Tell me about your first pt to code...

Specialties CCU

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So I am a new grad in a cardiac/medical ICU with a very high acuity. We have lots of codes. I am still on orientation for another few weeks. I have been part of 4-5 codes since I've been there only in the last 2 months, but none have been my own patient.

I drive to work deathly afraid every shift that my pt will code. I'm afraid I'll freeze and won't know what to do.

Tell me about your first experience coding your patient. Did your instincts automatically kick in, or did you freak out? Did you feel like there was more you could have done afterwards if the pt didn't make it? I'm afraid I'll feel somewhat responsible if the pt dies, like I didn't react quickly enough.

Of course this is all speculation, because I have no idea how I'll react or feel until it happens!

Would love to hear y'alls stories.

not an ICU nurse but my first code was on my birthday!!! Pt. appeared stable, however at some time between 0145 when I made rounds and 0240 when the aide went to do vital signs he'd died - we are not telemetry so I had nothing to alert me to his demise. Anyway I did what they taught me in nursing school - compressions and scream like a fool for help. I was panicked and didn't even drop the bed! I was doing compressions while the HOB was elevated about 30 degrees...the 2 senior nurses on the floor were lunching in the back and heard the code called and swooped in like their combined 50 years of experience demanded - calm cool and collected. I will say the creepiest thing was feeling all the ribs break on the way down - which WILL happen even in an obese patient.

Aside from him not making it, after it was all said and done my asthma flared up and I couldn't stop coughing - thought the nursing supervisor was going to RRT me!

Specializes in Emergency.

Pre-nursing. Brand new emt, ink still wet on card, walk into house for the chest pain, rest of crew is still getting supplies off the truck. Gray, ashen guy sitting on couch looks up, says "help me" and dies. Started cpr, tried to call for help over radio, did neither well, rest of crew walks in, set up aed, no shock, more cpr, medics arrive, iv, drugs, cpr, to no avail, pt stayed dead.

It's different for everyone but generally the more exposure you get the easier it is. I worked in operating theatres for years where intubation was a routine thing so when I worked on the ward and there was an arrest (code) I just went into automatic pilot. It was just like anaesthetising a patient. Most of us revert to default mode - work now think about it later! If you really want to get over your fear about it I suggest working with one of educators or senior staff and do a mock run through. It really helps. You will be fine.

The most memorable code that I was part of was when I had been a nurse for 2 years and I was in charge. The patient was "feeling funny" according to his wife and he was walking to the bathroom. He cardiac arrested and dropped to the floor at the doorway to the bathroom and at the same time was incontinent of urine--ALOT of urine. The hospital was a small one and the only physician in the building was in the ER taking care of 2 emergencies there. It was the hospital policy that the ACLS trained nurses ran the code until the MD was available. We coded the patient on the floor putting blankets around him the soak up the urine so we did not get shocked when we defibrillated him. The patient survived because the nursing team worked like a well-oiled machine, stuck to the ACLS algorithms and compressions were started very quickly. The physician showed up in time to help us lift the patient to a stretcher so he could be transported to the ICU.

I have been a nurse over 28 years and that was a long time ago. But I remember it like it was yesterday.

Hasn't happened yet. Think I'm going to poop myself when it does

My first 'code' which wasn't really a code because he was a 'no code', so I guess you could say my first death... was a guy on tele who I got up to go to the bathroom... he valsava'd himself into severe brady and then when flat line. I was horrified because he was a no code there was nothing we could do but let him go on the bathroom floor... :( called the nursing supervisor. She was very calm and matter of fact... I felt terrible but she was like 'oh, it was his time, don't worry about it'.

My favorite code was in ICU I had just come on shift and had just gotten the results of an ABG on my shift with a low bicarb. Called the doc who was in surgery... doc said 'I'll be there soon, don't treat it'. So I'm taking care of him and he brady's down, eyes roll back... called the code, started bagging et... immediately grabbed the bicarb and gave him a bolus... my charge nurse was like 'you just saved his life'. 'yeah, I know'... lol. It happened pretty quickly and was over pretty quickly... long time ago... He was septic from being shot with a shotgun at point blank range. He eventually did die because of sepsis. It was very sad for me... I had him every day for a month. :(

Remember OP, if a patient codes, you cannot make them any more dead than they already are. Start CPR while you are calling for help and the code team should be right behind you.

