 Alright guys welcome back to the channel and in today's video we are going to talk about what it's like saving somebody's life and running a code blue. Let's get into it. Now code blue means that there is a medical emergency and that a patient is or has to be compensated. Now this can be that the patient is not responding and or that you can't feel the pulse and the nurse in that room will go ahead and press a button and let everyone in the hospital know this patient needs help. That's where doctors like me will go ahead and stop what we're doing and run to go help that patient. So in today's video we're going to talk about what happens during a code, what it's like running a code and actually put you in my own shoes and most importantly what happens afterwards. So first let's talk about what goes into a code. Now most people think that as a doctor your whole job is to save lives but unfortunately most of our day to day activities are spent on things that are a little bit more mundane whether that's writing notes, putting in orders or just reviewing labs. But when you hear a code blue on the intercom everything stops. And so let's start from start to finish actually what goes into a code in the first place. And when the code is called one of the first things that will happen is that the nurses will start chest compressions and CPR. And a short amount of time an anesthesia team in the hospital will be running to the patient's room really for one goal and that's to support their breathing and often that means intubating them. And while I'm making my way over to the room as the nurses are doing chest compressions and the anesthesia team is taking care of the airway there can be other groups of nurses that will also get ready for the most important medications that I will likely be ordering. And finally there'll be a team of doctors and nurses and essentially technical staff that will be waiting around for my orders for anything that I may need whether it be labs, blood, medications to be given or for somebody to get in line for chest compressions. In a matter of just seconds to minutes strangers across the hospital will be at this patient's bedside for just one goal that's to save their life. Next let's talk about what it's like being the doctor who's running the code and I want you to imagine yourself in my shoes as you're running to the patient's room and you hear that code blue on the intercom. And as you go ahead and shuffle yourself through the crowd into the room you run into what looks like functional chaos. There's just people everywhere, things everywhere, chest compressions happening and it's your job to get it all under control. And so the first thing you'll be doing as you walk into the patient's room is to go at the front or the head of the patient's bed, put your hands behind your back and declare that you will be running the code and will be the leader from there on. As the doctor the most important thing for you to do is to delegate and make sure that things are happening appropriately so you can't be involved in a nitty gritty which is why we put our hands behind our back. Now by the time that you are running to the patient's room things have already started to happen and so you want to make sure that you catch up with all the roles of who is in the room and what exactly they'll be doing. Now one of the first things you'll be doing is assigning a timekeeper. Now this person will likely be keeping timer on their phone as well as writing down what medications have been given and at what doses. Now this person is probably one of the most important individuals in the room because they can shout out when it's time to go ahead and check for the patient's pulse which we do have every two minutes as well as when it's time to give another medication like epinephrine. And so if this person hasn't been assigned it's your job to point at somebody and saying you will be my timekeeper and make sure that they acknowledge that that is now their new role. Once you have your timekeeper next you're going to focus on who will be in charge of administering and drawing your medications. This will likely be two individuals, one who will be ready to draw whatever medication you ask for and one who's ready to give it at moments notice. Now once you have these roles identified the next thing is to talk about the access that you have to your patient particularly IVs. Now most patients usually in a hospital have one IV in one of their arms. It's important for you to have at least two just in case one of them fails. You have another one that you can give those life-saving medications to. Now if you can't get a good IV for your patients other things you can quickly do is to put an IV through their large jugular vein that's called a central line or actually do something that's called intraosseous access which is basically when you drill through somebody's bone in their legs and quickly give medication through there. Now once you have your roles and your access to find the next thing to make sure is that there are people ready to do chest compressions on your patient you don't want one person to be doing it longer than two minutes at a time because they're likely going to get tired if they're doing it correctly and you want that patient to have the best chest compressions every single time. Now for everyone else they need to give you space and you want to make sure as a leader and remember hands behind your back make sure the room is clear except the most vital team members. So moving on now that your tasks are delegated it's time to actually get to work now all doctors are certified in something called ACLS or advanced cardiovascular life support. Basically this is a more advanced version of CPR where we're not only are we trained on how to do chest compressions properly but also what medications and when to give them and luckily for doctors this is very algorithmic so if you see a patient with a pulse or not a pulse or their EKG looks like it has a certain type of rhythm you go down a different pathway in terms of what medications you give at what doses. Now the first medication you're likely to order that every patient during a code will get is epinephrine. Its entire job is to both make sure the heart starts to work increases the heart rate as well as constricts those blood vessels to make sure that enough pressure is getting to the most