My patient coded the other night

[jenrninmi]

Right in front of my eyes. Thank goodness I had my charge nurse there and a tech. I don't know if I would have realized he was going downhill so fast. The other nurse knew that the RAP team need to be called, then maybe two minutes after the RAP team got in the room I called a code. Once the patient was stabilized he was transferred to the unit. I believe he will be fine.

Some of my patients are so sick from the time I get them from another nurse. Their vitals can be poor even from the time I get them. Looking back through the day, they look the same. Experienced nurses say it will come with time, that you can just tell by looking at them with experience.

Any tips from experienced nurse how you "just know"?

[Daytonite, BSN, RN]

Did it work? :rotfl:

A lot of times, it did!

[Kristen_RN]

Well, I'm an ER nurse, and I've never heard of calling a code with the vitals that you've mentioned. How did the patient turn out?

I had a code experience on my 9th week of training, with a pt who had been having severe dyspnea on exertion, and PE had been ruled out. I had this pt for two days before she coded and she was able to tend to her own needs well, was A&O, and sat in bed knitting. As each test came back negative she would become more bewildered about her state of ill health. She told me several times that she just wished someone could tell her what was wrong.

She had a port-a-cath that was suspected of being the cause of her misery, as it turned out that part of it had an occlusion (we were unable to access the device).

When I came in on the third day, the night nurse told me and my preceptor that the pt had been confused and having trouble talking,saying the wrong words or things that didn't make sense.

When we first saw her that morning she was sleeping and snoring heavily; she had hx of sleep apnea. When we tried to wake her up to check her status, she did not respond to verbal or pain. She had a resp rate of about 28. As my preceptor and I were trying to figure out what to do next, the resource nurse came in the room and started screaming to call a code. I was surprised at the time because I am a trained EMT, and I had never seen a code from this end before (the circling the drain part, usually the pts have already gone down the drain by the time we got there).

So there I am in the room, which is beginning to rapidly fill up with people. I took a BP which was 120/72 with pulse in the 60's. People were asking ME all about the pt, since I was the most familliar with her. So here I am, new grad, with my pathetic scrap of pt notes and my poor overwhelmed brain, trying to remember what her test results were. Someone behind me was commenting on the fact the the pt had an actual BP, and the resource nurse was arguing with the Dr. running the ambu bag about why wasn't the pt going to be tubed in the room. (Doc wouldn't tube pt because we had to go to CCU in the elevator)

Now my question is: Is it customary to call a code on someone who's still breathing and still has a BP?

Rebecca:confused:

[Fairemaid]

Well, I'm an ER nurse, and I've never heard of calling a code with the vitals that you've mentioned. How did the patient turn out?

I don't know how the pt turned out, at least by the end of the shift, she had not regained consciousness.

Rebecca

[papawjohn]

Hey Y'all

This thread has obvious degenerated to the point where I feel comfortable.

When I started I chose Tele/StepDown cause I wanted to learn rhythms and meds and (what today we'd call) ACLS before I started in ICU/CCU--where I knew destiny lead me.

Had this Pt who was obviously not doing good. He got worse and worse. I was rushing back and forth from the NursesStation (where the monitors were) to his room (checking VitalSigns) and couldn't figure out what was going on. I'd been an RN about 4 or 5 months, I reckon.

Finally he says "John, I need to take a s**t." I dashed out and came back with a BSCommode because altho he'd had BRPrivileges, it was obvious he wasn't going to make it to the toilet.

I got him up to the side of the bed and he seemed OK. Hooked my elbows under his arms and lifted him toward the BSC. DAMN if he didn't have a seizure in my arms---eyes rolled back in his head, rhythmic convulsions....and had a huge diarrhea stool ALL OVER THE FLOOR.

I tossed him back into his bed, established un-responsiveness, and HOLLERED OUT: CALL A CODE!!! And (in those benigted pre-AIDs years) started mouth to mouth and CPR.

Next thing I knew the charge nurse (a very beautiful and perfectly coiffed black girl) came running full tilt into the room and slipped and fell into the diarrhea! She was followed by the whole CODE TEAM who, one by one, skidded into the room.

I don't remember what happened to my poor pt after all these years. But the sight of the Cardiology Resident laying on the floor, surrounded by liquid stool, calling out "has he had any BICARB yet?" has always stayed with me.

Jimmy Buffett says: We do for the stories we can tell....

Papaw John