Sara walked into a night shift to a patient that she recognized was very sick immediately. She grabbed another attending to help her evaluate the patient and get second opinions before the overnight attending arrived. She brought the patient to my attention immediately; we prioritized her care and came up with a resuscitation plan. We foresaw that this pt was not going to do well, so came up with an “IFTT” plan for this patient. The patient did end up coding and we were ready for it. Sara quickly intubated the patient and we continued to resuscitate the patient for hours before actually being able to get her to the ICU.

 Meanwhile, we received a total of 9 patients in our first hour and a half. She kept her cool and her head afloat during all of this, did not complain once and kept moving forward. We were even able to keep up with dispo-ing patients out of the ER while keeping up with the resuscitation and because of this, the department never came to a standstill.

 After getting the sick patient upstairs, we then got another bolus/wave of patients to hit us on the back end. She again handled it with grace.

January 2024:
AJ Mannarino

We began our busy B pod shift with an overhead code blue to the CT scanner--not all overhead calls are real, but it was quickly apparent that this was a true ‘code blue’. We found a middle age patient, who had been previously admitted and scheduled for a CT-guided procedure, in arrest with chest compressions just getting started by ancillary staff on scene. From that moment Dr. Mannarino took command, requesting rapid transfer, with compressions in process, to our resuscitation bay. Once arriving, he assigned roles, identified all team members, and spoke calmly and clearly with an assertive tone, caring for the patient while maintaining calm in the room. He led a lengthy code and afterward, Dr Mannarino led the involved staff through an organized debrief to highlight key moments and thoughts for the future. He was poised and demonstrated a level of competency that day that proved his readiness to be an attending physician.

September 2023:
Arpita Gupta

Close to 5 am, without warning an elderly patient who had been admitted to medicine, quickly decompensated after receiving a blood transfusion.  The ED team was called to bedside and found a hypoxic, diaphoretic patient that clearly needed to be intubated and was about to code. Dr. Gupta acted quicky but remained calm and composed and led the team. Her preparation for an anticipated major decompensation after intubation was commendable - predicting the need for push dose pressors before the intubation and preparing appropriately. She navigated a difficult anterior intubation and was able to switch out to a smaller ETT, with much commotion in the room in a stressful situation without major delay or hypoxia.  After the airway was secured she quickly placed a femoral central line with speed and grace, while quite a few other physicians were in the room. She acted quickly and effectively, all the while knowing very little history or information on this very sick patient. The patient subsequently made it out of the ICU and was discharged. Despite this big interruption at 5 am, Dr. Gupta was still able to effectively manage B pod and follow up on all her active patients after this event. Outstanding job!!

AJ Mannarino

Strong work managing a Type A dissection case! He recognized critical illness right away, managed fluctuating hemodynamic instability like a seasoned physician, advocated for a speedy CT scan and elected to go with the patient to our local CT Surgery receiving center to ensure the patient made it there alive. The patient made it, but unfortunately died on the table... not all Saves of the Month result in a life saved. Sometimes we do everything right but not the outcome we hope for. AJ should be recognized for the efforts he made to save this patient's life. Well done! 

August 2023:
Edgar Vega

I worked with Edgar Vega recently and he did a great job as a PGY1.  He had never done a central line or an intubation before and we had a sick encephalopathic patient that was likely due to an intentional overdose. He aced the intubation and placed a central line under difficult circumstances. He had a great attitude and was keeping up with the myriad of consultants that we needed to get on board to take care of the patient. He was able to manage multiple sick and complicated patients and he was challenging himself throughout the shift! Great job!!

July 2023:
Sara Amen

Dr. Amen expertly resuscitated an elderly patient with severe pulmonary hypertension presenting with respiratory distress and hypoxia. These are extremely complicated cases and Dr. Amen navigated the critical actions with the skill of an experienced physician. She was also able to deftly deflect some suggestions tossed out by others involved in the resuscitation (more oxygen! fluids! diltiazem! nebs!) with calm and composure. The patient not only survived to make it to the ICU but was discharged home a few short days later. Outstanding work!!

March 2023:
Nathan Jang

Dr. Jang spent an entire overnight shift performing bedside critical care on an extremely sick middle aged woman with cirrhosis and bleeding esophageal varices. He guided the team with skill and was able to parse out critical actions in this very complicated case. Additionally, he performed a flawless central line and intubation in a hypotensive patient with metabolic acidosis. Nate crushed it and should be recognized for doing such a great job on this extremely difficult shift long resuscitation.

Feb 2023:
Kim Allen

In the middle of the day in 'B pod' amidst an already busy module Dr. Allen dropped everything to respond to middle aged patient with chest pain and an obvious STEMI on ekg. About 1-2 min into the interview the patient became unconscious and lost pulses. Dr. Allen was the only person in room and she started chest compressions and took control of room - delegating responsibilities like a veteran attending. After 2 min of CPR and ACLS the patient was shocked for v fib - and then had 2 more minutes of compressions followed by an additional shock - with return of pulses but in v-tach. The patient was placed on amio drip and stabilized for emergent transfer to the cath lab where the patient was found to have a 100% LAD occlusion, was stented and made a full recovery.

