Pop Medicine / Pop Medicine

A Day in the Life of a Doctor: Code Blue Emergency

www.medpagetoday.com
7 min read
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Follow YouTuber Siobhan Deshauer, MD, on an eventful night shift
Join medical resident Siobhan Deshauer, MD, for a night shift in the intensive care unit. She'll be caring for critically ill patients, solving medical mysteries, intubating a patient who cannot breathe, and reacting to a code blue emergency.

Following is a rough transcript (Note that errors are possible):

Siobhan Deshauer, MD: Code blue, Level 5, Room 537. Code blue, Level 5, Room 537.

Hey, guys. I'm Siobhan, a 5th-year medical resident. I just got to the hospital and I'm starting a night shift in the intensive care unit and I'm bringing you guys along.

OK. First things first, let's go grab a call room and drop off my stuff. Oh, wow. I'm paged already. OK. Let's see who it is.

Hi, this is Siobhan from ICU returning a page. I'll be down shortly. Thanks very much.

OK, so that was the emergency room doctor. There was a patient who was found unconscious outside, was brought to the hospital, and was unresponsive, so they intubated him. At this point now, he is definitely going to get admitted to the ICU and the question is why was he unconscious. That's what we have to figure out now.

Walking into the emergency department, I find a middle-aged man lying unconscious connected to life support. I do a really thorough physical exam, which is largely normal, so no clues as to why he was found unconscious. Then I go to the computer and check the lab results. The CT scan of his head is normal, but there are some abnormalities on his blood work.

The pH in his blood is too low, meaning it's too acidic. This is really dangerous because the proteins and cells in our body stop working properly when it's too acidic, and that includes the brain, which may explain why this patient was found unconscious. We are already checking for the most common causes like lactic acid buildup or kidney failure, but so far all these tests are normal.

He has got what we call a metabolic acidosis, so there is basically too much acid in his blood. But the question is where is that coming…
Siobhan Deshauer, MD
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