My first code....I was actually still a student. My instructor and I went into a room to check on a girl who had been admitted for observation following an MVA. She was 8 months pregnant. We found her in shock and not breathing. I still can hear my instructor's voice telling me that we were starting CPR - and saying "You breathe for her - you can do it." That experience changed my whole career. I was going to go into maternity nursing. Instead, I wanted to overcome my fear of dealing with resuscitation and ACLS. I ended up with many years in ICU and CCU - and never did find my way to Labor and Delivery. I discovered that there are many reasons to relax about codes. One primary reason is that the ACLS algorithms make it pretty simple once you learn them. They are like following a recipe. I find that comforting. Another reason is that when someone arrests, they are clinically dead. You can't really make that worse (not trying to flippant). You might make it better. Relax and take control of the recipes you have been given (AHA algorithms) - and add a little prayer, treat the patient and their family with appropriate respect - and do what you can. Sometimes you really can make it better.

Specializes in ICU.

You know those tele strips that look like Vtach but are actually artifact from someone brushing their teeth? Well, it goes the other way too. I had a fresh post op heart sitting in the chair just before shift change at 0700 who was brushing his teeth. Suddenly, his eyes roll back and the monitor rings "VTach"! CRAP! We scooped him up and plunked him back in bed (the floor would have been better, but whatever) and away we went. "Uh, charge nurse? Scratch that transfer!" :whistling:

I think I was still on orientation in CVICU. Just got lunch in the cafeteria, set tray down on table with co-workers ... then over the loud speakers ... "CODE 4 ..... yada yada". We RAN down the hall. One minute I'm about to eat a well deserved lunch, the next I'm face to face with some guy doing CPR on him. :facepalm: Another interesting one ... I sat a fresh post up at bedside for his first time, giving him a sip of water. Suddenly his art line went flat (not good), his eyes roll back, and the monitor shows pulseless VTach. Here we go again. One minute I'm giving a guy a sip of water, the next I'm doing CPR on him. :no:

Can the monitor show " PULSELESS" v tach?

I saw v tach on the monitor when this happened to me, but I did not see pulseless. How to tell? By just looking at the flattened a line?

Specializes in SICU, trauma, neuro.
Can the monitor show " PULSELESS" v tach?

I saw v tach on the monitor when this happened to me, but I did not see pulseless. How to tell? By just looking at the flattened a line?

You just have to check for a pulse; can't tell looking at the monitor. Of course, if the pt is conscious that's a good indication s/he has a pulse...you'd still want to get the crash cart ready though.

Maybe a year ago, I had this pt in her 80s, was post-op from a vascular surgery. (I don't remember what her admit dx was--I want to say she was a renal pt w/ MICU overflow, but then she was dx'ed w/ a massive popliteal clot.) She was extubated and awake, and started going into VT, then SB in the 30s, then asystole, then SR, then VT again...she'd be in each rhythm for a few seconds at most. She was conscious the whole time. It was bizarre. She had an art line in, and she got hypertensive (like 180s/90s) when she was in SR, and then her BP would tank with the bad rhythms. My charge and the resident and I had the crash cart ready but she wouldn't stay in one rhythm long enough to do anything with. We just kept asking her, "You still doing ok?" She gave a weak but assured "I'm fine...." We gave her some calcium gluconate and bicarb, checked her K and Mg and replaced those according to protocol, and before too long she was back in SR again.

It was funny, the resident said to me "You weren't expecting to be a cardiac nurse tonight, were you?" I said "Actually I used to be a CVICU nurse at [big area teaching hospital that does more CV stuff than we do], and I've never seen anything like this!" lol

Specializes in SICU, trauma, neuro.

And flattened line would be asystole...also pulseless, but not V tach :)

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