She showed me my checklist and it was perfect...no notes scribbled or anything. She just smiled. I said "why did mine take like FIVE times longer than anyone else's???" She said "because you went first and did great so I wanted to throw you some curve balls and see if you crumbled or got anything wrong." I didn't ask for no curveballs!! lol She about had ME on the gurney in chest pains!!

All-in-all I'm very grateful that they think I did so well and I'm so thankful to the Lord that I got through that with no problems. But I'm so glad it's over. SO GLAD...for another two years anyways. lol

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