"Code blue" = deer in the headlights!

  1. I am a former poster to this site but I've gone so long between posts that I've had to change my user name a couple of times! (formerly known as Waggy).

    I love this site but don't get to spend much time here but today, I have to post!

    I've been an RN for seven years. To accomodate my young family, I've mostly worked part-time/PRN in rehab and urgent care. A year ago, I decided to try an acute Med/Surg floor to regain my rapidly disappearing skills! I have three small children so I work two 12hr shifts a week. My mind hasn't stopped spinning since starting my job!

    My last two shifts, I took care of an elderly lady being treated for a UTI w/syncopal episode x1 at home. Hx of CABG, stents , on tele, SR, occ SB in high 50's, asymptomatic, etc. PO abx and IVF . No problems the first shift. The next day, I thought something's going to happen with her today. !!!!!

    Midmorning, she converted to a bundle branch block. No change in her condition. BTW, she's full code! The doc orders an EKG. Shortly afterward, tele asked me to check her leads since they seemed to see "asystole". I booked it to her room. She's fine, leads in place, her monitor shows SR w/ BBB.

    Tele comes up with a strip showing two nine-second runs of non-conducted P waves. Yikes! Just as I'm paging the doc, my PCT comes running saying she was in asystole. (deer alert!)

    I find her glassy-eyed and "0" heart rate on her tele. I immediately pulled the code button and basically freaked! I didn't manually check for a pulse or see if she was breathing! I just noted her changed appearance and the monitor. Just as everyone came in the room, she came out of it and her rate went up to the 60's. I basically couldn't remember my name at that point but I was able to give some hx on her. Plus, the house docs taking care of her were there.

    Yet I felt so stupid! Was calling a code necessary? At first it seemed indicated, but she came out of it so fast. I didn't think about oxygen-she'd been RA but, of course she would need 02! Another nurse kindly put it on for me.

    She seemed OK at that point but we got her ready to transfer to CCU. The doc asked us to place pacer/defib pads on while waiting for an available bed. I finally got my wits about me, implemented the other orders while the charge put the pads on her. I was hanging her LR and the charge was explaining the pads and her heart stopped again!

    Amazingly, this time I was very calm! The charge pulled the button and the whole team came in again. Within ten seconds, she came back without intervention! We immediately put her on the transport monitor and got her to the CCU where, by last report, she was stable with pending cardio involvement!

    After the first event, I berated myself for what I thought might be overreacting and panicking. Although I consider myself a pretty good nurse, this level of acuity is new to me and I feel like a new grad again without the benefit of the recent education!

    Yet now that it's happened, I think I'll be more confident and focused now that I have a frame of reference to this particular situation.

    What are your experiences/suggestions?

    Thanks for listening!
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  2. 10 Comments

  3. by   matchstickxx
    You did do the right thing by activating a code team immediately. As you said, the rest will come with experience. Have you taken ACLS? If you have the opportunity, I highly recommend it. Any "code" education is beneficial, especially if you work in an area where you don't see too many codes.
  4. by   AlisonBSN
    Wow...I was feeling the embarrassment with you there for a minute, but then it happened again and I was relieved. I'm not a nurse yet (waiting to take boards) and I could see something like that happening to me. It sucks for the lady, but I'm sure you were relieved when it happened again in front of someone else.

    I called a code once while working as a tech on a MedSurg floor. This one patient needed 2 units of blood...so he was a little weak, but I didn't know that at the time. He asked to get up to the bathroom, so I walked him to the bathroom and sat him on the toilet. Well...as soon as he hit the toilet he slumped over to the right and went face down in the bathtub with a big CLUNK. I didn't watch him fall, so I wasn't sure if he went out before he fell, or if he just fell and then knocked himself out on the hard bathtub, but either way he wasn't responding to my frantic screaming at him and shaking him (Hey, I'm new.)

    I ran out in the hall and yelled up to the desk for somebody to come, but nobody did even though there was a whole group of LPN students standing up there with their instructor. So in a panic I pulled the code switch. He was fine. They drug him to the bed and the first thing out of his mouth was asking if they could find the remote for him. Of course I was crying and shaking like a leaf...completely not functioning. I couldn't even see for all the tears welling up in my eyes. Later on they told me that I did the right thing because he probably passed out from anemia.

