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How One Patient and Simulation Changed My Path

Nicklaus Children's Hospital

I was supervising the brand-new intern doctors as a senior pediatric resident at Miami Children's Hospital. An overhead page went out for a code blue, and I was one of the closest physicians. When I arrived in the room, I saw one nurse providing bag mask ventilation and another providing chest compressions, and the crash cart arrived right in front of me. I saw that the compressions were ineffective, so I took over from the nurse until I had the sudden realization that I was the senior physician in the room. No code leader had been established, so I became code leader and grabbed the code blue sheet. I directly asked several nurses to draw up epinephrine but was met with blank stares and head shakes. No one in the room could draw up epinephrine, and I was even told one nurse had never touched a crash cart before. So many things about that code went wrong, and it was a true case of the “swiss cheese” model. Thankfully, the patient's pulse returned, and he was safely transferred to the PICU, but it was an eye-opening experience.
Despite my time in simulation and multiple times being involved in codes, it was clear that I was not prepared to actually lead a code. I headed back to the SIM lab and ran the scenario until I could do it in my sleep. I supervised medical students running the codes, and I helped modify resident run codes to be more realistic. I created a QI project and ran two programs—first for residents, and then hospital-wide for nurses, residents, and staff—to teach them how to draw up and administer epinephrine during codes. I ran two codes during the last month as a resident, and both were night and day experiences. I was confident and able to coordinate the code to care for those two patients. I walked away with invaluable knowledge thanks to simulation, and I am better able to care for my patients.