Good morning! I hope you had a peaceful evening. My son, Charlie, and I watched the US Olympic Track and Field Trials – what amazing talent!

In my day job as a cardiologist, we’d run a couple of Mock Codes in May to prepare all the nurses, residents, and attending physicians in our outpatient clinic on how to handle a code situation.

Earlier this month, I thought, we at Walk with a Doc should also be well-versed. Let’s hire a CPR facilitator and bring a surprise Mock Code to WWAD World HQ. Even though our Walk with a Doc team is not hospital-based, learning BLS and ACLS can only make us stronger, right?

The day our CPR instructor, Robert Sykes, showed up, May 7th, it was just our four interns (Caitlyn, Pete, Jessica, and Jake) and me in the office. Rachael and Bryan were initially out at a meeting.

I borrowed some medical equipment from down the hall for our 30-minute mock code.

The interns were excited to take part in this exercise and I had promised the team beforehand that I would share the details from our session in our Friday newsletter.

(We used AI to record the minutes (amazingly accurate))

Here it is: (Mr. Sykes is speaking)

• Pete, remember when Dr. Sabgir was speaking in that high pitch? That was an indicator that you were giving the wrong gas. You were using helium, normally we would use oxygen when resuscitating people. We have better outcomes that way. Live and learn, young man. You’ll get it.

• Jessica, remember when Dr. David kept belching, over and over again? That suggests that you were giving the compressions a little too low. Next time you will aim well above the belly button to provide 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? Yes, I thought it was a number like that. 237 pounds is too much to be dancing on David’s chest and belly. You know? It happens. You’ll use your hands next go around.

Rachael speaks, “David, are you okay?” I couldn’t respond at that point in the session..

Bryan jumped in “Rachael, David’s not usually this red is he?”

“No, he’s not. Bob, could that be the atropine?”

“Good point, Rachael.”

Mr.Sykes is speaking again:

• “Caitlyn, remember when we said at the beginning that in a Mock Code we would only pretend giving medicine? Now Caitlyn, I am so impressed that you were able to give David the atropine intraosseously (deep into the bone) 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’. No biggie, 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. Did you notice 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 is very 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”. Thanks, Bob.

• Next, David, I’m especially sorry for this one. You guys aren’t in medical training, so there was no reason that you should have  known this.  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 had grabbed a fully functional AED. Again not your fault, you now know for the next time, 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?”

David

Disclaimer: While we all must learn CPR, the above scenario is entirely make-believe. No interns, RN’s, or physicians were harmed in the writing of this newsletter. I hope you all have a wonderful weekend.