Respiratory Made Easy- Understanding Codes: The Basics
If you're anything like me, you enjoy a good trauma case or a code. Helping patients with breathing treatments, O2 rounds, ambulation, etc. are all great things-- but there's nothing like the rush you get from an emergent situation.
There are so many factors that go into each individual code situation; sometimes it's hard to keep up. In this blog, I'm going to describe the 4 Critical Life Functions.
- Ventilation
- Oxygenation
- Circulation
- Perfusion
If you have all of these things, great! You're alive and in good shape. If you are missing any one of these things, you're coding!
As we've come to know, ventilation is the exchange of air in and out of our lungs. In an ABG result, our CO2 reading gives us a good gauge of how well our patient is ventilating.
Oxygenation is simply oxygen moving through the blood. PaO2 gives us that reading in an ABG.
Circulation is the blood's movement through the body. Do you have a pulse?
The blood and oxygen feeding the body's tissue is perfusion. Vital assessments such as blood pressure, temperature, and hemodynamics give us a feel for how well the body is perfusing. Blood pressure is obviously the most common test for this in a code situation.
As I said before, if any of these life functions are missing, it must be corrected immediately. Our piece of this mainly lies in the ventilation and oxygenation categories. This is what we are trying to restore when bagging a patient during a code, placing an ET tube, starting mechanical ventilation, etc.
Circulation and perfusion are often corrected through the use of CPR, defibrillation, or pushing cardiac medications.
If you have a patient who is worse for wear, and exhibits none of the basic life functions, the main priority is ventilation. That is why "listen" is #1 on our list. Oxygenation is number 2; circulation, #3; and perfusion rounds out the list.
Next time you get a chance to observe a code where there are no life functions, watch what is done first.
Intubation usually occurs first (ventilation).
Then bagging the patient will occur after the ET tube is in place (oxygenation).
CPR or defibrillation will occur along with cardiac medications (circulation).
Once those are underway, getting an acceptable blood pressure is next on the agenda (perfusion).
If you can memorize those 4 life functions and the order that they are prioritized, you are well on your way to understanding code situations!