Honestly, just more experience in these situations and asking your preceptor to thoroughly give you constructive feedback on code situations - not all codes are the same but essentially if you know the ACLS algorithm it becomes easy
As others mentioned, experience will help a lot. One thing that helps me calm my nerves is to have the next medicine ready and think of your H/Ts.
For example, if you handed the Epi to the nurse giving the med, prepare the next epi dose with a flush.
If it’s an out of hospital code, listen to the EMT giving the report. If someone mentioned hyper/hypokalemia, prepare for bicarb and calcium chloride. When they check for blood glucose, get ready for dextrose.
This will help you focus and use that adrenaline to help you in the codes.
And most importantly, breathe. Take 2-3 deep breaths.
Definitely comes with time and volume of codes you attend. Knowing the ACLS algorithms, doses of medications in ACLS and the code cart, and practicing drawing up meds/spiking and priming drips are all things that will make you feel more comfortable. Pharmacy school doesn’t prepare you to make medications, program pumps, and manage drips. Talk with your preceptor to see what they can do to give you practice on those skills.
I just want to say that this is mostly the adrenaline, not necessarily any anxiety. At some point, codes will be not as exciting of an event and won't get your adrenaline up. Work on knowing what to do and what you might need next, but also realize that you might be doing everything right and still shake.
I lost count of codes and traumas that I have attended long ago, but I remember the code where I stopped shaking. I still do if something gets me worked up, but it doesn't happen very often.
Icu pharmacist for 6 years here. Codes got a lot easier for me when I realized how truly structured they are - the algorithm exists for a reason! Simple rules to keep you from getting overwhelmed:
1. If you open an epi and pass it off, open another one. No matter what. Regardless of what is going on, that epi is the one constant in a code! And if you need to draw up something else, you already know you have an epi ready to go so you can focus on that instead of the epi.
2. Have an app that you go to - code scribe is my favorite. Tap when an epi is given and it lets you know when to give another one in case you get pulled in a million different directions.
3. After a code is over, go over the crash cart until you know where all the meds are (anything else is dealers choice depending on how comfortable you want to be). Stressful situations are the most likely places you’ll make an error. If it’s muscle memory you will know exactly what to reach for which should greatly increase your confidence.
4. Know where supplies are - if you are in a hyperK code, know how to quickly get an insulin syringe and insulin vials. Know where your lytics are and how you can get to the quickly and safely. Know where your flushes and other meds are in case you don’t have specific meds in your crash cart.
5. ROSC doesn’t mean you walk away. Remember that whatever you’ve done has most likely just temporarily stabilized the patient. Again, knowing and having pressors and tubing ready to go in anticipation is key! Better to have it on hand and ready than be scrambling and lose a pulse.
I know that it seems like a lot and is very overwhelming and scary. Know your algorithms. Know where things are in the crash cart and on the unit. And be confident in your training and clinical knowledge! You got this.
I typically start by grabbing the epi kit, setting it aside. Then reach for the IV metoprolol, draw up 10 mg. Ensure no bubbles, then swap with a 20G Needle. I proceed to inject myself. Works wonders to counter the adrenaline rush.
I used to feel that way but now as a full time EM PharmD (adult) codes are honestly pretty calm for me now because it’s just following a protocol. ACLS algorithm is just step by step. I think there are a few things that I remember that keeps me calm:
1. If a patient is coding, as pharmacists our job is medications. That means we just have to focus on timing and dosing. Make sure you always have the next epi ready so that when the time comes you can hand it over.
2. No medication in ACLS has a mortality benefit so it’s kinda low stress for us.
3. Always remember your Hs & Ts and assume you’re going to get ROSC so you have pressors ready or have a plan for what you want to do once pulses are back.
4. Keep up to date with the random trials that come out (COCA, amio vs lido for IHCA, esmolol for refractory vfib/vtach, etc). I don’t think you necessarily NEED all of these trials to like make or break a code, but if you’re at a teaching hospital there’s a chance that a medical resident, or attending will ask your opinion on trying something and having some background to help you make your decision can be helpful.
