first call

Today was my first weekend day in the hospital.  I really wanted 1) to see a stroke code, and 2) for no one to actually have a stroke that needed stroke code called.

A stroke code is called when a patient manifests any signs of a stroke, because in the first "golden hour" or hours, it may be possible to dissolve the blood clot and restore oxygen to the brain using tPA, or tissue plasminogen activator, which can only be administered within a certain time window. (As one lecturer reminded us, "Time is brain!") However, there is a risk of bleeding (and causing hemorrhagic stroke) with certain patients, so it is imperative to get an emergency CT scan to check what is causing the stroke before administration.

"They also serve who only stand and wait," and the neurology consult residents and fellows were certainly waiting, having doughnuts in the call room.  Then the stroke code pager blared one long high-pitched beeeep! and everyone sprung into action.

It felt like being on a TV show or something, but instead of yelling and running around, the residents just purposefully speed-walked (with me trailing along behind them) to the cardiac unit where a patient's face had started to droop on one side.  Precious seconds ticked by as the resident questioned the attendings and nurses what time the patient was last seen to be normal.  "Yesterday evening" was not good enough, but finally one person volunteered that the patient had smiled and conversed with him at breakfast at 8 am.  Good enough.

The nurses unplugged the man's bed and hooked him up to a portable oxygen canister.  We wheeled him to the elevator with the resident checking his vision, finger-nose-finger abilities (testing for cerebellar damage), ability to sense touch and move his limbs along the way.  We got stuck at the elevator (how do you fit a whole team of people along with a patient bed in there?), divided and conquered, and fast-pushed him through the lobby to the emergency department.  Fortunately I wasn't steering because I didn't actually know the way to the emergency department.  The attending cardiac physician had already ordered an emergency CT scan, so they team was ready and waiting for us.

The only thing I was useful at was finding a wall plug for the bed so the patient could be placed in the CT scanner.  But the resident in charge - even though it was his first day! - directed everyone, and the other resident and fellows trailing along ran everything to order.  The patient's head was constricted at a weird angle, so the techs rushed to scan the patient as he tried to keep his head straight.

As it turned out, he didn't qualify for tPA and his stroke symptoms began to improve spontaneously afte the CT scan.  But it was amazing to see the jokey neurology fellow morph from telling stories about his daughter ("she brought home bread from this summer camp, and of course I had to tell her how delicious it was, but it was terrible!") to being all business.  Nobody yelled or waved arms; but the team coalesced around the resident.

Pretty good for his first neuro call and first stroke code!

I, afterwards, took a ridiculous 3 hours to write up the note because I had never used the electronic medical record system.