We all learned it, “Ah, ha, ha, ha, stayin’ alive, stayin’ alive.” Administer 30 chest compressions to every two breaths. Hands centered on the chest, shoulders directly over hands; elbows locked out, depth 2 inches, allowing for chest recoil. Sounds easy until you need to put it into action.
I was in the ED on my fourth rotation. I had taken an APPE rotation in an ED and felt fairly confident in my abilities. My thought was, “Well, this shouldn’t be too bad, right?” It was my last week on rotation. I had just completed my ACLS training the week prior and officially received my ACLS provider certificate 2 days before I had to put it all to use. I knew that when I performed CPR for the first time, I wanted to be in a controlled environment (i.e., an ED surrounded by nurses, doctors, and interns).
Everyone’s pagers went off about 5 minutes before the ambulance arrived at our ED: “Male with complaints of chest pain and shortness of breath.” I started walking to the trauma bay where we were expecting to triage the patient. As soon as the wheels of the stretcher reached the ED door, I heard “He’s starting to code!” My eyes widened, my heart immediately started to race, and I took a deep breath and rushed to open the crash cart. I looked around, found the crash cart, and broke the lock on the med drawer. I started pulling out the epinephrine and connecting the parts while putting a handful of saline flushes in my pocket. When the patient arrived at the trauma bay, one of the paramedics was administering compressions while the other was giving report. Quickly, the ED team transferred the patient to the hospital bed while connecting him to the monitor and AED.
The ED attending, the nurse practitioner, the first- and second-year medical residents, several nurses, and a handful of other people were all crammed into the trauma bay. I stood between the Pyxis and the crash cart, ready to hand out meds. I looked at the monitor: there was a rhythm, and I thought, “The rhythm looks like normal sinus – he’s going to be okay.” Then the attending shouted out, “I can’t find a pulse, give a round of epi, continue compression!” I handed over the stick of epi, repeating the order out loud, and reached down to get the next dose of epinephrine ready.
The code continued for what felt like forever; every 3 minutes, another dose of epinephrine was given, and caregivers were switching places every 2–4 minutes to give compressions. Finally, we were able to obtain a weak pulse. The attending ordered to start an epi drip. I pulled out a bag of epinephrine from the Pyxis, primed the tubing, and started to program the IV pump. The nurse connected the epinephrine to the patient, and the patient appeared to be fairly stable. I assumed the code was complete, so I started back to the crash cart to help clean up. However, before I could reach it, which was less than 5 feet away, the NP called out, “He’s in v-tach, prepare to deliver a shock.”
Compressions were started again, with pulse checks happening every 2 minutes and more epinephrine given every 3 minutes. It was time for someone to switch out for compressions, and I asked the NP if I could give compressions the next round. She nodded, and I stood behind the nurse giving compressions. At the next pulse check, we switched places. I interlocked my fingers, locked out my elbows, and pressed down on the patient’s chest. For 2 of the longest minutes of my life, I administered compressions to our patient.
After 2 minutes of compressions, I switched places with another nurse. I was exhausted, and my body was buzzing with adrenaline. I resumed my position at the crash cart, ready for the next order. At this point, we were about 30 minutes into the code. We finally learned that the man had recently had an aortic dissection repair. His point-of-care hemoglobin had dropped to 4 mg/dL during the code, and it was assumed at this time that his aortic repair had failed. The providers looked around and asked, “Does anyone have any suggestions on how we can save this man’s life?” No one responded. The attending instructed the team to continue CPR while she talked to the family.
The attending and the patient’s wife entered the room as we were still giving CPR. At the next pulse check, the provider called the time of death. The room was silent, and everyone looked at the wife. She was in shock – understandably so. One by one, we exited the room, giving our condolences.
When I tell this story, I am always asked, “What did it feel like to give compressions?” My thoughts are, it feels similar to the mannequin that we train on, but at the same time, it is completely different. I knew that giving compressions in a real-life scenario would better prepare me if the day came again when I needed to administer CPR. This day, like so many others during my residency, taught me how invaluable this experience was and has allowed me to become a confident pharmacist.
About the author:
Samantha Bodan is a PGY1 pharmacy resident at Sparrow Hospital in Lansing, Michigan. She completed her Pharm.D. degree at Roseman University of Health Sciences in 2022. Her professional interests include oncology, emergency medicine, and leadership/administration. In her free time, she enjoys cooking, working out at her local CrossFit gym, and spending time with her friends and family.
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