Code Status
“Do not boast about tomorrow, for you do not know what a day may bring.”
Proverbs 27:1
Code status is a difficult discussion, but it’s a vital one. Especially when you’re admitted into the hospital. I’ve seen people come in for routine procedures and end up in one of my ICU beds hanging on for their lives.
It’s a routine discussion that is supposed to be had on admission- no matter how “healthy” you are.
That discussion is generally pretty quick because you’re there because you want to live, right? So of course, the easy answer is yes- I want to be Full Code. Do everything for me.
But circumstances change. Things can go side ways pretty quickly, and when that happens, do you know what you actually signed up for? And more importantly, does the person who will ultimately be making medical decisions for you understand code status and the choices that are out there?
Full Code- This means yout want everything done to keep you alive.
If your heart stops then we will throw everything but the kitchen sink at you: meds, procedures, medical equipment, staff ect.
CPR will be performed. Understand that when CPR is done correctly, it is rare for ribs NOT to be broken.
Most likely you will have to be intubated. It’s kind of a combo deal. If your heart stops and CPR is performed, the intubation team is no doubt standing by.
-Intubation means the team is putting a medical tube down your throat (or nose- yes… nose… sometimes the throat is too damaged/swollen and we have to go to plan B) and hooking you up to a ventilator so that you can breath.
NOTE: I have seen (on multiple occasions) a patient resuscitated without being intubated. However, more often than not, that’s not what happens.
3. When you are intubated you will also be restrained to the bed. This is because when you are hooked up to the ventilator, you more than likely, are on 1 or more sedatives to keep you comfortable and calm so that you don’t inadvertently pull out your tube.
- The tube inside your throat will be anchored by a tiny inflated balloon to keep it from moving. If you were to pull that out on your own: A. It would hurt a lot. & B. You could damage your wind pipe causing alternative medical interventions that wouldn’t otherwise be needed.
- Sedatives make you disoriented and unable to follow directions safely. I’ve taken care of many patients where the families were appalled at the restraints. I know it seems barbaric, but I promise, it’s only for your safety.
4. How long you are intubated depends on the severity of your condition. It could be as little as 6 hours or as long as 14 days. I have seen people go longer, but it’s not ideal. As I have said in other articles: There is an exception to every rule.
DNR/DNR CCA- Do Not Recusistate. This gets confused a lot. The CCA stands for Comfort Care Arrest.
This means the SAME thing!
In the medical world there is DNR-CCA and DNR-CC
Plain old DNR MEANS THE SAME AS DNR-CCA
EVERY medical resource is at your disposal up until your heart stops.
DNR/ DNR CCA with exceptions- You can be as specific as you want in your wishes.
- It doesn't always have to be black and white. No "extrodinary measures" doesn't have to be so... final.
- Maybe you don't want CPR, but maybe you would consider being intubated for a max of, say, 48 hours if you were in a respiratory crisis. Or perhaps you would be okay with IV medications, but you don't want any kind of surgery.
DNR-CC- The "CC" stands for Comfort Care.
- If your heart were to stop then we would make you comfortable and allow you to pass away peacefully without medical intervention
They key to navigating all of this when you’re in the thick of it is ASKING QUESTIONS.
You don’t know what you don’t know.
And that’s okay!
Coming Up Later
**The specifics of what it means to be intubated**
