[Morettia2]

Originally Posted by ICUCoOLWaTER

Hi am really speechless i do not know what to say to u but God bless u me i know what was the patient diagnosis was he going down or it was sudden heart attack lead to Cardiac Arrest? and were u thinking of DNR protocol that time Ethically. thanks

the pt. was s/p ICD lead revision or ICD replacement...I can't get the right ans. b/c I have heard 4 different things. But from all the info I gathered over the last few weeks, the original ICD the pt had for th last few years was one of the Medtronic ICD's ( I think that's the brand but don't quote me on that) that had the recall due to the leads fracturing and breaking off...I have had a great number of pt's that have had recall ICD, or just the leads replaced, in fact during my first week of orientation I had a pt. with a Medtronic ICD that the leads literally came right through the Left pectorial area and were exposed, and that was one of many pt's since I started on my floor 9 months ago. But the patient that you are asking about, the ICD replacement was done on Friday, since it was done on friday the pt. had to stay the weekend b/c the cath lab is closed on the weekends, and the ICD check was to be done monday. During the week if the pt. had the ICD insertion on say, a monday, it would be check the very next day on tuesday...back to the main point, it was a Saturday night that the pt. coded, so you know what that means..weekends+code blue+low staffing of MD's and nurses=disaster. That's why the EPS MD, as soon as he was notified, was driving a 110mph on the Highway to get to the hospital, b/c he knew it was a weekend and the only MD's on the code team are tele residents that are eager to learn which is good, some surgical residents (like 1 or 2 MD's), 1 cardiac fellow, maybe 2 respiratory therapists and the house MD(who is covering about 100 doctors and is the only House MD for the entire Hospital, you would think that in this century that there would be a better system at night), oh YEA and us NURSES. One nurse to do the code count and write down all the meds ,shocks, people, times, you know acls protocol, one nurse to draw up all the meds, and get the items out of the crash cart b/c the MD's just rip the drawers open and toss **** all over(which was me )and I also had the awesome duty of this, "Nurse Charge the paddels, nurse press Sync, nurse I left my cell phone in the car can I use yours" We had another nurse who was running all over the unit doing god knows what, and one nurse from day shift that stayed 4 hours OT just to enter orders and be a runner for what ever we needed. As I stated before in the original post, I was not the nurse assigned to this pt. that night but as a team during a code you are the only nurses for that pt at that time.. but any way, so I had no idea of the pt. Hx untill after the EPS MD showed up, I looked through the chart for the H&P before the EPS MD showed up, but the H&P was written in jibberish. All I know is when I heard the pt. mutter those words My chest...., and I looked up at the bedside monitor and saw the HR was 280 and in that rhythym you never want to see, and with in 0.5 seconds the pt. turned blue and the pt's back began to arch up from the bed..I knew it was going to be a long night, screamed call a code. I grabbed the bed side clip board and looked for the care map every pt. has (it's a nurses H&P and what not) and it was missing, GREAT..nothing to tell the code team, and it was right after shift change so..usually if a pt. is on my floor they have an extensive cardiac Hx. I can't tell you what triggered the v-tach, it could have been a number of things, K+, Mg, MI, EPS MD told me that the pt. had a code like this in another hospital some time ago, so PMHx, but I have my theories about what happened and and I am going to keep it to my self for reasons.
But did I look for a DNR, YES I DID...our patient data bases that are on the bedside clipboard, which is our nursing admission, the first question is, "DO you have an advanced directive?" Most of my pt's have no idea what this means so I always follow up with "A DNR, Living will, something along those lines" and then the light bulb goes off and the pt. usually says yes or no. I ALWAYS ASK IF THEY ARE DNR....It is something that is very important to me b/c of personal family experience. But I can tell you that the family of this pt. actually came bck to our unit a week ago, and at night b/c they knew the night shift were the ones who ran the code, and brought homemade macroons, and italian cookies and thanked all of us, even gave us a card adressed to the "Angels of the Night"..The nurse whose pt. it was and I wnet up to the CCU last week to visit the pt and the the pt. is doing great, has some deficiets, but It felt good to see that pt. is alive and talking....

