4 hour code blue

Nurses General Nursing

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Specializes in CTICU, Interventional Cardiology, CCU.

I work on Interventional Cardiology/Cardiac Step down. I just got home from one of the worst nights any Nurse or MD has ever had.. I work at an inner city hospital that is one of the top cardiac hospitals in the US. Pt. was talking to me and another nurse when pt. said chest felt heavy and pt turned blue and stopped breathing, I looked at the monitor the HR went to 280 v-tach, pt's ICD was firing out of controll, then pt. went into pulseless V-tach then full out cardiac arrest pt's only 57 y.o.. we shocked the Pt. 50+ times over 4 hours , CPR cracked a bunch of ribs, ambu bag and this went on for 4 hours..pt. went in and out of pulseless v-tach. Respiratory Acidosis, we pushed so much NaHCO3 that we ran out of it from the code cart med tray which we had 2 of them and the pyxis supply.Who evver invented ACLS is my hero .Interventional MD put a Aortic Baloon in at the bedside..we used 2 code med trays we pused more drugs into that pt. than any MD said they ever had, drips galore, 3 pumps with 3 channels per pump..that's 9 drips I think, TLC placed in groin after 10 attempts, ABG's x's I don't even know how many,tubed the pt only for the pt. to start foaming at the mouth, then vent at the bedside..CCU had no open beds, the EPS MD was caled 30 min. into the code he was at home, he said he was doing 110 MPH on the garden state inorder to get to the hospital. one MD wanted to call TOD 30 min. into the code..we said no, then they realized that they had only been shocking the pt at 200 joules b/c I looked at the defib. machine and said Hey we might wanna shock him at 360 joules, :banghead:((ya think))..this all started at 8:30 pm. Great way to start my shift. We finished the code at 1:30 AM!!!! We cracked 3 ribs, MD's burnt the crap out of the pt's chest from the defib. paddels. cath lab on call was activated..Pt went to CCU, 25 min after pt was in CCU he was AAOx3..still tubed in Normal Sinus...I was happy that we didn't let the one MD call TOD..the family hugged all of us and said they are going to write a letter to the hospital and say how we saved the pt's life and didn;t give up when the one MD wanted to call TOD..the family asked for my name and said that if it wasn't for me pushing the fact that the pt had only been coded for 30 min. and we weren;t going to give up untill the EPS MD arrived and we were going to do every thign we could for the pt., the family said that the pt. had gone through this before at another hospital..that actually felt good that the family said we saved his life. But 30 min after our code was over there were 3 more codes in the ICU...the EPS MD said that was the longest code he ever had in his 20+ years of medicine and thanked all of us..he asked if it was my first mega code..I have been in codes before but nothing like this..he gave me a hug and said I can't even tell you how greatful I am that you didn't let the code team give up on this pt, and that you opened your mouth and wouldn't give up, he asked how long I have been a nurse, I said about 9 months. The MD said that there should be more nurses like me in our hospital. I was totally shocked he said that..I said thank you so much...needless to say I am BEAT!!:heartbeat:heartbeat

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Thanks for sharing your story! I think that Dr was right. You are a wonderful nurse. Hang in there.

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Specializes in Cath lab, ICU.

Great story!!! Sometimes you have that "feeling" not to give up!! I had a similar experience not too long ago!! I have seen my share of too long codes in the ICU, but when you have a patient that walked in with a stomach ache you just can't let it go!! I am now on the cardiac cath team and when you get activated more times then not a code will be involved!! We shocked a gentleman of the young age of 51, 46 times in the ER and 2 more in the hallway on the stretcher to get him to the cath lab!! All in all he was probably down for a good 2 hours. This patient walked out of the hospital 5 days later with no residual neurological deficit and starting another day of the gift of life!! I ALWAYS trust my "feelings" and never feel bad about speaking up and not letting the doc say enough!! j.

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Specializes in Med/Surg.

:icon_hug:*wine

Well done. Go take a nice hot bubble bath

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Specializes in ER.

AMAZING!

You did a great job!!!

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This code started at 8:30 and ended at 1:30? That's five hours, not four. Amazing. Simply amazing. Glad you stuck to your guns. Enjoy the high while it lasts. Think back on this little miracle on those nights you want to walk out the door and not come back. Remember the life you helped to save.

You did a great job!

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Specializes in SICU/CVICU.

shocking the pt at 200 joules b/c I looked at the defib. machine and said Hey we might wanna shock him at 360 joules

Don't you guys use biphasic defibs?

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Specializes in pedi, pedi psych,dd, school ,home health.

congrats on using your gut!! keep it up!!:heartbeat:nurse:

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Wow, strong work! The funny thing is, as we all know, most 10 minute codes don't turn out so well but this mega had a "happy" ending. I coded a 23yo with some weird cardiomyopathy for several hours once a couple years ago. He survived, and recovered, but the family sued for "not preventing him from getting sicker". Ugh. BTW - balloon pump at the bedside, gotta love it! I relocated from a large hospital outside NYC to a 25 bed community hospital in rural VT, I think if I uttered the words "balloon pump at the bedside" peoples heads would explode! Again, nice job!:yeah:

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You 'coded' a person for 5 hours and 25 min s/p code they wer AAOx3?

:confused:

And 10 tries to get a fem cvl? No wonder it took 5 hours.

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Specializes in CTICU, Interventional Cardiology, CCU.
shocking the pt at 200 joules b/c I looked at the defib. machine and said Hey we might wanna shock him at 360 joules

Don't you guys use biphasic defibs?

yes we do which is a pain in the but I have asked many times for a monophasic defib for this reason!

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Specializes in CTICU, Interventional Cardiology, CCU.

You 'coded' a person for 5 hours and 25 min s/p code they wer AAOx3?

:confused:

And 10 tries to get a fem cvl? No wonder it took 5 hours.

when the pt went to the CCU pt had just had the baloon pump inserted aboiut 30 min before on my floor. That's how fast the heart took the the baloon. It just needed to open up the arteries a little bit, just enough so the pt. would stop going into pulseless v-tach and have the blood pumping ..we wuod have put one on earlier but it was saturday the cath lab is closed it was 8:30pm, only MD's are house MD and some tele residents..so that's part of the reson it took soooo long. Cath lab had to be activated on call md's, Rn's ect...I am sure if it was a monday our cath lab is open till 11pm M-F..so but pt survived and was extuabated today! talking dosen't remember a thing of course..

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