Welcome to Ringling Bros. Hospital, enjoy your stay!

by girlwithaknife

While most people are familiar with the idea of a “code blue” for communicating a medical emergency inside a hospital, they may not know about the many other codes we use.  Some are intuitive, such as “code red” for a fire.  Others are convenient ways for staff to communicate without embarrassing a patient who needs to be cleaned up – “code yellow” for urinary accidents, “code brown” for incidents of a fecal nature.  My least favorite is probably “code alert,” denoting a combative patient.  They seem to follow me around like a black cloud.  I joke that I have to dodge at least one punch per year.

Hmm…  That might be funnier if it weren’t actually true…

One incident is particularly memorable.  I was on call on a weekend night, hoping that things would remain calm.  While doing some quick rounds in the ICU, I started chatting with Dr. G, the medical intensive care attending.  Neither of us were especially busy, and he sounded almost disappointed – “It’s been kind of quiet around here for a few days.”

Famous last words.

I was in my call room when I heard “code alert” on the overhead speakers.  I don’t usually go to those – we’re more liable to end up in the way, and the nurses call if they need us.  But this one was one the cardiac floor, which meant that a surgical patient might be involved.  I decided to head over since I wasn’t otherwise occupied.

I arrived to find that security had established a perimeter around a patient who was talking rapidly into a phone.  He was brandishing a 10lb hole punch at anyone who approached him and rambling that people were trying to hurt him.  Despite multiple efforts to calm him, his agitation wasn’t improving at all.  The situation definitely had the potential to turn physical, so I pulled the security guards aside.  They’re pretty good with patients, but they needed to know a few things about this particular one, Mr. T:

“Guys, this patient had his chest cracked a few days ago for heart surgery.  The only things holding his heart and lungs inside his body right now are a few little steel wires.  If you have to take him down, please be careful, he’s not supposed to do any weight-bearing with his arms, and he shouldn’t get any pressure on his chest.”

“No worries Doc, we don’t take patients down.”

Phew!

My relief was short-lived because a few minutes later, a couple of the boys in blue showed up.  I made a bee-line for them and gave the same spiel.  They looked me over and responded with a dismissive “yeah, yeah…” before walking away.

The next few seconds unfolded as though in slow motion.  As they approached him, Mr. T was already moving to raise his hands in surrender.  I gasped as I noticed one officer reaching for his taser – Don’t tase him bro!  I don’t want to run a “code blue” in the hallway when his heart stops!  But I didn’t have time to say anything.  As Mr. T was moving to kneel, the officers had each grabbed an arm and twisted it behind his back.  What happened to being careful?!  Crap!  And now he was face-down on the floor with both arms behind him and two knees in his back, both officers almost sitting on him.  So much for sternal precautions!

By now, I was freaking out internally, but one of our nurses was freaking out audibly, screaming at the officers to be gentle.  I moved closer to the scene to try to calm things down.  My plan didn’t quite work, because then I was near enough to see that Mr. T’s face was quickly turning blue.  Instead of getting the nurse to stop yelling at the police, I joined in.

“Can’t you see, his lips are turning blue!  You need to get off him!  Right!  Now!  He can’t breathe!  He’s hypoxic, we need oxygen, where’s the code cart?  I want an ABG!  Who has the O2? – Get! Off! Him!  Move!  Get him on his back!”

Eventually the officers got out of the way, and we were able to begin treating Mr. T before putting him onto a gurney.  The “code blue” team had arrived, and since I had some major concerns about Mr. T’s physical condition, Dr. G agreed with my decision to move him to the ICU for the night.  He’d have closer nursing supervision, plus we could assess for any potential injuries from this little adventure.

I soon noticed that there had also been a “code brown” in the midst of this chaos.  Wonderful.  I picked my way around the mess and went back to my call room to put in some orders.

Haldol, to calm him down.  Stat!

Chest x-ray, to make sure his sternal wires were still intact.  Stat!

EKG, to make sure we hadn’t knocked his heart rhythm out of whack.  Stat!

Perhaps some Haldol to calm me down…

I had just finished sending a page to the cardiac surgery attending telling him about this incident when the overhead speakers went off again.

“Code alert, ICU.  Code alert, ICU.  Code alert, ICU.”

I looked heavenward with a sigh.

Somebody up there must really hate me.

to be continued….

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