A Code With the Field Open

In practice

Twenty minutes after an antibiotic is given, the anesthesia provider sees the patient's blood pressure fall sharply and the heart rhythm change. Hives are spreading on the patient's arms. The anesthesia provider announces a likely severe allergic reaction and then cardiac arrest. The circulating nurse calls for help and the code cart and directs a nurse who arrives to begin compressions. The anesthesia provider leads, treats the reaction, and manages the airway. The scrub person, Nadia, keeps the sterile field covered and protected from the people now moving around the table, holds her instruments ready, and stays out of the way of compressions. A second nurse arrives and takes over circulating so the first circulator can assist the resuscitation. Nadia and the second nurse keep track of every sponge and instrument on the field, because the surgeon may need to pack the wound or close quickly. When a heart rhythm returns, the surgeon decides to pack the abdomen, cover it, and stop. Nadia counts with the circulator before the temporary closure, and the count is correct. The patient is moved to intensive care, and the antibiotic is recorded as the suspected cause in the patient's allergy record.