[MEME123]

SWEET
Again great job, happy ending.

[anurseuk]

Sounds like it's all fun on your ward!

Unfortunatly it seems to happen like that; it'll be (quiet) for a few weeks and then on my unit (cardiothoracic critical care) we'll have 2 simultanious open chest on the unit where pt's have tamponaded post cardiac surgery. But then at the end of the day we're nurses and we have a sick way of enjoying these situations!! am i alone?

What's a blue code? I get lost in your language a bit sometimes living and working in the UK. We have a US sister on our unit so I know a code is a cardiac arrest. Do you have different colour codes?

Well done though; seems like you are a born nurse. Have you thought about critical care?

[Morettia2]

Originally Posted by abirobs

Sounds like it's all fun on your ward!

Unfortunatly it seems to happen like that; it'll be (quiet) for a few weeks and then on my unit (cardiothoracic critical care) we'll have 2 simultanious open chest on the unit where pt's have tamponaded post cardiac surgery. But then at the end of the day we're nurses and we have a sick way of enjoying these situations!! am i alone?

What's a blue code? I get lost in your language a bit sometimes living and working in the UK. We have a US sister on our unit so I know a code is a cardiac arrest. Do you have different colour codes?

Well done though; seems like you are a born nurse. Have you thought about critical care?

Code blue at my hosp and I think it is a national thing in the USA is a medical emergency..my hospital also had the rapid resonse system that is a pre-curser for a code...the RRT is called if you think that you may need help and want a team to eval. the pt. but latley it's been more codes and RRT's then ever. In fact I have had 2 in the last 2 night both my pts. I have an interview next week in the ICU..I hope I get the jjob!

[anurseuk]

Originally Posted by Morettia2

Code blue at my hosp and I think it is a national thing in the USA is a medical emergency..my hospital also had the rapid resonse system that is a pre-curser for a code...the RRT is called if you think that you may need help and want a team to eval. the pt. but latley it's been more codes and RRT's then ever. In fact I have had 2 in the last 2 night both my pts. I have an interview next week in the ICU..I hope I get the jjob!

Good luck for that; I couldn't work in any other department now. I think you'd really enjoy ICU

[lorilou22RN]

I have a question, Perhaps I didn't absorb it from your post but after 4-5 hours of this, and subsequent acidosis etc, did he even have a myocardium left? What about his cognitive status, was there any anoxic brain injury? Would love an update regarding his current condition, cause it seems to me that God was trying to call him home!

[Morettia2]

Originally Posted by lorilou22RN

I have a question, Perhaps I didn't absorb it from your post but after 4-5 hours of this, and subsequent acidosis etc, did he even have a myocardium left? What about his cognitive status, was there any anoxic brain injury? Would love an update regarding his current condition, cause it seems to me that God was trying to call him home!

I have only seen the pt. one day that I went up to the CCU to visit. I am asuming that there is some injury b/c of the long standing acidosis and all the durgs that were pushed into this pt. I heard the pt. follows simple commands, and will need extensice cardiac rehab. And I do oagree that God was trying to call him home.

[CVICURN2003]

Originally Posted by Morettia2

Code blue at my hosp and I think it is a national thing in the USA is a medical emergency..my hospital also had the rapid resonse system that is a pre-curser for a code...the RRT is called if you think that you may need help and want a team to eval. the pt. but latley it's been more codes and RRT's then ever. In fact I have had 2 in the last 2 night both my pts. I have an interview next week in the ICU..I hope I get the jjob!

At a **large superstore** they called a "Code Blue" overhead. Ofcourse the ICU nurse in me went on alert (habit)...and waited. I have heard them call a medical emergency at this store and they asked overhead for a CPR certified person to come to a certain area of the store. Turns out...code blue is to go get the shopping carts in the parking lot

I don't know if it is a national standard or not...but for any medical professional it is enough to make our adrenline get going, even when you are grocery shopping. You would have thought SOMEONE in their upper management would have at least watched enough incorrect ER shows to know that Code Blue is medically related.

