I don't push bicarbonate during a code. If there's a clear indication once I have ROSC, then yes. At my hospital, nurses on the floor and medicine residents are obsessed with bicarb during codes and are always screaming for it. I'm tired of explaining why it isn't going to help.
As far as tips:
- If you're going to be running the code, assert yourself as the code leader by calmly but loudly announcing "I'm running this code." I hate codes when no one knows who is in charge. It's ok to not be in charge, but everyone needs to know who is.
- Give everyone a job to do. Get the nursing/medic students in line for compressions. Get someone ready with an ultrasound for pulse checks. Do this early, it will help with organization.
- DELEGATE. You should be overseeing things, not concentrating on placing a line, messing with the ultrasound, etc. Of course this can go out the window if you're in a small critical access hospital with limited resources.
- Involve the family. Explain what is going on and what you are doing.
- If it's a young person, get used to running the code longer. Even when I know it's futile, I can't yet bring myself to call it early.
- Constantly run through things in your mind; airway, are compressions effective, are we missing any H's and T's, etc.
- End tital CO2 is your friend, get it hooked up ASAP.
- Remember that ACLS is a guideline.
I'm not a veteran by any means, but these are some things that popped into my mind as a senior resident.
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