I have been a nurse for almost 3 years and have never had a code happen on one of my pts. (I work in med/surg on a tele unit. )I have had pts decompensate and get sent to TLC/ICU however, not codes.
This worries me because I am not sure if I can just "jump into it" if a code were to happen since I have no experience in the matter.
I would really appreciate some tips and advice on the matter as to how to get myself more comfortable with codes and also advice/tips from those experienced in codes.
Feb 15, '07
Remember Your Abc's And Try And Stay Calm. Get Help So You Have A Team With You While You Wait For The Code Team. Amy
Feb 15, '07
Are you ACLS certified? Taking this class may help.
Feb 15, '07
ACLS will definitely help. I felt much more prepared after taking that. Also be involved with any codes that happen on your unit, even if it isn't your patient. The more you are around it, the more comfortable you will feel. I remember the first code I ever helped with. I was still in orientation and it wasn't even our patient but the nurse who was my preceptor that day said "you have to see this!" and practically dragged me in the room. I was scared to death but the adrenaline was flowing and I just hopped in there and started doing compressions. It was scary but exciting at the same time!
Feb 16, '07
acls definitely. I remember the relief I experienced on taking my first PALS class. I was new to working with peds and this helped my confidence enormously when dealing with sick kids in the ER. Also it might help to remember that you can't hurt the patient because (and I know this sounds callous) they are already dead.
Feb 16, '07
Well I think its natural to fear codes, especially if you have never been involved in one.
I'm actually kind of shocked that as a med/surg nurse you've gotten away without one! My unit has codes constantly, its ridiculous. I was terrified of codes until I had my first one, and frankly you'll never know how you'll react till you're in the middle of one. I've seen some of my coworkers repeatedly freeze, and others jump right in. The key if you actually find yourself in one is to force yourself to jump in, even if you are terrified and have no idea what to do. Offer help, get the cart, do the documenting. Usually as soon as you call the code there are so many bodies in there you can't move, but they tend to be an uncoordinated mass until somebody starts barking out orders.
We've been fortunate as the "code floor" since we are literally right beneath the MICU. We literally have ICU on the scene within 2 minutes. In a couple of months our MICU will be moving to a new building, and the response time will be considerably longer. Not looking forward to that.
I'll say that since you've had experience with ICU consults, or medical emergencies (called various things like "code 88" or "medical 25" depending on your facility, the routine isn't all that different as a floor nurse. Just add in the bagging and the CPR. I find in "25"s we end up intervening almost as much as a Blue.
Feb 16, '07
Agree with the above posters especially regarding ACLS. Also does your facility through the education department offer mock codes? If they do attend that training.
A lot of anxiety about first codes revolves around not doing the right thing and thus the patient expires and attendent guilt that I did something wrong. Thus training will help with that. Also when a patient codes you have basically two choices. You can either do nothing (patient dies) or initiate code proceedures. If you initiate code proceedures and do things "not up to snuff" the patient may die but may also survive. If you do everything perfectly in a code the patient may (probably) die but has a chance to survive. So it is better for the patient for you to do something. It is inaction that is the worst choice.
Feb 16, '07
I agree with the other posters that exposure to a code and ACLS helps. I did have my first code 6 months after I had been a nurse. I tried and tried to get the patient off my floor. I had admitted her the night before and she was a/ox3 and talked to me with her eyes closed. She was admitted for a CVA and CT was negative. Next night I came in and she was not responsive. I called the house resident on call and she ordered a stat CT. I called CT and told them she needed to have stat CT for r/o CVA and she is being sent down now. CT told me they did one last night and it was negative and she didn't need one. I explained that the pt had suddenly become non responsive and CT said "Fine I'll do the scan to rule out CVA but you need to sedate the patient if she is uncooperative." I told her that the patient was not responsive and she was cooperative. CT tech kept telling me to sedate her. I decided not to waste any more time and told her I would sedate the patient. The patient went for CT and came back to the floor with the CT report taped to the front of the chart. Massive Cerebellar CVA. I called the resident on call and she came up to see this pt after CT and tried to get ahold of the attending to get permission to transfer. The attending wasn't returning any pages. I told the resident to transfer to ICU before the patient codes on me. At 2330, I was starting another round and went to see this patient first after my already frequent checks on her and she was breathing really strange and her SPO2 was 52%, I had not O2 setup in the room. I called for some help and everyone came and we intubated the pt and sent her to the ICU finally. It took me a total of 4 hours to get this pt off my floor and to the ICU.
I didn't have one of my own pts code until 4 years later. I always tried to respond to every code on the unit. I also took ACLS and I felt better about my skills in a code since. As you can see my first code was a mess. The pt lived but died 1 week later in the ICU.
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