Without Dr. Allen’s quick thinking and calm control - this was the type of situation that could have easily gone sideways resulting in the death of an otherwise healthy middle aged patient. Dr. Allen was a true hero and saved a life.

July 2022:
Joey Gerondale

A patient who came into the ER with reported altered mental status and a blood sugar that read “high” on POCT.  Upon transferring from the gurney to the bed, the patient became more apneic.  Joey was quick to recognize this and had the nurses start BVM for the patient.  As we were setting up for intubation, the patient lost pulses and CPR was started.  Joey did great with intubating the patient. He then had the nursing staff appropriately give epi, calcium, and bicarb (recognizing that these would help what was likely a DKA patient).  The patient got pulses back and then went into a wide complex tachycardia, which he appropriately requested shocking for.  The patient converted back to a NSR.  The pt had a pH of <6.9, K of 6.8, and glucose of almost 1200.  The patient became more hypotensive and Joey was able to expertly place the central line without any issue.  Clearly, Joey managed this very sick patient very well and was able to get him to stably transfer to the ICU.  I was super proud of how he was able to handle and manage the situation.  The patient went from embarking on a “stairway to heaven” to riding an elevator for a “stairway to the ICU.”

June 2022: Kristel Choy

Young patient with a history of alcoholic cirrhosis. Arrives hypotensive 60/40, very jaundiced and reports of hematemesis at home.  Had 2 large volume hematemesis events in ED (200, then 500cc).  Requiring aggressive resuscitation and massive transfusion protocol.  Acted very quickly to assess (and reassess) and start treating the patient.  Patient was successfully resuscitated to EGD, which required banding. Central line placed in the unit by Dr. Choy on a bleeding cirrhotic patient with rising lactate and INRs.  She remained calm and collected throughout the whole case, acted quickly, and most importantly, advocated for her patient.  We also now have 2 Blakemore tubes in the ED at SDMC due to Dr. Choy’s request!

May 2022:
Alex Kursinskis

EMS arrived with a somnolemt and hypotensive patient. Dr Kursinskis immediately evaluated the patient, initiated resuscitation, and when nursing staff couldn't obtain IV access adeptly started two ultrasound guided IVs. She immediately recognized the patient's hyperkalemia and treated appropriately. She continued managing the patient for many hours after. She led the room like a seasoned resident.

April 2022:
Justin D’Avanzo

We were having a busy shift in B-pod, where we had just been assigned 4 patients in the past hour. (Justin was really proactive and picking up patients outside the pod as well, given that we were impacted with admitted patients). Despite having new patients, Justin was very proactive in scanning the board.  He noticed that there was a C-pod patient that was sent in for hemoptysis. He asked me if he could pick up the patient, since he thought he would be a sick patient. He saw the patient expediently, and had the nurses move him to the resus room so he would be closer for management. The patient had a soup bowl full of hemoptysis. He was on warfarin and immediately recognized that the patient would require pulmonary for an emergent bronch after hours. Justin was able to get the patient up to the ICU and intubated this patient in the ICU with the pulmonologist at bedside! From what I heard, it was not an easy intubation as there was a lot of blood in the airway. Justin deserves the utmost praise for not only appropriately managing the patient, but also for his proactiveness in seeking out sick patients by scanning the board. He is the exemplary resident and I do not use those words lightly. 

Feb 2022:
Justin D’Avanzo

Justin D'Avanzo was the outgoing resident on B pod. He had a young patient with a complicated history of a DVT/PE prior to discharge had a very sudden, catastrophic event. I was walking by to see a patient nearby and noticed the commotion in the resus room. The patient's pressure bottomed out, his respirations became agonal, and he was clearly pale and mottled. Although Justin was already post-shift, he quickly took tremendous leadership action, addressed everyone in the room and clarified roles, and performed a bedside echo that demonstrated a blown out RV and compressed LV signaling massive PE. He also placed the central line and prepared for an airway. He called interventional cardiology and radiology to arrange higher level care, and redirected ancillary and nursing staff to stay on targeted management. Ultimately (amazingly), the patient was rescued from certain death.

Sept 2021:
Brent Klapthor

A patient presented to the resus room with syncope and bradycardia. Brent noticed abnormal ekg and had early concern for 2nd/3rd degree heart block. Normal labs and electrolytes and not on nodal agents. He sent ekg's to cardiology who gave bad advice over phone initially. Brent stuck with his gut and continued to watch pt closely and pursue. eventually had long pauses and syncope x 3 in ed and nearly coded.  In peri-code situation then placed cordis central line and assisted by cardiology he calmly floated transvenous pacer to ultimately stabilize pt admist a stressful situation and environment. patient was then promptly transferred to scripps for pacemaker. any delay in this situation would have lead to a full code situation with a different outcome. 

Aug 2021:
Joey Gerondale

Well beyond the time his B shift ended, Joey heard that the charge doc was called stat upstairs where they needed an emergent cric to be performed. Joey asked if he could stay late to help out. He performed a successful cric on a medical ward on a post-op pt with very severe active bleeding. There were over 5 attendings in the room. He kept his composure and performed at a level well beyond his years and training!