My first pediatric code...still shaken

  1. 0
    I am a brand new ER nurse, fresh out of nursing school and still in training. Last night an ambulance brought in a 6 month old with a croupy cough. Medics said the kid looked good, had a mild cough, but was non-labored. I saw him briefly before I registered him into the computer and he looked okay. Sating 100% on simple oxy mask, good color, etc. Then about 3 mins later, the tech who was getting his vitals screamed at me to call the RT. When I ran in there, the kid was blue and retracting. We got the whole team in there, established IO's, IV's, at attempted intubation. After multiple unsuccessful intubation attempts we kept him at a high flow oxygen mask and he was later trached in the OR and transferred to a pediatric hospital.
    This was my first pediatric code and it was very scary. I still feel nauseated thinking about it. Kids can turn so quickly. Does anyone have any advice on dealing with pediatric codes?
  2. 8 Comments so far...

  3. 1
    Sounds like you had a rough go of it last night. I'm sorry to hear that.

    Pediatric codes are particularly difficult to reconcile As you stated in your post, when they turn, they do so frighteningly quickly. Some of that has to do with the whole lack of reserve they have so when they finally tire, it's an instantaneous downturn.

    I don't know if it's ever possible for them to become easier as they are always high intensity for all parties involved--it's a kidlet, after all, but it is possible to become more comfortable with them as your experience grows. Which leads me to my next question: was this your first code in a general manner of speaking? If so, then it carries a deeper significance. As many on this site have stated, you never forget your first code. And you definitely never forget your first peds code.

    As you go along, you will develop that sixth sense ability to be able to sniff out the ones that are going to decline on you. Sometimes all you can do is the best you can in the moment you are in. No more, no less. And it sounds to me like you did all you could.

    I wish I had something better and more clever to say, but alas, not this time.

    Kindest regards,

    ~~CP~~
    Last edit by CheesePotato on Dec 8, '12
    JeanettePNP likes this.
  4. 1
    Welcome to AN! The largest online nursing community!

    Pedi codes stink......no matter what you will always have the pit in the bottom of your stomach and in your minds eye you are thinking "Oh!Crap!, Oh!Crap, Oh!Crap!" Experience will help you gain confidence in dealing with these situations.

    Several things come to mind about this baby. Did it need O2 to maintain an O2 sat? As a part of my assessment when the baby arrives I would see what the baby did without O2. That would be a good indicator if this baby is in real trouble....you take the O2 off and the sat drops. If the sat dropped I would do the vitals myself and get the EDMD ASAP.

    Babies airways are made differently....simply put they are made to breathe and eat. When we breath and eat it's called choking. When an infant has 1mm of swelling on a 3mm airway there isn't much airway left...there is no room for any more swelling. That is the thing with the little ones they look great until they don't. It's always traumatic. https://apps.acep.org/WorkArea/Downl....aspx?id=42276

    I don't think anything could have been done different. This baby was ready to go down the drain.

    It sounds like you kept your head. The baby got out to a tertiary center who probably would have had to trache the baby as well. What I think will help you feel better and if you don't already have it.....take ENPC ENPC - Emergency Nursing Pediatric Course

    it's always hard ....good Job!!!!
    canoehead likes this.
  5. 0
    Being a pediatric ER nurse I feel that it truly never gets "easy", but you will slowly heal. I think to myself after a code that I was there to help, I was someone who cared and did my best to help that child during that emergency. And in case of a demise, I found it to be more helpful if I went to the parents and showed them I cared, either by a caring hug or making sure I was there for consult if needed. Take a deep breath :-). This to will pass...

    AeronurseNJ
  6. 1
    If a patient was on a o2 mask when they came in, they need to md promptly assuming that ems provides a valid reason for putting them on it (and its not just something they do to everyone). Kids often code from their lungs. Further, they have a long reserve but their reserve drops out without warning. Lesson learned. My advice about pedi code is that you forget it was a pedi. It was a patient and kids have every right to be sick as all get out too. I think aero is right: it gets easier.
    hiddencatRN likes this.
  7. 2
    I haven't any words of encouragement for you that peds codes will get easier because they just don't no matter how many of them you do and this is coming from a pediatric flight nurse. My suggestion to you to help make them feel less chaotic is to familiarize yourself with the location and types of pediatric emergency equipment available in your ED. Look at the Broselow tape and learn how to use it. Make yourself a cheat sheet with normal pediatric vital signs. Have the RT's show you how to bag an infant and pediatric patient. When a sick kid comes in even if it isn't yours ask to assist the other nurse. Definitely take the ENPC course. Learn what to look for when assessing a peds patient that could clue you in to impending disaster. I'm also not sure what your facility's policy is but any child,especially under a year, who comes in with a chief complaint of respiratory distress should be immediately evaluated by a physician. Even if the child appears stable. Also, just an FYI for your learning. If you are dealing with an airway issue and you can maintain adequate oxygenation/ventilation with a bag and a mask sometimes that is the prudent way to go rather than monkeying with the airway and making things worse. However, in the heat of the moment sometimes you just act on instinct and do the best you can. The staff involved may need a de-briefing to allow all of you to process your emotions in a healthy way. Good luck in your journey!
    lindarn and AND7RN like this.
  8. 0
    Just like the other nurses have said, kids can turn quickly. Good rule of thumb is when you know a pediatric is coming in resp, go ahead and call RT for backup. It gets better! Hang in there!
  9. 0
    My first pedi code was about 1.5 years ago, I've only been a nurse for right at 3 years; anyway, when I think back I still get teary eyed about it. Someone mentioned looking at the Braslow tape and familiarizing yourself with it - very good advice! You'd be surprised how many don't know how to use it. Good luck and take care!
  10. 3
    I have been an ER nurse for 13 years..I can remember EVERY pedi code, I will share some advice a medic shared with me.. After cracking all 3,pedi codes we pronounced..my son at the time was the age of the baby..I was an emotional wreck...a couple hours later I took a break and started tocry again..and a seasoned.medic said What's wrong Jonesy?? I recited everything including the fact that I cried in front of the family and how embarrassed I was..My medic friend gave me a hug and said Don't be afraid to cry in front of or with your pts.. it let's them know.that on top of all that head smarts, you treated their family from the heart!! I have passed that advice on many a night,especially in the pit where we are known for.being tuff as nails.
    It's okay to still.look back and cry kid, that makes you human and humane!!!
    wrwtex, canoehead, and lindarn like this.


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