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We are all cuddled on the couch, popcorn, snacks, and soda half gone as we munch. We are all invested in the characters and the protagonist is in the hospital bed, her heart stops and they call the code team. My nurse eyes just can’t unsee all the errors and I say, “What?! We wouldn’t do that… You don’t shock that rhythm… Why aren’t they starting more IV lines?!” And this is why, as a former ICU nurse, I have been banned from watching medical movies or shows with my family.
It would be a shorter list to say what medical shows get right rather than to point out all the things they get wrong.
Codes can be dramatic. More dramatic when outside the hospital, but once in the hospital, it is more like athletes getting into position for the start of the play: a little chaos as they shift, but once started, it is “go” time. With all the monitors, especially in the ICU, we often see it coming. The heart rhythm is getting unstable, the blood pressure dropping, the decrease in responsiveness. Be assured we are doing things to prevent a full code. The medication dosages get tweaked, bed gets laid flat, code cart outside the room, extra fluids given through IVs. But sometimes the body needs more aggressive help.
Starting chest compressions quickly is important. The new CPR guidelines show that quality chest compressions started quickly is the most beneficial aspect until we can defibrillate (shock) the heart. In order for them to be “quality,” we compress the chest about 2 inches; effectively we are pumping for the heart. It is 100-120 compressions in a minute. Whoever is on the chest is breathless, straight-armed and using full force to get the needed depth. We change out compressors every 2 minutes or when fatigue sets in. It is exhausting.
Defibrillation needs to be quick. Did you know that not all heart rhythms are shockable? On TV, everything gets shocked. Shocking is a reboot, not a recharge. If the electrical rhythm isn’t there, we can’t add more in. We do clear the bed when we administer the shock, because electricity travels and we don’t want to feel it.
People do survive codes, but the numbers aren’t nearly the same in real life versus TV. I was at a conference where the presenter discussed that 85% of codes survive on TV. In reality, about 12% survive (see links below). And let’s discuss what survive means. On TV, they wake up, are responsive, answer questions, and look AMAZING (thanks to great lighting and makeup).
In reality, “survive” usually means we got the heartbeat back decent enough to push blood to the important organs. We are probably intubating the person (placing a breathing tube) and getting them on a ventilator. We need to get a tube from the nose or mouth to the stomach to get the air out of the stomach. The stomach gets full of air because the mouth is the opening to both the stomach and the lungs, so to push air in one we end up pushing air into both. This is one reason we need the breathing tube, so air gets where we need it (the lungs). We will need several IV lines for the all the medications we may need: sedation (sleepy meds), pressers (meds to keep the blood pressure and heart rhythm sustained), analgesics (pain meds for the broken ribs), fluids, nutrition, and lines to monitor a variety of pressures inside the body.
Hard conversations do happen at the bedside. Doctors and nurses do approach the family to discuss the current situation, expectations, variety of treatments, and test results. These can be emotional, but often families are in shock and need time to process. Not only are they seeing their loved one in a way they have never seen before, but they are having to interpret a language they are hearing in a fog of emotion.
On TV and in movies, the focus is entertainment: drama and plot. So they can get the tubes wrong, timing wrong, and interventions wrong. The reality is different: raw survival. We do our very best, knowing the outcome might not be picture perfect.
8 things medical TV shows get wrong: https://ro.co/health-guide/8-things-medical-tv-shows-get-wrong/
CPR Facts & Stats: https://cpr.heart.org/en/resources/cpr-facts-and-stats
CPR Success rate: how effective is CPR? https://www.mycprcertificationonline.com/blog/cpr-success-rate/
CPR survival rates are lower than most people think: https://www.reuters.com/article/us-health-cpr-expectations/cpr-survival-rates-are-lower-than-most-people-think-idUSKCN1G72SW
