Code blue, level 0: Diagnostic Imaging. Code blue, level 0: Diagnostic Imaging.
Hey guys. I'm Siobhan, a 3rd-year medical resident. Right now
it's Saturday morning and I'm heading to the hospital to start a 26-hour call shift in the intensive care unit.
Oh, good morning Siobhan. Morning, how was the night? It was great actually. Yeah? I had a new patient come in.
It's a really interesting story, so
I was hoping for your advice. Each morning
we do a handover where the resident who was on call overnight passes on information to the incoming resident.
So Kevin and I discussed each patient one-by-one so that I'm up to date on everything.
And a lot can change in just 1 night in the ICU. Oh Kevin,
I just realized thinking as I found you before you left, I didn't get the pager from you. Oh yeah, here you go!
Oh, okay. Here we go.
Now it's time to meet up with the attending physician and together
we'll walk around and see our 14 patients. And then comes the less glamorous part of medicine: all the notes and paperwork.
*Pager goes off*
Code blue, level 0: Diagnostic Imaging. Code blue, level 0: Diagnostic Imaging.
When I arrived at the CT scanner, the patient was lying unconscious and a nurse was doing CPR.
Seconds later the anesthetist arrived, positioning herself behind the patient's head.
Skillfully she intubated the patient while CPR was ongoing. And just 2 minutes later another round of CPR was done and we got a pulse back.
Ok, so it always feels really good when you get the patient back. So our patient now has a heartbeat,
a blood pressure... We basically brought him back to life, but this is just the beginning of the work in ICU.
We're transferring the patient up to the ICU right now and we're gonna continue to
try to resuscitate him, figure out what caused the cardiac arrest
and then go from there.
So this is just the beginning of the night in ICU.
First thing I'm gonna do is try to call the patient's family to update them.
Still no answer.
Okay, I'm gonna call back again later or see if someone can track down another number.
The next step is to read through the patient's chart carefully, looking through old notes,
X-rays and blood work to help figure out what caused his cardiac arrest.
Okay, so it looks like there are actually a lot of things going on with this patient.
He has underlying heart disease, he's had a heart attack in the past, he's had some funny rhythms in the past that
I can see in the computer.
Plus his x-ray clearly shows an
infection and I wonder if he's gonna have an infection in his blood too. I'm kind of waiting for that to grow.
So it's a couple things we can do: we're gonna make sure we manage his blood pressure with some
special medications called pressors, which kind of squeeze the blood vessels tight.
We're gonna give antibiotics and we're gonna support him and continue to do some more investigations.
And let's actually call the family back again. We're trying to try to get ahold of them. I've got a new number, so we'll see.
Hi, my name is Siobhan. I'm a
doctor in the ICU.
Can I ask who I'm speaking with?
Great, okay. Well, I look forward to meeting you in person.
Again, I'm so sorry to have to tell you this over the phone.
Okay, see you soon.
I find it so much more difficult to break bad news to people over the phone, because
you just... You don't get that kind of feedback
from body language, someone's facial expression. You don't... You have no clue what they're feeling, what they're thinking.
So anyway, I'll meet the family when they come in and I think I'll get a better sense of where they're at.
In order to give all these medications safely at the same time,
it's helpful to insert a central line, which is basically a large IV that I'll be inserting into the patient's neck
right into the jugular vein. Because the vein is so close to the carotid artery,
I'll be using an ultrasound machine so that I can see exactly where my needle is at all times.
Okay, so the central line went in well.
So now we just need to actually order a chest x-ray to make sure it's going in the right place.
Meaning it's in the vein and it's not in the artery, cuz that would be a nightmare. So it's something you worry about.
And then we also look for any complications, make sure there's no pneumothorax.
So it didn't actually puncture the lungs, all these things that you would never ever ever want to do to a patient,
but they're complications that are possible
even when you use ultrasound.
So we're just going to double check with the x-ray, but I think everything's fine.
How much oxygen is she on? Oh you already intubated here?! Oh okay.
Yeah, absolutely. Okay, I'll come by soon.
Alright, thanks.
So that was the emerge doc and it sounds like he just intubated a woman, which
automatically means that the patient is being admitted to the ICU.
Because once you've been admitted and you're hooked up to a machine breathing for you, the only place you can go is the ICU.
So that makes it easy.
But the reason this patient got intubated is because she came in just gasping for air, breathing super fast and
she has a condition called
COPD.
So she's been a really heavy smoker for the last 40 years, smoking about 2 packs per day,
that's what he's telling me. In the emergency department I met with the patient's husband.
He tells me that his wife ran out of her puffers about a week ago.
They planned on going to the doctor today, but her breathing became so severe that they came to the emergency department instead.
So now I'm gonna prescribe some steroids puffers,
antibiotics and hopefully her breathing will improve and we can get her extubated in a few days.
Alright. So now that we have admitted that patient in the emerge, we need to
follow up on some blood work on the patient who had that code blue.
So I ordered some repeat blood work, so we can see what we're at in terms of
resuscitating and how he is doing: his heart, lungs, liver, kidney, all of that stuff. So, let's see.
Oh boy. Okay, so when blood work is abnormal, it turns red and unfortunately most of his blood work right here is red.
So you can see that he's got strain to the heart, even
just the act of CPR is gonna put some strain on the heart, the muscle of the heart.
Um, you can see he's got shock liver, meaning he didn't get great blood flow to the liver for a period of time.
Which means that you can see those enzymes are up.
Same thing with the kidneys.
So I mean... The reality is it's expected at this point. We're gonna keep giving him fluids, we're giving the antibiotics.
I'm gonna repeat some more blood work in the morning and hopefully we'll be able to see things trending
in a better direction, because right now
it's not looking so great.
Okay, but let's actually let's go see the patient himself and see what he looks like clinically. So is he looking any better?!
Okay, 4 o'clock.
Finally back in
my call room. I'm actually gonna try to go to sleep for the first time today.
But I'm this weird combination of being a little bit wired from all the admissions and the excitement
and then I'm also exhausted from the day.
So I'm pretty sure when my head hits the pillow, I will be able to sleep.
Problem is the light, it's all the way over here and away from the bed.
Good morning.
Okay, it's time to look at blood work and
to get ready to hand over to the morning team now.
Okay, so just looking at the blood work from the patient with the code blue yesterday.
Things look like they are at least holding steady right now, which honestly is all that we can ask for right now.
I'm glad to see that he's turning the corner and stabilizing.
So we'll know in the next
24-48 hours are gonna be critical to finding out about his long-term
prognosis, but I think we're making some good steps forward right now.
Morning, Kevin. Hey Siobhan.
Hey, you're back again.
I'm back again.
Alright, so I need to tell you about some of the patients that you handed over and what happened today.
Yeah.
Okay, but I won't forget to give you the pager.
Responsibility is all yours... For another 24 hours.
Heading home, finally done and
that was a satisfying call shift. I really feel like being there really impacted someone's life.
So I'm walking away at a high.
But anyway, if you have any questions if you want to say hi, just leave a comment.
I really love to hear from you guys. And if you want to see more like this, don't forget to subscribe.
Otherwise, I'll be chatting with you in the next video. So bye for now!