A Tale of Two Codes

In one shift....

An elderly patient who suddenly suffered a witnessed arrest at home (and who had an advance directive) was brought in already intubated by EMS after almost an hour of CPR/ACLS, reportedly in PEA. I fully intended to simply check for a pulse and call the code on arrival, but I thought I felt a thready pulse, so I looked with the ultrasound and sure enough, the heart was still beating. We worked on this patient for another half hour or so before our hearts finally gave up.

A youngish middle-aged woman with recently diagnosed widely metastatic breast cancer (including hemorrhagic brain mets) was brought into the ER for the new onset of unresponsiveness. She did not have a previous DNR order, and her family initially wanted "everything done." Instead of coding her, she was sent to the CT scanner where it was immediately evident that she would not survive more than a day or two even if the most aggressive interventions were performed. A long discussion with the family ensued, and she expired later that evening.

So we coded the elderly DNR patient and didn't code the youngish full-code patient.

Weird.