The worst code you've seen?

Long Term Care Columnist / Guide · Mar 27, 2010

A 42-year-old man, husband and father of two little girls, who was a direct admit from his workplace after complaining of "a little chest pressure". Taking his medical history as I admitted him to our med/surg unit, I learned that he had the same inherited heart defect that had killed his father and his uncle at ages 51 and 48 respectively; this admission was strictly for precautionary purposes, he informed me, as he "really didn't feel all that bad".

A co-worker and friend of mine who was taking over his care asked me to grab a telemetry monitor for him. Just as I came into the room, this red-headed, freckle-faced man who looked 10 years younger than his real age---and who'd been chatting with us only minutes before---suddenly became pale, short of breath, and profusely diaphoretic.

"Oh please, don't let me die," he begged us as his color changed alarmingly from white to grey to purple. He grabbed my hand as if it were a lifeline and repeated his plea. "Don't let me die, I can't leave my wife and girls......."

Naturally we both promised him that we wouldn't let him die, even though we could see we were losing him even as we ran his bed down the hall to the ICU with RT and several other nurses working on him in transit. He lost consciousness almost immediately after we got there, followed in quick succession by his pulse and BP. Meanwhile, his wife and daughters were still in the med-surg waiting room, having no idea of what was transpiring.

We coded him for over an hour. But despite our promises, we were never able to re-establish a rhythm and he was pronounced dead, a mere two hours after feeling that "little tightness" in his chest at work. There wasn't a dry eye in that ICU after the doc called it........we all felt horrible. Even the physician and the RT were crying. Worse, we had to walk by the family on our way back to Med/Surg after it was all over; they'd been sent to wait outside the ICU and obviously hadn't yet been told that their loved one was gone. We didn't want to be around when that happened.

That one still haunts me, years later. We had a debriefing with the social worker and hospital chaplain after that, but dang, when someone clinging desperately to his last moments of life begs you to save him......and he doesn't make it.........well, there are some nights when sleep is slow in coming and I hear that poor man's voice again, and I see the fear in his eyes and feel the terrible knowledge that my hand, and not those of his beloved 'girls', was the last comfort he received on this earth.

TigerGalLE, BSN, RN · Mar 30, 2010

A ruptured pulmonary artery...looked like a very bad crime scene...blood all over everything and everyone. sad, obviously didnt make it.

This happened to a guy on my old medsurg floor. I wasn't there but they said when they tried to draw some labs on him before he actually coded all they got from his vein was plasma.

The worst code I've ever been involved in was an older lady that came in with c/o abdominal pain and fevers. She had just arrived to the floor as a direct admission. A fellow nurse got her admitted and we were waiting on her MD to arrive to write orders. She was okay one minute and the boom she became unresponsive and became bradycardic. When they started compressions dead bowel projectiled out of her mouth and nose. The code didn't last long. It was really sad having to tell her granddaughter who arrived at the hospital in the middle of the code. She had dropped her grandmother off at the hospital and then went home to get her some clothes and toiletries. I have never smelled anything so awful in my life.

aerorunner80, ADN, BSN, MSN, APRN · Apr 1, 2010

The most difficult situation I've been in is in the ICU. I was working as a tech at the time but I was still somewhat involved.

Lady came in, 3 months postpartum, started back up on birth control.

Boyfriend says she went to brush her teeth and feel flat on the floor. She was in full blown DIC. This was my first experience with DIC and it shocked me to see that she was bleeding from every possible hole in her body.

She was vented, boyfriend at bedside, mom at home with their baby.

Everything was in the toilet on her and we were just waiting for her to code. SHe was still a full code at that time.

Luckily the boyfriend and now mom who had come in, were in their right mind and when the time came to code her, they said don't do it, just let her go.

I come in after and see the boyfriend holding her hand at the bedside crying his eyes out with her family around her saying prayers for her as her soul went up to heaven. All the while, she still had some blood oozing out of her where some IV's were taken out already.

I helped with postmortem care.

Why this was so hard: she was one of us (worked at the same place).

lizeroo · Aug 26, 2012

When I worked in CVICU, I received a fresh case from the OR at start of shift. She was visiting from another country and ended up needing urgent CABG.She was on pressors from the start and rapidly began to lose her BP as she circled the drain.Our in house call resident was actually an anesthetic fellow, which was a problem when we had to crack her chest. He managed to do it while we waited for the surgeon and chief resident to come in from home, but in the process of giving internal cardiac massage, her pulmonary artery was ripped.Blood hit the windows behind the bed, the ceiling, and everyone involved. Of course the patient did not recover, despite a good effort. We were slipping in the blood on the floor when it was over and all had to change clothes. The family did not take the news well and had to be restrained in the waiting room but oddly enough, phoned us after midnight to ask if were true that they would not have to pay if she died within 24 hours of surgery.

flynurse828 · Aug 26, 2012

Many years ago as a new nurse I came in for my shift which was 7p-7a @ the time and prior to completing report we had a code on a 89 year old lady, her husband stood by screaming I told them early that I did not want this the doctor just hasn't called back to modify the order, fortunately he was heard by the ER doctor and the code was stopped, needless to say the patient did not make it however the husband began to have chest pain and was rushed to the ER, and after a couple of days in the Critical Care Unit the husband survived and was discharged.

