Speech is Golden: Communication

Abstract

On a late afternoon, the code team of an intensive care unit was called to a “code blue” on the general ward. Upon arrival, the patient was unconscious, two nurses were frantically performing CPR, and several other individuals were observing the events in disbelief. The first impression of the ICU physician was that the resuscitation was chaotic and uncoordinated. He took over the mask ventilation, announced in a loud voice that he would be running the code, and then allocated specific tasks to the medical staff in the room. Several minutes later, a surgery resident arrived and was immediately briefed by the intensivist. The initial diagnosis entertained by the two physicians was massive pulmonary embolism, but soon it was learned that the patient had just had an uneventful splenectomy. Suspecting hemorrhagic shock, the physician ordered aggressive fluid resuscitation. A large-bore Shaldon catheter was inserted into the right internal jugular vein, 2500 ml crystalloid solution was infused, and repeated boluses of epinephrine were given with subsequent improvement of the blood pressure.