It depends. I've worked at 5 different hospitals. 3 had pharmacists on the team, 2 didn't.

Typical codes team here is: a cardiology resident leading, an anestheisiolgist, respiratory therapist, someone from the lab, 3-4 ICU nurses, 2 pharmacists, and usually a chaplain or social worker type. That is in addition to the floor nurses who help/provide background info, every physician within 200 feet who usually shows up, walks in halfway and starts asking questions to code team people about what's happening and gets in the way, and family members.

On the night shift we don't have a cards resident; we have the physician staffing the ICU. We also don't have respiratory therapy, chaplains, or lab (have to call lab), and only one pharmacist (I'm the only one here). Less gaukers too

The cool thing about this case was how everything all made so much sense in the end.

Our patient just had his kidney removed and it looks like maybe the other kidney isn't in the best shape. The high potassium, high creatinine, and furosemide drip all point to this. The low bicarb is the result.

So our damaged kidney isn't able to resorb bicarb and we get a metabolic acidosis. This causes his blood pH to start dropping. This body responds by hyperventilating a bit, breathing off extra CO2 and giving himself a compensatory respiratory alkalosis. This raises his pH back towards homeostasis and he's not really showing any ill effects (my guess is he's chronically acidotic but that's neither here nor there).

So what happens? This big, obese guy with an apparently challenging airway goes to sleep in a hospital bed on his back. Maybe he's even sloshed from surgery and all the drugs we've given him. He has sleep apnea and now hypoventilates. Instead of fighting the metabolic acidosis with the compensatory respiratory alkalosis his lungs are actually making things worse with their own respiraotry acidosis. His pH quickly drops and he loses conciousness. In fact, his apnea is so bad that once his brain can no longer wake up to breathe he quickly desats and sets off the alarm, beginning the code.

Anyway, thought it was a cool case. Had nobody to talk to in the middle of the night, made thread.

I thought it was interesting. It was the most urgent of the medical mystery threads, though, so I think that forced it to be quick/short here too.

There is a syndrome called Pickwickian where big huge fat guys like this have respiratory decompensation because their chest wall is so heavy from all the fat that they are unable to take deep breaths. Named after a Dickens character.

Cool case - interesting to see the pharmacists perspective on things.

Fwiw, iirc, furosemide should cause a metabolic alkalosis if anything, due to its effects on Na/K/2Cl cotransporter in loop of henle (ie hypokalemia and alkalosis)

Well, I guess my point with the furosemide was it indicated that he probably wasn't making adequate urine, indicating bad kidney function.

Now that's just a bedside guess; the thing about codes is you don't really have enough time to dig into background or know things for sure and have to make a lot of assumptions.

To those of you who will be running codes someday (anyone here?), the best code leaders think out loud. The rest of us are drawing up meds, shoving tubes down people's throats, doing CPR, etc. It's nice to hear what you think is happening so we can anticipate where you're gonna go.

that would be me soon

Theoretically I am responsible for running codes in certain situations. Have yet to be the actual one running it yet, and would fail miserably at present.

Just do what all the others who don't know wtf to do and bust out your ACLS/ATLS cards or your Maxwell's.

Haha, I definitely will.