[cdktRN]

acls now says on biphasics to shock at 200 not 360 that was for the old monophasic...you might make sure which machine you have in your unit just to make sure...

[Morettia2]

ok HERE I GO AGAIN...so at 0615 this morning I was just checking on all of my pt.s when one of the nurses screams my name to come help, she found her pt. unresponsive with little to no pulse, and not breathing. I had this pt. previously this past weekend, so I knew the pt. and pt. only spoke spanish, which I speak a little. The pt's a screamer b/c pt's in a private romm b/c of MRSA and is lonely so when I didn;t hear the pt. screaming I knew something was VERY wrong. And just to note I am no longer the new girl on my floor( I have 9months) we got a new orientee thay just graduated in december to nights shift, it was her first code she was like a deer in headlights, that was me a few months ago. Anyway I ran picked up the phone called the code and jumped over the nurses staion and into the room and jumped on top of the pt. who was morbidly obese and began compressions It was probably the worst possible person you could do compressioins on. Thank god there happened to be a respirstory therapist on the floor and it just so happened when we called the code the Head cardiologist was just walking onto the floor to make his rounds. He ran the code, the pt. hooked up to the defib. pulse of 15, pt.s completley edematous, like anascarca, atropine, epi, bicarb, the nurse taking care of the pt. had not seen the pt. at all, all night. I had stopped in the pt's room around 0400 to say hi b/c I had the pt 3 nights in a row and knew the pt., pt. smiled at me grabbed my hand and said alot of info in spanish I caught..Pain..pain..asked the pt to point to the pain, it was in the leg,so I had told the nurse, she didn't do a da** thing, she went back to charting and said to me, "oh pt's fine" I said no pt is not fine pt. in alot of pain, told my charge nurse which is not like me but I had that GUT feeling that something was wrong 2 and a half hours before the code..pt. is s/p fem bypass surgery and s/p Left foot amputation, and pt. probably has CHF, and now b/c of the neglect all night b/c the nurse didn;t check on the pt.probably has a PE and is intubated and I hope to god the pt. makes it through the day. So back to the code, I have the ER cart memorized now so I was the ONLY one who knew where everything was, so at this point the craziness calms a little bit people begin leaving the room b/c it's shift change and it's only me and the respiratory therapist at this point where's the pt's nurse I have no IDEA, I got a pressure it was 140/45..wide ..but bettter than before..ok not more then 2 minutes later I get another pressure it's 60/30, I begin screaming for everyone to get back into the room and not to leave untill the situation is undercontroll, the one MD asks for dopamine drip..and I must have titrated it like 10 times b/c the pt's pressure was going up and down And the nurse walks back into the room ,I said "what was the pt's blood sugar this monring", she says to me, "well last night it was 70 so I just gave a skim milk.I didn;t check t this morning." I was ready to scream..I get the sugar it's 80 so I pushed D50, we try to do a 12 lead EKG can't get a reading but on the bedside monitor and on the defib monitor it looks like peaked t waves, I tell the cardiologist, labs still arn;t back yet, couldn't get an ABG to save our lives b/c of the edema. So we didn't know what the K+ was, sidenote pt. had high K+ of 6 this weekend when I was the nurse, I gave kayexelate and it came down to 4.Anyway FINALLY the BP stablizes. The family is there at this point. The respiratory therapist and the Cardiologist said to me, "You are the only nurse that knew anything about this pt. and you are only one of a few the nurses that can run a d*** code on this floor the right way". I said "can I get that in writing cause I am one of 6 canidates for an ICU job here at this hospital", they said to me "I would be glad to stand by your side during a code anyday"..I hope that the pt. gets the care the pt. deserves..It made me so mad that the nurse just ignored the pt. b/c never rechecked the blood sugar and ws no where to be found during the code. This is a nurse with 20+years experience. I now know I have the ability to run a code the way it shsould be done. I don;t know if it's just my presonality but anytime something goes wrong the first person they as for help is me. That is encouraging b/c The last few weeks have been that point where I am over my first 8 months of nursing..I think this morning it just clicked and I know I want to either tranfer to the ED or the ICU, pray that I get the ICU job!!!!