There’s this strange moment during a code—especially when you’re new—where it’s so loud, so frantic, that your brain does the opposite of panic:

It zones in.
So far in, in fact, that you almost start to tune everything else out.

This hyperfocus can be a gift… but it can also be dangerous if you’re not used to working under pressure—especially if you’re learning, and so is your resident.

Staying calm is essential. But so is being confident, and more importantly:
✅ Communicating clearly
✅ Repeating back orders
✅ Double-checking everything—especially meds

💉 Sedation First. Always.

One of the most common missteps during a code—especially in high-stress RSI situations—is mixing up the med order.

Sedation always goes before the paralytic.

It sounds obvious, but in the rush, it can get flipped. And while your doctor should be giving clear, step-by-step instructions, it’s often another nurse at the bedside who’s actually pushing the meds.

That’s why I’ve gotten in the habit of calmly asking:

“Just to confirm—Versed first, then Roc?”
or
“That’s 100 of Propofol before the paralytic, correct?”

Even among experienced teams, mistakes happen—and you’re the final checkpoint. It’s not about calling someone out—it’s about protecting the patient when the room is moving a mile a minute.

Sometimes it’s a miscommunication.
Sometimes it’s a slip of the tongue.
But either way—you’re the one holding the syringe. So double-check everything.

🧠 Why I Created My Code Room Cheat Sheet

Some ERs are lucky—pharmacy is present at every code, especially in Level 1 trauma centers. But that’s not the norm everywhere. At several hospitals I’ve worked in, we didn’t have that luxury.

That’s why I made a small, durable badge card for myself:

• Common adult sedation meds
• Typical doses + routes
• The correct sequence during RSI/intubation
• Quick reminders when your adrenaline is spiking and your brain stalls out

👉 [Click here to grab my ER Code Cheat Sheet for Nurses]
It’s designed to fit on your badge and give you confidence in the chaos.

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🧰 Running the Room: Know Your Setup

If you are the nurse in charge of a code room, then guess what?
That room is your responsibility.

At a minimum, you should:

• Know where everything is (airways, meds, suction, crash cart, emergency blood setup)
• Know if it’s fully stocked (ask for or help create a checklist!)
• Know who’s doing what (assign roles early)

Even before the code hits the room, I mentally walk through everything. Why?

Because you can’t lead in chaos if you don’t know your terrain.

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🧍‍♀️ Key RN Roles During a Code:

Here’s how I like to break it down when I’m assigning roles:

• Recorder: Writes down meds, times, compressions, shocks. This is often me—it helps me stay in charge and keep the big picture in view.
• IV/Med Nurse: Pushes code drugs, draws labs, confirms doses
• Airway Assistant: Assists RT or MD with BVM or intubation setup
• Compressor: Rotates every 2 minutes
• Runner: Goes to lab, gets extra meds/supplies
• Monitor Nurse: Tracks vitals, rhythm, and defib pads

✅ Pro tip: If someone isn’t actively helping, kindly ask them to step aside.
Too many bodies = too much noise = too much risk.

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🧬 Communication is Everything

One of the most overlooked skills in the code room? Hierarchy control.

In a teaching hospital, there might be three MDs with ideas. That’s not a bad thing—but it can get messy.

So I ask:

“Dr. Smith, are you running this code?”
“Great—I’ll be taking orders from you directly. Everyone else can funnel through you.”

This keeps communication clear and prevents conflicting orders, which can delay or harm patient care.

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💨 Don’t Forget RT

If your ER has Respiratory Therapy, they should be alerted the moment you are about a code or intubation coming.

They’ll be the ones:

• Setting up the vent
• Assisting in bagging
• Helping with advanced airways

In codes, they’re your best friend. Don’t assume someone else called them—make sure.

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💬 Final Thoughts

Running a code is intense—but it becomes manageable when you’re prepared.
Know your meds.
Know your roles.
Know your room.
And when things get loud and fast—be the one who slows it down by getting it right.

👉 Need a quick refresher you can keep on your badge
Grab my ER Sedation + Code Meds Cheat Sheet—for the moments when your brain goes blank and the adrenaline is spiking.
[Click here to grab my ER Code Cheat Sheet for Nurses]