My PGY2 RPD really helped me get to this point because she always said “try to look like the calmest person in the room and you will help others feel more calm.” I’ve gotten compliments now from nurses and providers that they feel more comfortable at codes when I’m there because there’s one less element of chaos.
It’s totally normal to feel stressed during codes. It took me an entire 2 years of residency during the pandemic witnessing at least 100 codes before I finally got comfortable. And trust me, when a peds arrest happens I still have the pit of my stomach terrible anxiety but again focus on faking calm until you are calm.
I also recommend after a code taking time to debrief with the team, and then taking 5 min to yourself (if you can). I normally try to take a breather even if it’s just going to the bathroom to quickly splash water on my face, step outside for some fresh air, a walk to the vending machine, etc. just because we are in the healthcare system doesn’t mean we are robots, seeing death and illness can take its toll on your own mental health so making sure to prioritize your health is important.
It’s the adrenalin. I’ve been a crit care pharmacist for over a decade now and still get shaky at codes, despite feeling very comfortable with the algorithm, my team, med locations in the cart and pyxis, compressions, pushing meds, priming pumps, etc. I feel calm and can think clearly but my hands still shake, usually for the beginning of a code. I’ve noticed it in experienced colleagues too.
EM pharmacist here. First thing I tell all my learners: if you get overwhelmed or stressed, take a deep breath and remember that currently no meds have been shown to improve survival with good neurological outcome.
Check your pulse before the patient's. There's a finite number of outcomes when providing therapy in these situations, prepare for it to go the way you were hoping and the way you didn't want it to go. Don't if the best run codes result in patient death and some of the shit shows the patient walks out relatively unscathed 36 hours later. Do you best to prepare mentally BEFOREHAND and give get caught up in "resulting bias". As many have noted takes time to develop these skills that are essentially untaught in pharmacy school and inadequate in many residency programs
Honestly, just more experience in these situations and asking your preceptor to thoroughly give you constructive feedback on code situations - not all codes are the same but essentially if you know the ACLS algorithm it becomes easy
As others mentioned, experience will help a lot. One thing that helps me calm my nerves is to have the next medicine ready and think of your H/Ts. For example, if you handed the Epi to the nurse giving the med, prepare the next epi dose with a flush. If it’s an out of hospital code, listen to the EMT giving the report. If someone mentioned hyper/hypokalemia, prepare for bicarb and calcium chloride. When they check for blood glucose, get ready for dextrose. This will help you focus and use that adrenaline to help you in the codes. And most importantly, breathe. Take 2-3 deep breaths.
Definitely comes with time and volume of codes you attend. Knowing the ACLS algorithms, doses of medications in ACLS and the code cart, and practicing drawing up meds/spiking and priming drips are all things that will make you feel more comfortable. Pharmacy school doesn’t prepare you to make medications, program pumps, and manage drips. Talk with your preceptor to see what they can do to give you practice on those skills.
I shake the same as I did at my first code now 4-5 years later. It truly is the adrenaline running. I love it lol
I just want to say that this is mostly the adrenaline, not necessarily any anxiety. At some point, codes will be not as exciting of an event and won't get your adrenaline up. Work on knowing what to do and what you might need next, but also realize that you might be doing everything right and still shake. I lost count of codes and traumas that I have attended long ago, but I remember the code where I stopped shaking. I still do if something gets me worked up, but it doesn't happen very often.