    They still pick on me about it...because when they ran in I was screaming WAKE UP, MR. So and so, WAKE UP! :chuckle
  5. by   SCRN1
    I think you did the right thing too in calling the code. Think of it this way...what if she hadn't come out of it? You never know when or if someone will convert on their own.
  6. by   chadash
    I am not a nurse, but, I would conjecture that failing to call a code would be far worse than calling one by mistake. See it as a learning experience and a great drill for the staff!
    And as far as Drs seeing you as an idiot, that is no thing!
  7. by   SharonH, RN
    Quote from chadash
    I am not a nurse, but, I would conjecture that failing to call a code would be far worse than calling one by mistake. See it as a learning experience and a great drill for the staff!
    And as far as Drs seeing you as an idiot, that is no thing!

    You're not a nurse yet but you're 100% right! I don't know why the OP is so embarassed. It doesn't matter that she came out of it, she needed intervention and it is better to implement it before the asystole "sticks". You did the right thing...both times.
  8. by   Momto3RN
    You guys are awesome! Thanks for your words of support. It's always nice to have a sounding board!

    ACLS is next on my cert list! I just recently finished Tele so I'm a little more comfortable.

    I wasn't so much embarrassed as I was frustrated at my inability to think! I know it's a normal reaction but I've always been a tad neurotic!!:chuckle

    AlisonBSN, I totally appreciated your story! And, honestly, though I regret my pt having multiple asystole episodes, if it had to happen again, I'm glad I wasn't alone!

    I love my job though nursing has given me the tendency to second-guess myself more than I should! Yet I finished that shift a better nurse than when I started!!

    You guys rock!
  9. by   RNperdiem
    I can relate to how you feel. I have not been the nurse I once was when I left full time nursing for per diem. Speed and fluency in skills get lost when you don't use them as much.
    Hope some more time in med surg, will help boost your confidence.
    You did the right thing by calling the code; there is nothing you could have done to help you patient more than to get the help she needed.
  10. by   chuck1234
    Quote from Momto3RN
    I am a former poster to this site but I've gone so long between posts that I've had to change my user name a couple of times! (formerly known as Waggy).

    I love this site but don't get to spend much time here but today, I have to post!

    I've been an RN for seven years. To accomodate my young family, I've mostly worked part-time/PRN in rehab and urgent care. A year ago, I decided to try an acute Med/Surg floor to regain my rapidly disappearing skills! I have three small children so I work two 12hr shifts a week. My mind hasn't stopped spinning since starting my job!

    My last two shifts, I took care of an elderly lady being treated for a UTI w/syncopal episode x1 at home. Hx of CABG, stents , on tele, SR, occ SB in high 50's, asymptomatic, etc. PO abx and IVF . No problems the first shift. The next day, I thought something's going to happen with her today. !!!!!

    Midmorning, she converted to a bundle branch block. No change in her condition. BTW, she's full code! The doc orders an EKG. Shortly afterward, tele asked me to check her leads since they seemed to see "asystole". I booked it to her room. She's fine, leads in place, her monitor shows SR w/ BBB.

    Tele comes up with a strip showing two nine-second runs of non-conducted P waves. Yikes! Just as I'm paging the doc, my PCT comes running saying she was in asystole. (deer alert!)

    I find her glassy-eyed and "0" heart rate on her tele. I immediately pulled the code button and basically freaked! I didn't manually check for a pulse or see if she was breathing! I just noted her changed appearance and the monitor. Just as everyone came in the room, she came out of it and her rate went up to the 60's. I basically couldn't remember my name at that point but I was able to give some hx on her. Plus, the house docs taking care of her were there.

    Yet I felt so stupid! Was calling a code necessary? At first it seemed indicated, but she came out of it so fast. I didn't think about oxygen-she'd been RA but, of course she would need 02! Another nurse kindly put it on for me.

    She seemed OK at that point but we got her ready to transfer to CCU. The doc asked us to place pacer/defib pads on while waiting for an available bed. I finally got my wits about me, implemented the other orders while the charge put the pads on her. I was hanging her LR and the charge was explaining the pads and her heart stopped again!

    Amazingly, this time I was very calm! The charge pulled the button and the whole team came in again. Within ten seconds, she came back without intervention! We immediately put her on the transport monitor and got her to the CCU where, by last report, she was stable with pending cardio involvement!

    After the first event, I berated myself for what I thought might be overreacting and panicking. Although I consider myself a pretty good nurse, this level of acuity is new to me and I feel like a new grad again without the benefit of the recent education!

    Yet now that it's happened, I think I'll be more confident and focused now that I have a frame of reference to this particular situation.

    What are your experiences/suggestions?

    Thanks for listening!
    Very interesting!!!
    But I hate "Code Blue"
    It drives me "crazy!!!"
  11. by   MelRN13
    You absolutely did the right thing! Great job!
  12. by   chuck1234
    By the way, I forgot to let you know that you did the right thing...don't worry about what other people say.....
    Good luck!!!!

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