Code Blue-a misapplied procedure - page 2

by MollyJ

4,049 Views | 22 Comments

I'm sure that many of you remember hearing that report of research that showed that on TV, the code blue save rate is something like 90%, but in real life it is much lower than that. TV contributes to a misapprehension that the... Read More


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    One important aspect of codes I think is that the latest research is not being utilized. Specifically, End-tidal CO2 levels. This is pretty prognostic sign of survival to discharge. But very few doctors utilize it. The studies have shown that if after 15 minutes of CPR, ACLS, etc...If the EtCO2 is < 10 mmHg then the chance of survival to discharge is <1% pretty much zero.....I feel that if the new research were to be utilized then there would be many less needless codes that go on for an 1/2 hour or more...Of course I do not think that this research included pedi's, hypothermia or other oddities. Pretty much in hospital adult arrests were looked at. Hopeful one day the public and the media will learn to look at this aspect of healthcare with more respect and with a different perspective...
    While working in the cath lab, I had a patient arrest (VF), we defibrillated her 16 times out of VF and every shock except the last one, hurt her, this I know because she kept saying "that hurts, stop it", the last shock she was pretty much out of it, so for airway safety she was intubated and sedated. During all of these shocks she had little or no BP, so the doctors said no sedation for fear worsening her hemodynamic status.
    It is funny I can remember every code that I was involved in or every patient that coded on me, can't remember names of all, but can remember circumstances around them....I too believe that is family members were educated about what goes on in a code this would only help matters in my opinion. I truly believe in family presence during resuscitation or invasive procedures the research shows a great deal of support for allowing famliy members in during a resuscitation attempt....Though that is another issue all together....Well....my .02 worth........
  2. 0
    I heard from a doctor that a study done on thrombolytics was skewed to make it look like it was more successful than it really was. You have to read how the study was done before you accept the results as fact and alter your practice.

    Questions to ask: Who did the study and do they have anything to gain by skewing the results to make themselves or their product look good?
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    You hit upon one of my favorite soapboxes, but talking about it here is pretty much preaching to the choir! I deal exclusively with folks who have a terminal diagnosis and you would be surprised how many of them still find it hard to sign a DNR form. One of the hardest things is presenting this realistically while still being gentle.
  4. 0
    Originally posted by Nittlebug
    I heard from a doctor that a study done on thrombolytics was skewed to make it look like it was more successful than it really was. You have to read how the study was done before you accept the results as fact and alter your practice.

    Questions to ask: Who did the study and do they have anything to gain by skewing the results to make themselves or their product look good?
    Nittlebug, I'm a little concerned IN GENERAL about the state of health care and academic research because so much of it is funded by drug companies and other industries "in the field". Uh, what kind of research agenda do they have?

    Perhaps our academic colleagues could chime in here. Tenure in big schools is granted based on research dollars brought into the institution. Believe me Lilly isn't interested in proving that their new antibiotic has efficacy equal to Amoxicillin; they want pay dirt. even if you have a desire to have a research based practice, it's hard to separate the grain from the chaff.

    In my field, drug prevention, I feel the waters are greatly clouded by the need to say that your prevention curriculum is "research based"! We have very respected researchers who are scrabbling to get some financial remuneration from their life's work and we often hear that they tweaked their data to be able to claim "significant impact" on behavior. I also am tired of being told that this curriculum must be implemented with fidelity or you just can't claim our impact (a true statement). While this statement is true, it constitutes "all or nothing" thinking. Most schools do not have room in their academic schedules for elaborate prevention curriculums (especially with schools nearly being held exclusively responsible for student's academic success AND the test, test, test mentality). Most of us just don't work in perfect worlds.

    Anyhow, nurses I still feel that we are in a great position to talk with families about the true limited efficacy of a code blue procedure in the elderly, those with a damaged heart, infected, debilitated, etc. Soldier on.
  5. 0
    Originally posted by aimeee
    You hit upon one of my favorite soapboxes, but talking about it here is pretty much preaching to the choir! I deal exclusively with folks who have a terminal diagnosis and you would be surprised how many of them still find it hard to sign a DNR form. One of the hardest things is presenting this realistically while still being gentle.
    Agree with everything you just wrote!!!

    I think too often people equate DNR with NO CARE and then I think the discussion needs to switch to what care without the impetus to "cure" looks like. The DNR needs kind, considerate CARE.
  6. 0
    education of patient and families.....regarding advance directives.
    getting doc's more involved in the discussion......cause they is supposed to be the ones headin' this discussion
    but you know us nurses are the ones......
    bringing in pastoral care(to listen.........)(where I am at pastoral care is fantastic)
    and then follow whatever the decision is as any good nurse does.....
    nursenancy-----I have had a few family balk at the topic.....but they haven't taken offense.....they are just not ready for that thought process yet........
    good ???
  7. 0
    The 90% survival rate for a code blue fits in with the average of 12 seconds for delivering a baby, non dripping IV's, a baby born with a diaper on (ER) and my favourite the nasal prong ventilator (wouldn't that be nice?).
    Yes it is time to educate the public, and maybe that's what we should concentrate on as nurses. People need to be made aware that there are conditions we can not cure and people do die, no matter how sad it is. In my job I see a lot of people coming for major surgery, while they are with one foot in the grave already. I often wonder why the surgeon puts them through this ordeal, with all the pain and missery. Very often it is the family which demands something is done to save their relative. Maybe it is time we get more grieve councelors in the medical setting to help people with the proces of death and dying.
    I have made it very clear to my relatives what I want and don't want if I ever get critically ill, so they have my support in the difficult decission making proces (I hope it is a long time from now).

    On a happier note happy easter everybody, hope all is well with you and your loved ones.

    Marijke:kiss
  8. 0
    Marijke,

    Perhaps we need to figure out a way to have pre -grief councilors. Try to educate the public before the hard times. During the stressful times it's a lot harder to get the message across. If we could somehow educate before that, as to how much better it could be for all concerned, perhaps we could ease the actual pain and grief. ????

    As usual, I have more of a question than an answer.

    just my $ .02

    ken
  9. 0
    Marijke and Ken,

    How right you both are!!
    Happy Easter and take care, Renee
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    Yes Ken you are correct, that would be very nice. I have noticed that the attitude towards dying in North America is even more disfunctional than it is in Europe. A lot of families find it unacceptable that grandma is going to die at age 95!!!!!! She was always in such good health and the medical system should fix her or they are going to sue the hospital, the doctors and of course the nurses.
    I am not saying we should let 95 year olds die just because they are 95, but on the other hand is it fair to perform big debilitating surgery, to prolong life for 6 months (and their agony?).
    We need to educate the general public even before they enter the healthcare system.
    On a happier note, today I planted some flowers in my garden, spring is here I hope for all of you out there if you don't have it already, it will arrive soon.

    Marijke


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