Saturday, February 18, 2006

Codes

It's astonishing what we do to dead people. If only members of the lay community knew what "full code" means, we would have less of senseless pounding on chests, IV drug pushes, transcutaneous shocking, bagging of a patient already waxy yellow with the look of death. Competent patients should be educated on what a code (http://wanderingvisitor.blogspot.com/2006/02/defining-codes.html) means and the reality of meaningful success rates after a code. Everyone should have to review this yearly and it should be well documented. No more codes where someone brings up that the patient might actually not be full code. It would be horrible to code someone against their wishes... And demented patients should not have their families make code status decisions, especially family who don't know what the end looks like.

There should be a standardized time that codes are carried out for. Adjustable to situations, but a code that hasn't brought someone back in 5 minutes is not likely to do so in 30... It's almost morbid to keep on pumping the sternum, all the while hoping that the patient/? spirit/ ?conscience goes in peace. Hard to imagine how it could with a room packed full of people, none of whom, sometimes by profession, but often due to patient/family wishes can let the patient pass naturally.

Also astonishing how desensitized we become at these events. We don't usually realize it, except today there was a person in the resuscitation team that was maybe new to code blues - at least that's was the working conclusion after the person burst into tears outside the room halfway through the code. "Is this her first time?" people whispered to each other, more shocked at her reaction than with the situation at hand.

I don't know what the solution is. People need to be educated about death and hospitals and what full code means.

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2 Comments:

Blogger babe said...

Yes, patients and families need education on what a code entails but the modified or partial code is just so fracking ridiculous it shouldn’t even be brought into the conversation. When someone’s heart stops, the only question should be “do we try to restart it or not?” By giving families too many options you end up with abominations like yes to CPR but no to intubation, or yes to drugs but no to CPR.

11:44 PM  
Blogger always learning said...

agreed, but some family members want those options, and other times, offering options will cause less pain for the patient. for example, a patient who has advanced dementia who does not recognize self or others who survives only by a feeding tube in the stomach and is being admitted for complications of metastatic cancer should not be full code. the odds of success are so pitifully low that all that will happen in the event of a code is a painful, prolonged death. however, family may not see that, and in that case, maybe it is better for the patient to be no CPR (so no ribs are cracked before death) but medications are OK to try to jump start the heart (not recommended by us in this case, but a compromise due to family wishes that will likely be less painful for the patient)

but your point is definitely well taken. we don't usually break down the code status "offerings" because it's way to complicated - just in these cases.

6:16 PM  

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