Brian is one of the coolest nurses I have ever met. Overall, he is a cool dude. Sporting a sleeve of tattoos, he has swag. We have been side-by-side in many traumas and sick medical arrests. He always remains calm, cool and collected as he navigates the resuscitation bay. So, when Brian ran into the pediatric ED looking a little flustered, I knew we were in for something.

“I just got a run. Five-week-old cardiac arrest. Five min ETA. Gray on the Broselow,” he announces.

The room goes silent, and I tell everyone to move. The current patient in the peds trauma bay is pushed out, and before I know it, chaos ensues. Multiple people are trying to get the same monitor started and the same IVs prepped. Two residents are scrambling to get airway equipment set up.

There is nothing worse than losing a pediatric patient, especially an infant. When an adult in full arrest comes in, everyone works together like a well-oiled machine. But when word comes of an infant run, all hell breaks loose. There is an uncontrollable release of adrenaline that leads to cloudy judgments. Systems that usually run like clockwork start breaking down.

Three minutes have passed, and the room is sputtering as it tries to set up for the incoming patient. I look at the disorganized action, and suddenly I remember an adult cardiac arrest I witnessed as a med student. The patient was having a hard time breathing and as we were assessing him the senior resident, Ari, looked up at the monitor and without a break in his voice announced coolly that the patient was peri-arrest and instructed the junior resident to get ready for compression. The patient coded, and they were able to get him back. The patient was about to die, and Ari didn’t even flinch. He didn’t panic. He stayed calm, cool, and collected. Later, I asked Ari about how he was able to maintain his composure. That situation should have made anyone panic. Ari looked at me and said, “It’s like scuba diving, if you panic you die.” Ice cold.

After four years of training, I have learned how to channel that adrenaline surge. It no longer paralyzes me but rather helps me amp up and become laser focused. Be ice cold. I look around at the chaos and say, “Alright everyone, stop. We’ve done this before. We know exactly what to do.” I assign everyone a job. I dictate exactly how this is going to go so that not a moment will be wasted. The room comes alive just in time as the smallest patient I have ever had is brought in. An eerie silence falls upon the room. Without a word, everyone springs into action, and the resuscitation kicks into full gear. Two-finger compressions start. Epi is given. Pads are placed. And we cycle through the algorithm. Everyone is working in unison. No wasted movements. Twenty minutes go by, and we call it.

We cover the infant. Lights go out. Everyone walks out. The room is now silent. I hang my head. This sucks. I guess it’s impossible to always be ice cold.

Zahir Basrai is an emergency physician who blogs at the Physician Grind.

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