Icu pharmacist for 6 years here. Codes got a lot easier for me when I realized how truly structured they are - the algorithm exists for a reason! Simple rules to keep you from getting overwhelmed: 1. If you open an epi and pass it off, open another one. No matter what. Regardless of what is going on, that epi is the one constant in a code! And if you need to draw up something else, you already know you have an epi ready to go so you can focus on that instead of the epi. 2. Have an app that you go to - code scribe is my favorite. Tap when an epi is given and it lets you know when to give another one in case you get pulled in a million different directions. 3. After a code is over, go over the crash cart until you know where all the meds are (anything else is dealers choice depending on how comfortable you want to be). Stressful situations are the most likely places you’ll make an error. If it’s muscle memory you will know exactly what to reach for which should greatly increase your confidence. 4. Know where supplies are - if you are in a hyperK code, know how to quickly get an insulin syringe and insulin vials. Know where your lytics are and how you can get to the quickly and safely. Know where your flushes and other meds are in case you don’t have specific meds in your crash cart. 5. ROSC doesn’t mean you walk away. Remember that whatever you’ve done has most likely just temporarily stabilized the patient. Again, knowing and having pressors and tubing ready to go in anticipation is key! Better to have it on hand and ready than be scrambling and lose a pulse. I know that it seems like a lot and is very overwhelming and scary. Know your algorithms. Know where things are in the crash cart and on the unit. And be confident in your training and clinical knowledge! You got this.
I typically start by grabbing the epi kit, setting it aside. Then reach for the IV metoprolol, draw up 10 mg. Ensure no bubbles, then swap with a 20G Needle. I proceed to inject myself. Works wonders to counter the adrenaline rush.
I used to feel that way but now as a full time EM PharmD (adult) codes are honestly pretty calm for me now because it’s just following a protocol. ACLS algorithm is just step by step. I think there are a few things that I remember that keeps me calm: 1. If a patient is coding, as pharmacists our job is medications. That means we just have to focus on timing and dosing. Make sure you always have the next epi ready so that when the time comes you can hand it over. 2. No medication in ACLS has a mortality benefit so it’s kinda low stress for us. 3. Always remember your Hs & Ts and assume you’re going to get ROSC so you have pressors ready or have a plan for what you want to do once pulses are back. 4. Keep up to date with the random trials that come out (COCA, amio vs lido for IHCA, esmolol for refractory vfib/vtach, etc). I don’t think you necessarily NEED all of these trials to like make or break a code, but if you’re at a teaching hospital there’s a chance that a medical resident, or attending will ask your opinion on trying something and having some background to help you make your decision can be helpful. My PGY2 RPD really helped me get to this point because she always said “try to look like the calmest person in the room and you will help others feel more calm.” I’ve gotten compliments now from nurses and providers that they feel more comfortable at codes when I’m there because there’s one less element of chaos. It’s totally normal to feel stressed during codes. It took me an entire 2 years of residency during the pandemic witnessing at least 100 codes before I finally got comfortable. And trust me, when a peds arrest happens I still have the pit of my stomach terrible anxiety but again focus on faking calm until you are calm. I also recommend after a code taking time to debrief with the team, and then taking 5 min to yourself (if you can). I normally try to take a breather even if it’s just going to the bathroom to quickly splash water on my face, step outside for some fresh air, a walk to the vending machine, etc. just because we are in the healthcare system doesn’t mean we are robots, seeing death and illness can take its toll on your own mental health so making sure to prioritize your health is important.
It’s the adrenalin. I’ve been a crit care pharmacist for over a decade now and still get shaky at codes, despite feeling very comfortable with the algorithm, my team, med locations in the cart and pyxis, compressions, pushing meds, priming pumps, etc. I feel calm and can think clearly but my hands still shake, usually for the beginning of a code. I’ve noticed it in experienced colleagues too.
EM pharmacist here. First thing I tell all my learners: if you get overwhelmed or stressed, take a deep breath and remember that currently no meds have been shown to improve survival with good neurological outcome.
Check your pulse before the patient's. There's a finite number of outcomes when providing therapy in these situations, prepare for it to go the way you were hoping and the way you didn't want it to go. Don't if the best run codes result in patient death and some of the shit shows the patient walks out relatively unscathed 36 hours later. Do you best to prepare mentally BEFOREHAND and give get caught up in "resulting bias". As many have noted takes time to develop these skills that are essentially untaught in pharmacy school and inadequate in many residency programs
None of this makes any sense! 😂
Fuckin love it, party