Wednesday, November 14, 2012

Writing a Code Blue--Cardiac Arrest and Resuscitation

Here's the set-up:
The character is a doctor-in-training (He has graduated from medical school, and is now doing a residency--training in Emergency Medicine).
A young man in his early thirties has coded. No sign of drugs or alcohol. Good health history. It's the third man who has come in with massive cardiac arrest with no known health problems. My doctor doesn't want the patient to die so I have him ordering them to keep doing the chest compressions (like I've seen done on TV shows). Since I am starting this mid scene, the patient has already been intubated. Eventually the doctor's supervisor talks sense into him and he calls it. I really need to know how long should the doctor do this before calling time of death.

It's fine to start mid-code with the patient intubated and during chest compressions.
To introduce a little reality, consider having your doctor administer some IV medications. Epi (epinephrine) is an easy one and most people will have heard that used in a TV cardiac arrest scene. Atropine is another. They are usually ordered in doses of ampules, as in "Give him an amp of epi!"
At some point, you may want to have the doctor defibrillate the patient, something like this:
"Charge to 300 Joules. Clear!" (this is when everyone jumps back from the bed) and have him slap the paddles on, press the button on the side of the paddle, and deliver the shock.
Consider a comment about the patient's heart rhythm. "Damn. Still V fib." (Ventricular fibrillation, a fatal rhythm.) Alternatively, it can be a "Flatline" with no rhythm at all.
Your doctor can insist they keep doing chest compressions through all this.
A respiratory therapist to “bag” the patient (use an ambu-bag) to deliver breaths through the ET tube in the throat is appropriate.
The supervising doctor may want to suggest that "The patient's heart is gone," or "It's too late," or "You've done everything possible and it's time to stop."
The duration of a true code can be minutes to nearly an hour, depending on the situation and the determination of the doctor doing the resuscitation.
Cardiac arrest occurring outside a hospital is likely to have a shorter resuscitation period after the patient arrives in the ER. If the paramedics can't resuscitate the patient in the field, it's unlikely the ER will have much better luck.
You may want to consider a time interval of twenty to thirty minutes since the patient is young and apparently healthy, and the doctor is determined.
I hope this helps. If you have questions about the above, or have other ones that crop up, let me know.
Cheers, Kelly
Kelly has worked in the medical field for over twenty years, mainly at large medical centers. With experience in a variety of settings, chances are Kelly may have seen it.

Sometimes truth seems stranger than fiction in medicine, but accurate medicine in fiction is fabulous.
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  1. Really enjoying your med explanations!

  2. Hi, Kelly! Interesting post.

  3. Thanks, guys. It's fun writing them too.

  4. I am writing a scene in which a patient goes into cardiac arrest and eventually flatlines. Can you provide a blow by blow of the vitals? What is a bad BP level and how does that progress from caridac arrest to flatline. For example, it might start BP at 110 over 50 and then go above 180. How might a doctor or a member of the crash team say them (e.g., "BP is 180 over 50. Heart rate is 92 and climbing.") Are there other vital signs to look out for?

    1. Hello, Paco.
      Your question is up on the front page today! 2-28-13.

  5. i'm putting you on my list of go to for accurate info. i wish more writers would take the time. as a reader and editor i can tell you some write some pretty far out scenes. thank you

    1. Thank you, Larion!
      I love accuracy in medical scenes too.
      Cheers, Kelly

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