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.

Specializes in Critical care.
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?

Yep, the flattened a-line (of course you must determine if you can reasonably believe it's truly flat) would be a huge clue. The spo2 pleth and cvp waveforms would also help paint the picture, as long as the pt's appearance jives with what the monitor is telling you.

Specializes in Cath lab, acute, community.

When I was a new grad, my work put me through an advanced life support course as I am in a cardiac cath lab, so needed the skills. This enabled me to learn a) recognising a code, b) what to do during a code. The course rammed into me an auto-pilot mode of what drugs to do, what not to do, how to mix teh drugs, when and how to defibrillate. Prior to that, I didn't really know. I had done basic life support, and I knew how to bag a patient, and I knew those kind of things, but not the life support algorithm for advanced life support. It sounds like you really need to go to an advanced life support course (it goes over 2 days here in Australia) and learn what to do. That way, when it happens, you won't need to be instructed as to what to do ("Hey, nurse, bag the patient") but instead will START it yourself.

Until then, when a code happens and you are the only one in there - PRESS THE EMERGENCY BUTTON and yell "GET THE CART". Don't leave the patient alone. Start o2, put patients bed flat, and start compressions (or 2 initial breaths with the bag). The cart will get in there, and the team will be on the way. They will know when to defib, when to give adrenalin etc.

Until the situation comes, you don't really know how you will react. My first code, despite having the training, I panicked. My patient didn't have defib pads on, and was under a drape. I didn't know how to put the gel pads on properly. I panicked and was saved by another nurse. My second code, I had ALS training, and went into autopilot. Afterwards I started shaking, and needed a debrief. The adrenalin kicks in, and afterwards is when you think and start shaking. It's strange, when I am out in public and see a car accident or something, I start shaking straight away. I think because I don't have the "hospital back up support" . But within the hospital walls, I am able to deal with it.

Always remember, during a code, you are not alone. It is VERY much a team effort. Also, once the doctor is there, THEY will instruct. It looks busy, but if you stand back and watch as much as you can, you will see it's like a symphony - everyone has a place, it's being conducted, and it all just works.

Specializes in Cath lab, acute, community.

Chances are, the colostomy bag will explode, or the tube dislodge, during CPR. It just happens. It's not the priority, and can be fixed afterwards. It means poop everywhere. If you are a "spare hand", pop a piece of plastic (or garbage bag) over it, or a towel. But make sure that doesn't get in the way. Kind of difficult. It also means slippery hands and potential contamination, but everyone should be wearing gloves anyway...it's kind of a difficult one. It freaking stinks too.

Specializes in Cath lab, acute, community.
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?

Pulseless V-tach is when there is no "pulse" (ie you can't feel the beat at the wrist or carotid) however there is V-tach showing on the machine, because ventricular tachycardia is actually happening in teh heart. There is no pulse because the v-tach is beating the ventricles so badly that no blood is actually coming out enough to give a blood pressure or for you to feel the pulse. This is the VT that is really bad, the one that makes someone die. As opposed to VT that someone is amazingly conscious with!

So basically, if they are unconscious and in VT, then it's CPR time. If they are conscious and in VT, it depends on the case.

Specializes in Cath lab, acute, community.
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

I work in a cardiac cath lab, and we had a patient last week who had V-tach for 2 days! Conscious, BP systolic ranging between 90-120, happy sitting up and chatting. Said he felt fine, a bit dizzy when standing, and that his heart just felt a little jumpy sometimes. His pulse was 120 and thready. Was amazing. We ended up ablating the pathway and inserting a defib and off he went! It astounds me to this day when I see fully conscious VT patients! It seems to me they are "going against the grain"

My first code wasn't one of my own patients. It was a patient who was known to have rhythm problems and we were watching closely in IMC. They went into torsades out of nowhere and we leapt into action. I actually earned lots of street cred that day for diving right into the fray with my two whole months of experience and not being afraid to go to work. The oddest part of the whole thing was that the patient seemed to go in and out of pulselessness throughout the code. I don't know if that was a feature of torsades and I was just unaware, but he actually went in and out of consciousness and left us really uncertain about whether or not to do compressions.

First code on one of my own patients was a lightning quick affair. The patient was transferred out of CCU earlier that day after having had a bad MI (intubated by paramedics while en route) and spending a couple days on IABP. Seemed for all the world to have dodged a bullet. The tele tech informed me that they had gone into bigeminy. I go into the room and check the patient over. The only thing remotely abnormal was that the pulse rate that the BP cuff read was half their rate on tele (the PVCs apparently weren't perfusing). The patient felt fine and was giving me the "why are you bothering me at this hour?" look. I left the room to go recheck with tele and call for a 12 lead. Right as I was looking at the monitor I saw an R-on-T hit and trigger polymorphic VT that degenerated into straight vfib within seconds. I hollered out to call the code and grabbed the crash cart right next to me and ran it to the room. Despite the quick response we never got that patient back. The funny thing is, even though I was on my game and did everything right it didn't change the outcome. Still took me a couple weeks to convince myself that I wasn't at fault. Probably didn't help that just the previous night I had had my first patient death (a 90 y/o s/p AMI DNR). Oh well. I hate to admit it, but these days I almost look forward to codes so long as they aren't on my patients.

My first Code happened about a month ago in a PCU! I'm a 3rd semester nursing student and it was on my last day of clinical rotations for the semester! The patient was admitted with an altered mental status. In a matter of seconds, her heart rate disappeared and the code was called! I was so amazed and impressed with how fast the rapid response team assembled! It was literally like 45 seconds! I got a chance to do chest compressions, and was sweating and panting much faster than I had anticipated! lol Luckily by that time, there were about 6 or 7 staff in the room, and another nurse was able to take over for me! It was a great experience!! To my surprise, I was very calm and collected, which I feel is super important in a situation like that!! It felt great to be a part of such a great team that has such a great purpose! To top it off, the nurse manager of the unit thanked me and said that I give great chest compressions! Yipee! lol Unfortunately, the patient didn't make it. What I take from the situation is that everyone in the room tried their very best, including me!! I attribute the patient not making it to the fact that it was probably just her time to go! She was older and had a ton of comorbidities!

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