How is a resuscitation ran in the ED?

[Pose]

Hello everyone,

I start my job as a tech in a busy ED on Monday. Reading my job description, "perform chest compressions" and "assist in codes, and traumas," has me wondering: how does it work in the hospital? I'm a certified EMT-B, although I have not worked a shift.

I know the sequence of events for your standard CPR/AED (check responsiveness, open airway & check breathing, 2 successful rescue-breaths, check pulse, begin compressions/defib) but I'm sure this differs in the hospital. What is the sequence? What happens following someone collapsing? Check responsiveness, open airway, check breathing, provide two breaths (BVM?), check pulse, start compressions and wait for defib to arrive. And then what? When are drugs, and advanced airways introduced? When exactly do I perform compressions? What would I (generally speaking, of course) do to assist?

I have one month of orientation, so I'm sure this will be touched on, but I'd still like to prepare in my mind a little before I begin. All advice is appreciated.

[Ridryder 911]

Resuscitation in hospital settings is quite different than you were probably taught. First there are usually several members that will be assisting, respiratory therapy, nurses, etc... You will notice, it will not be "text book" pausing for ventilation, usually more relaxed, and maybe short in time period <15 minutes in length.. Again, all dependent on the staffing, and circumstances.

Sounds like your job, is to assist, to perform compressions and probably be a "gofer".. so I would suggest learning were equipment is.

Good luck,

R/R 911

[AZCEP]

I don't know Rid, the codes in my hospital are raging clusters.

As a BLS level provider, you will probably be expected to do the grunt work. Compressions, bag-mask-ventilation, running for more equipment, etc.

If you have no field experience, the humor in the situation will be lost on you. If, and when, you do make it into a field unit, you will realize that having all those resources, doesn't make a better patient care setting. Give me an RT that can ventilate effectively, an RN that can get the drugs we need to have, and a doctor that is willing to listen to suggestions, and everything else will be okay.

[Ridryder 911]

I agree.. nothing worse than to have a cardiac arrest in a hospital. Actually, studies have shown you they also have a lower survival rate. We had a code in ICU the other night & I took one of medic partner with me, he had never seen a code in a hospital before... after seeing the nurse recommend uhh... maybe some epi or lido or let's do something for God's sake... to the Dr. standing there with his thumb in his sphincter.. he was surprised on how unorganized it was. .. I laughed, & I told him.. this was more organized than normal....

Yeah, I rather work a code in the field any day rather than in hospitals.. the old saying 'too many chefs'.." come into mind.

R/R 911

[Pose]

Thanks for the replies, guys. I start New Employee Orientation tomorrow. Quite nervous. Wish me luck!

-Pose

[AZCEP]

Know your limitations, and use every opportunity to learn. You'll do fine.

[AnthonyM83]

I agree.. nothing worse than to have a cardiac arrest in a hospital. Actually, studies have shown you they also have a lower survival rate.

Is that because of the way they do their ressuscitations or because people in the hospital are more likely to have worse problems or something along those lines.

[IreneRN_ED]

Resuscitation in hospital settings is quite different than you were probably taught. First there are usually several members that will be assisting, respiratory therapy, nurses, etc... You will notice, it will not be "text book" pausing for ventilation, usually more relaxed, and maybe short in time period <15 minutes in length.. Again, all dependent on the staffing, and circumstances.

Sounds like your job, is to assist, to perform compressions and probably be a "gofer".. so I would suggest learning were equipment is.

Good luck,

R/R 911

Good luck to you but I have to agree that you will be a gofer, likely as not. Just remember to assist those with the licenses, like Docs & Nurses, RT's & Anesthesia who have the training for code situations. Techs in the ED need to remember to assist the other stable patients up to the bathroom, out in a wheelchair when dispo'd, & other so called mundane things. As an ED RN, sometimes I find that the techs want to do other things they feel are more important. All aspects of patient care are important, even if it's just bringing someone a warm blanket. You will learn a lot & maybe even enjoy yourself.

[FarNorthMedic]

I've seen doctors fight over which meds to push first, shocked the hell out of an asystole for around 5-10 minutes (might have been for the RN students sake I guess ), and even one saved with a quick precordial thump.

Code teams are usually pretty good from my experiences, but until they get there it can be a mess and some heated times.

[ffpm41]

Is that because of the way they do their resuscitation's or because people in the hospital are more likely to have worse problems or something along those lines.

We see patients that are either just as bad or worse than they get in the ER.

ER

The advantage, and at times disadvantage, that they have plenty of resources, it is a more controlled environment, bright lights, plenty of help etc.

Field

We see patients in all kinds of environments with all kinds of things going on with limited resources. You would think that the patients have a worse chance, but they don't.

Most hospital codes are like going to a 3-ring circus, at least those on the floor where the RN's last took ACLS in 1978 because they needed it to pass school. I will say that a majority of the ER resuscitation's I have assisted in (code for needing tubes) have been good most of the time.