Tell me about your first pt to code...

Specialties CCU

Published

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.

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Specializes in SICU, trauma, neuro.

Mine first came in quite unstable, and declined from there. I could NOT have run the code by myself, but I kept pretty cool. Just remember if the pt loses his/her pulse, start compressions and summon help. From there, you won't be alone.

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Specializes in Pediatric CICU.

I work night shift in a pediatric CICU. When I first started, I had a patient who had a heart defect repair during the day and came out of the OR around 1600. We always monitor our patients for what we call the "12 hour slump". Around 0400, my patient went into v-fib arrest. All you need to do is start compressions and CALL FOR HELP. Instinct definitely kicks in, and there are so many people around to help. Regardless of the outcome, you will do the best you can to save the patient.

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Specializes in ICU.

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:

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My first code was a lady who came in talking, quickly went into ARDS, then A-fib/RVR, then bradycardia, then v-fib.

I was the only nurse in the room... with a tech and a doc...

I didn't freak out but it wasn't nearly as smooth as it is now that I've been through it so many times.

Just review your ACLS algorithms everyday until you know them by heart.

ACLS has gotten very simple... shocks/epi... usually some calcium, usually some amiodarone

And great compressions (presuming your patient doesn't have a VAD)... At least 2" and at least 100/min

And for goodness sake, know the times to the second (and use a timer if you have one)... I was in a code and when the doc asked, "How long has it been since...," the recorder responded, "Umm, about 2 or 3 minutes..." as well as having missed a dose of one of the meds... (had to go through the crash-cart inventory to figure out what was used... it was a total fustercluck.

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And before you start CPR, know whether the patient has a colostomy bag... one of my techs works on a truck and learned this the hard way... before a 30 minute transport...

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And before you start CPR know whether the patient has a colostomy bag... one of my techs works on a truck and learned this the hard way... before a 30 minute transport...[/quote']

This may sound like a stupid question but what do you do if the patient has a colostomy bag? Make sure it is out of the way?

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This may sound like a stupid question but what do you do if the patient has a colostomy bag? Make sure it is out of the way?
Remember, there are no stupid questions...

only stupid people!! (sorry, couldn't help myself... and not suggesting that you're one of them by any means... just being clever)

It's actually a great question... I've yet to experience it first hand but when I do, I'm planning to drape a blanket or two over the patient inferior to the costal margin and hanging over both sides of the bed/gurney... just try to contain the ickiness or at least keep it off of me.

And put on a gown (ours are plastic and impervious to fluids... not sure how well those yellow ones would work... probably not so well but still better than nothing).

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Remember, there are no stupid questions...

only stupid people!! (sorry, couldn't help myself... and not suggesting that you're one of them by any means... just being clever)

It's actually a great question... I've yet to experience it first hand but when I do, I'm planning to drape a blanket or two over the patient inferior to the costal margin and hanging over both sides of the bed/gurney... just try to contain the ickiness or at least keep it off of me.

And put on a gown (ours are plastic and impervious to fluids... not sure how well those yellow ones would work... probably not so well but still better than nothing).

I know, I know. I just didn't want it to be one of the those common sense type of questions... :sarcastic:

But it's good information to know, incase I ever encounter it!

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Specializes in Quality, Cardiac Stepdown, MICU.
I know, I know. I just didn't want it to be one of the those common sense type of questions... :sarcastic:

I'm glad you asked, bc I was thinking it too! I'm sure we weren't the only ones.

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Specializes in Quality, Cardiac Stepdown, MICU.

He wasn't even my pt, I was covering for a friend at lunch. He was wild and in restraints, I think he was DTing, also he had had a rapid earlier in the evening bc his sugar was in the 40s. They had just instituted some retarded policy at my hospital that D50 syringes were no longer stocked in the Pyxis -- you had to request them from pharmacy. We have a tube system but it's a big hospital and pharmacy is literally a quarter-mile away. The tubes don't move THAT fast.

Anyway, he starting wilding out again, the tech and I took his BP and it started dropping. His sugar was again somewhere in the 40s. I hollered at my charge nurse (a very nice lady who hasn't worked at bedside in over 20 years) that I needed D50 now, and she started running away muttering something about pharmacy. Well heck, I know exactly where to find some -- in the top drawer of that crash cart over there. I had seen other pts code and even die from low BG, and then his pressure was dropping more, so I just went ahead and hit the darned button. I got my D50, and just as the cavalry arrived -- he actually arrested. It wasn't until later when someone asked me "Why did you call a code again?" that I realized I guess I'm supposed to wait until their heart actually stops, and not right before.

It was my first time doing compressions, and the tech also. We did it like a boss! Transferred the pt, he woke up while they were intubating him, and was wild again in his ICU bed. Went down to the cafeteria for my lunch, and was shaking so hard I dropped my freshly made sandwich on the floor. The RT from the code was there too, and he laughed and told the lunch ladies why I was so jittery, and they made me another. :-)

Thankfully, the D50 is now back in the Pyxis where it belongs.

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Specializes in Med Surg, Parish Nurse, Hospice.

My first code that I remember was off the unit in CT scan with an unstable pt. This was probably 1982. First off,no crash cart in the dept. 2nd, I was about 7or 8 mos pregnant. I remember the bed was in high fowlers and unplugged. Got that fixed and started CPR. I was the only nurse in the area and several Drs appeared. They were yelling for all this stuff and I had nothing until the ER arrived. Since then, all pt care depts have crash carts. I have been in numerous codes since then, some turn out well and others not so good.

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