vital organ particularly the brain. Now during this time you have individuals doing chest compressions and you do it at the making of this video for two minutes at a time. Now because you've assigned somebody to keep track of time they will shout out to the entire team pulse check. Now at this time everyone will stop what they're doing including chest compressions and try to feel for a pulse from the patient. Now if you don't feel a pulse the process is pretty simple you're essentially going to do the process all over again and during your next pulse check you hope that the patient has a heartbeat. Now during this process of going through multiple cycles of chest compressions and epinephrine and other medications you also want to keep in the back of your head why that patient's heart stopped in the first place. That means you want to check the most basic things including electrolytes, blood count, sugars, and other things as well. Now obviously it's going to take a little bit of time for you to get those results back and so you may start prophylactically giving medications to increase or decrease certain numbers like your electrolytes or giving somebody sugar if you notice that their glucose is low or giving somebody blood if you think that they're bleeding. And so during this code you're super alert the algorithm is really second nature and you really have one goal that's to get that patient's heart rate back. And so hopefully during one of your pulse checks you'll realize that that patient actually has their pulse back. And if this is the case you will immediately try to stabilize the patient which means hooking them up to a ventilator making sure there are inappropriate medications to keep their blood pressures up and quickly wheel them to the ICU. And in other situations you run into instances where a patient's pulse just doesn't seem to be coming back. But every patient deserves a chance and so you as a doctor is to continue to do chest compressions and CPR for as much as it's appropriate for that patient and try to give them a chance. So as you guys can see running a code has various emotions coming into it. In your mind there's a lot of anxiety, there's a lot of hope, there's a lot of just nervousness of hoping this patient makes it. Oftentimes you as a doctor may be running a code on a patient you have no idea of what their story is, what their history is, or why they're in the hospital in the first place. But immediately as you walk into that room and start that code you feel some sense of personal responsibility. In addition sometimes you may have family members who are in the room the moment that patient's heart rate stopped and are now yelling in the hallway again your main job is to stay focused. And so during the codes that I've run I realize that the most important lesson is to walk into the room, check your own pulse first, and take a deep breath. Now next I want to talk about what happens after a code. Now if you're able to get a patient's pulse back unfortunately they're not out of danger. Like I mentioned you're going to take them to the ICU as quickly as possible but many patients may have their heart stopped during the process of transitioning or when they're in their ICU themselves they may have their heart stopped multiple times. But hopefully by this time you have some of that initial information back including their basic labs as well as imaging x-rays things that you can start acting upon. And so while in ICU the doctors including myself will try to do their best to stabilize them and keep them out of harm's way. But the most important question you're probably asking at this point is how do these patients actually do? And the truth of the matter is many of them not so great. The act of actually having to do chest compressions on somebody means that there is a moment of time that blood is not going to the brain and so even if you're able to get a pulse back sometimes these patients don't always recover the cognitive and neural function they once had before. A lot of times you may have somebody who you get the pulse back the first time but then their heart stops again and unfortunately the second time you're not able to revive them. And for the patients who do recover their heart rate many of them do have long-standing consequences of not getting blood to their brain for some period of time. And even for the patients who you are able to bring back only about 10% are actually able to be discharged from the hospital. And many of these patients may have a repeat cardiac arrest while in the ICU and unfortunately you have to remember that during CPR there's a good amount of time that blood is not going from the heart to the brain and so many of these patients may have some long-standing functional and neurological decline. So even if they are in that 10% are able to be discharged unfortunately many of them don't get to go directly home. Some of them and many of them actually have to go to long-term facilities and physical therapy centers and nursing homes. So as you guys can see the process of running a code is something that every doctor hates because that means that we're taking care of somebody that's severely sick. But it is a skill that we all need to know to provide that final bit of medical support and hope. And for all the codes that I've run myself I remember all of them because they have their own unique challenges. I always walk out of the room learning more hoping that I can use that lesson to help the next patient that I have to serve. But that is a broad overview of what it's like running a code and trying to save somebody's life in their final moment. Hopefully this video and this episode was able to give you a little bit of insight. If you did enjoy this video and you want more content like this first of all go ahead and hit that like button to one let me know that you guys want more content like this. Drop your comments and questions down below in the comment section down below. Make sure you hit that subscribe button and in case you guys are interested go ahead and check out this video to see how long it took me to become a doctor in this video to see how much doctors make in the United States. But thank you guys as always for watching this video. Thank you so much for being a part of my journey. Hopefully I've been a little help to you on yours. I'll see you guys in the next one. Peace.