Walk with a Doc Newsletter
Good morning! You are probably aware that here at Walk HQ we love to team with you to get your WWAD Chapter up and going.
We don’t practice medicine, well not all of us do.
In my day job as a cardiologist, we’d recently run a couple of Mock Codes to keep us prepared in our outpatient clinic and in the hospital.
In early May, I thought, what the heck, let’s hire a facilitator and bring a surprise Mock Code to WWAD HQ. BLS and ACLS
training can only make us stronger, right?
The day they showed up, May 7th, it was just me and our 4 interns (Caitlyn, Pete, Jessica, and Jake). Rachael and Bryan were initially out at a meeting.
I had borrowed some medical equipment just for the 30-minute code.
I promised the team I would share the instructor’s (Robert Sykes) summary in our weekly newsletter. Here ’tis:
- Pete, remember when Dr. Sabgir was speaking with a really high pitch? That was an indicator that you were giving the wrong gas. You were using helium, normally we would use oxygen when we are resuscitating people. Better outcomes that way.
- Jessica, belching suggests that you were giving the compressions a little too low, you will need to aim way above the belly button to give adequate circulatory support.
- Jake, yes, you were absolutely correct that Staying Alive is the right tune. But that is for hands-only CPR, you should not be dancing on top of Dr. Sabgir. Jake, how much do you weigh? Yeah, 237 pounds is too much to be dancing on David’s chest and belly. Next time use your hands.
“David, are you okay?” I couldn’t speak at that moment.
“Rachael, is he usually that red?” (she had returned mid-code)
“No, he’s not Bob. Could that be the atropine?”
“Good point, Rachael.”
- Caitlyn, remember when we said at the beginning that in a Mock Code we would only pretend giving medicine? Now Caitlyn, I am impressed that you were able to give David the atropine intraosseously on the first stick. But, do you see the monitor even now? His HR is still in the 220’s. That’s too high. That’s why in these Mock Codes, we just say ‘given’, next time you won’t actually give it.
- Jake, the same thing applies to the endotracheal tube. Just like Caitlyn, you nailed it first try. But in a real code situation, the patient will either be unconscious or sedated. You noticed how forcibly Dr. Sabgir was trying to fight the tube? You saw how hard Pete, Jessica and Caitlyn had to work to restrain him? That’s because it isvery uncomfortable for a fully conscious patient to be intubated.
David, I’m sorry I didn’t step in, but I felt it was important for them to just ‘play it out’
- Next, David, I’m especially sorry for this one. You guys aren’t in medicine, but just because David’s heart rate was in the 220’s doesn’t mean you should shock him. This is partly my fault because I didn’t realize you grabbed a fully functional AED. Again not your fault, but typically we shock once and reassess the rhythm. We don’t shock 5 successive times, one after the other, especially for a non-sedated patient in sinus tachycardia.
- Finally, as a general rule, if the patient is kicking, screaming and crying like David was odds are they’ve likely regained ROSC (Return of Spontaneous Circulation). At that point it’s safe to hold on compressions. That said, you kids did a nice job restraining him and gagging him with that sweatshirt.
You sure can squeal, can’t you Dave?
- Other than that I think you kids did fine and learned something. We may try and come back in 4 weeks and see how you’ve improved. David, your availability?”
I have a confession that has nothing to do with anything.
I really like the band A Great Big World.
Please don’t share.