Sometimes things work out like they are supposed to.  More often than not, things tend to go wrong and it begins to look like a comedy (or in some cases a tragedy) of errors.  In the ER I would say things go awry more often than they go smoothly.  Things get ordered but not done, calls don’t go through, the thing you need during a code is curiously absent from the room, etc.   But sometimes it’s like clockwork.  Sometimes you feel like those impossibly good looking actors in starched, crisp white coats from those ACLS recertification videos.

Things just happen correctly sometimes. The person doing airway gets a good seal with the BVM and have a nice wave form capnography. The compressions done are the correct rate and depth.  The drugs you need are right at hand. The monitor leads hook up properly to the defibrillator. The pads stick properly to the patient. The team is calm and no one is freaking out.  Everyone seems to remember the protocols without looking things up or shouting.

And then the best part occurs.  The patient wakes up.

If there’s one thing that irritates the heck out of me now is when people do poor quality CPR. The new ACLS recommendations are that they be done at 100 bpm and to compress the chest adequately. You’re not supposed to pause to check for a pulse every 15 seconds. You not supposed to push down like you’re giving the person a massage.
Now if the person is a billion years old with terminal cancer, I’m not quite so irritated. However the point is if you’re going do it, you should do it right.
I don’t feel like getting in the discussion of the unofficial “slow code” but for everyone else, PUMP HARD. You should be sweating after two minutes! It means you just might be saving that person.

RN: Mr Afterload with CHF in room 6 is in respiratory distress!

Me: “Quick! Fetch me some rotating tourniquets!”

RN: “Huh?!”

Me: “Just kidding. Bust out the Lasix, nitro and BiPAP. ”

Learn some history of medicine people!