What would you do?
- 0Jul 17, '13 by tnelso150I'm a still very new nurse (just over one year) and have been working in a CTSICU for a little over half of my short nursing career. I like asking hypothetical questions that could very easily happen and one just occurred to me...it might be a really weird/stupid one or maybe has been asked already, but what would you do if your patient coded in a chair? Our surgeons like the patients up and sitting in an arm chair we keep in the room by POD1...so what would I do if my patient suddenly threw a PE or just went into v-tach or something? My initial reaction would be to pull them onto the floor (probably ripping out art lines/PA catheters in the process) to start CPR immediately. But have also thought that maybe it would be best to scream for help and wait for someone to come help me pull them to bed. The problem is a lot of these patients are big people (as you probably all already have experienced) and sometimes it can take a good three to four nurses to even help them stand up, let alone pick them up and move them somewhere...so my question for you: what would you do?
Thanks for responding!
- 2Jul 18, '13 by lisajtrnHave had patients code in chairs, on the toilet is a great one, on stretchers, in hallways far from their room, stuck between the bedside table and the bed in the corner of the room feet sticking up in the air. So many places. Get them to the floor or into the bed whichever is easier and faster.
- 0Jul 18, '13 by BiffbradfordYour best options are if you've got them in a recliner, just flip up their feet, slam the head down, push the code button, and away we go. Unfortunately, there are usually only so many recliners available, so if they are in a straight backed chair, and go into a tachyarrhythmia and are still awake, then have them cough. Not sure if this is still legit, but we've done precordial chest thumps in the past (slam your open hand into their chest). "HEY!!" I had one guy stroke while he was brushing his teeth in a straight backed chair. It was 'brush brush brush' - eyes rolled back, lights out. Pushed the code button and when helped arrived we each took an arm or leg and just picked him up putting him back to bed.
The 'right' way, I guess, is get them to the floor, and use a back board to lift them back to bed, and continue the code. I guess that's probably my 'official' answer.
- 6Jul 24, '13 by CountyRatGood comments above, here are mine for what they are worth.
Don’t “scream for help.” Yeah, I know, I’m being picky about words, but seriously, in in any emergency, you have to minimize your own stress response. How do you do that? Good question; glad you asked. You do that by acting calm even though you do not feel calm. Take a deep breath (yes, you DO have time, as discussed below) and call for help in a clear, slow, controlled voice. You will be faking it, but that does not matter. Behave as though you were calm, and your behavior will change your emotion; which works better and faster than trying to control your emotions directly. Really, this works.
I agree with moving the patient to the floor if transfer to bed is difficult or time consuming. You do not know, initially, what is causing the crisis, so the safest thing is to supinate the patient because it facilitates circulation. Since lowering a heavy patient is easier and faster than lifting that patient, I go for the floor. Better to use gravity than to fight it, whenever you can.
You might be able to save those IV, arterial, and pulmonary lines if you can put the equipment or pressure bags that they are running on the floor too, but that depends on what kind of equipment is in use. If you carry a couple of straight Kelly clamps (which I suggest) you can clamp them, disconnect them and position the patient. Yes, I know, that is dangerous, both in terms of sepsis and clotting, however, losing access in a crisis is also dangerous, and, once the patient is back in bed, you may be able to use them (and, trust me, you will probably need every line you have). It is a risk/benefit decision that you just have to make on the fly.
MOST IMPORTANT OF ALL: Do not allow yourself to get frantic by trying to do everything at once. Do not become agitated because it is taking what feels like a long time to position the patient. Your sense of time will be distorted. Again, ignore your feelings, concentrate on doing the one, next, necessary thing, and do not try to rush. Bottom line: if the patient dies in the 10 – 20 seconds it takes for you keep things under control, you could not have saved that patient anyway. I am sorry for how harsh that sounds, but it is true. If you try to manage everything at once, you will quickly loose control of everything. Taking it one thing at a time gives your patient the best chance possible.
- 0Jul 24, '13 by FranEMTnurseTake it from a former CPR instructor. Always remember, A B C…after getting the patient onto a solid surface. It is needed to properly compress the heart.
My brother was in a nursing home where nobody told the staff, and neither did the staff nor the physician in charge check his medical history, so although he had an implanted pacemaker equipped with a defibrillator, he was sitting in a wheelchair in front of the nurses station when he suddenly slumped forward in his chair. EMS was called, but when they arrived he was already dead.
- 1Jul 25, '13 by hodgieRNJust as a note. It's no longer ABC, it's CAB now (according to new ACLS guidelines). Compressions first. The longer you put off compressions, the higher the mortality rate. If there is a code, you hit the code button and immediately start compressions. Jump on the chest.
If you are first on scene and you start bagging, it's redundant because oxygen isn't being carried anywhere. Oxygen reserves do not drop to zero once the heart stops. Sure, it's 40% but not zero, so you establish circulation first.
If they are in a chair, lay the head down and immediately start compressions. Once there is enough staff, then you can move them to the floor or the bed. Put a CPR board underneath them and you are good. The quicker you start compressions, the better chance they have. It's pump, pump, pump.
A nurse who starts bagging a pt while waiting for someone to start compressions is not following proper guidelines. You always hit the code button and jump on the chest.