KymmD77 · Aug 28, 2012

I have a few:

First was a guy who was being taken care of by a nurse who was new to the ICU. The doc had come in to perform a thoracentesis and drained an impressive amount of fluid. Shortly after this, the nurse decides to put the pt in the cardiac chair. Stood him up, the pt went orthostatic, and once they got him into the chair, was way Brady. Unresponsive. We ended up coding him, in the chair, but he didn't make it.

We also had a 17 yo that came into the ER as a Trauma 1 that I responded to. He'd fallen off a 3 story roof, is head was split. Everytime we'd do a compression, blood and brain matter would spurt out of his head with each push. He didn't make it.

I also had an MI who was young, in his 50's, and had 2 daughters in their mid 20s. He was inoperable. The docs said they try their best medical management, but jad given less than 6 months. The next night, after being fine all day, he suddenly did the classic AMI in the bed right in front of me. Pale, diaphoretic, cp, sob. But he had the capacity to tell us not to do anything. His daughters agreed. And he passed within 5 mins. 10 mins before this he was eating his dinner, laughing with his family.

And I also had CABG who was high risk, came back to the unit 3 hrs late, open chest, balloon pump. Dumping as fast as we could squeeze the PRBCs in. Looking at her numbers and the bleeding and based on the OR personnel, the Doc had obviously nicked the PA! Yes, I've seen that a few times, and it is the stuff that would put the horror movies to shame.

IHeartDukeCTICU · Aug 28, 2012

Post op AV replacement. PEA arrest, opened up the chest only to find a new ruptured aortic aneurysm/disection. Two words: RED SEA.

KBICU · Aug 28, 2012

Exploding ventricle. Pretty much says it all!

guest239592 · Sep 30, 2012

Where do I start?? Too Many...

This one though has stuck with me for awhile (wasn't my pt thank God) Transferred a pt to our unit at 2300 from small outlier hosp with initial unstable angina, suspect non-ST MI which was relieved by a nitro drip (the hosp had a 24/7 cath lab). Cardiologist wanted to wait to cath the pt till morning because the pt was a diabetic with renal failure (on outpatient dialysis) and had allergies to contrast dye. Plan was to do bicarb drip overnight and load pt with Benadryl before the procedure. The pt was hemodynamically stable with no active symptoms at the time of admission, and we started a heparin gtt upon admission. Through the night the pt became progressively more symptomatic (all the classic signs including now ST elevation in multiple anterior and lateral leads), called the doc 4 times insisting the pt was unstable and needed to be cathed, still didn't want to cath and by change of shift (when docs started rounding) pt was being prepped for emergent cath (duh!!) Well, during shift report the pt of course coded, I responded to the code and initiated compressions, the first compression I did I could feel the pt's entire sternum fracture which spread to the pt's ribcage bilaterally. After we got the pt intubated, copious amounts of blood were coming out of the ET tube (didn't help he was on Heparin overnight) and literally the way we ventilated was RT would give 1 breath and 1 of the nurses would suction. So breath, suction, breath, suction. This went on for over 45 minutes before we finally called it (and the room looked like a murder scene by this point, though not nearly as bad as some of the ruptured aneurysms mentioned above, so are the worst!)

The sadest part of the story was about 10-15 min before the code, the pt called their spouse to let them know everything was ok and to not rush in (about an hour drive for the spouse from where they lived). We couldn't get a hold of them during the code after multiple attempts, by the time the spouse got there the pt had expired (needless to say we had a Chaplin there when we broke the news, heartbreaking...)

turnforthenurse, MSN, NP · Sep 30, 2012

I wasn't the primary nurse of this patient, but I was in charge. The primary RN was asking me for advice for her patient, a 94-yo who had a bad case of pulmonary edema. You could hear how wet the patient sounded just by standing in the doorway. The patient kept having random bursts of v-tach and they were confused. Abdomen was VERY distended. I had a feeling in my gut and this thought crossed my mind - "this patient is going to code by the end of the night." They were a full code, too. We spoke to the hospitalist on call who didn't want an NG tube placed and also didn't want to transfer the patient to ICU because "I don't think they would do much more there than what you are doing here."

I was at the desk and noticed on the monitor that the patient's O2 sat started dropping...80's to 70's, then 60's...I called RT and ran into the room, then the patient stopped breathing, so we started to code them. Feces then started to literally POUR out of the patient's mouth. That patient aspirated, for sure. We flipped the patient on the their side and it was like a waterfall on the side of the bed. We dropped an NG tube and filled up two and a half suction canisters within minutes. That abdomen shrank in size.

That was a very messy code. We were able to get a pulse back and we transferred the patient up to the ICU, but by the end of the night the patient's blood pressure started tanking and they coded the patient again right before shift change. The patient didn't make it that time.