Code Status I

I don't know what to think about the "code status" discussion. Briefly (and bluntly), the code status of a patient addresses what we do in the case that the patient's heart or breathing stops. In its barest skeletal form, we want to know whether someone wants to be intubated ("have a breathing tube placed and be hooked to a ventilator or breathing machine"), have CPR ("chest compressions"), undergo defibrillation ("shocks"), and be treated with vasopressors ("special medicines for blood pressure"). It is a requisite piece of information for everyone being admitted to the hospital.

To be honest, I could almost always force a particular code status on a patient if I wanted. It is the same as a magician forcing a card trick by giving the audience an illusion of free will but pre-determining what they will pick. I might say, "Some patients would like CPR, also known as chest compressions. This comes with a great deal of pain; indeed, we occasionally break ribs while doing compressions. Although it may restart a patient's heart, they almost never regain the same level of function and quality of life they had prior to the cardiac arrest, and many don't even make it out of the hospital." Or I might say, "Chest compressions, or CPR, can be undertaken if your heart were to stop in the hospital. As you might imagine, cardiac resuscitation in the hospital is more likely to end in a better outcome than if your heart were to stop out in public and require CPR there. Although there are side effects like rib fractures, this would be part of this life-saving maneuver and we'd certainly treat those problems." Presenting the matter - which is incredibly serious, life-determining, and difficult for the layman to understand - means everything.

More on code status in tomorrow's blog.