OF mega codes and AED's in LTC...(kinda funny!)

  1. So, I am crazy..LOL! My hubby, who is a paramedic, and I (I am a floor nurse at an assisted living...one nurse per shift for all 160 patients!) take ACLS together every two years...kind of like a 'date' so we can work together and see the differences in our jobs and find new respect for eachother (after 2 years, the nurse vs paramedic thing starts up a bit..LOL!). We really enjoy this time, even though I once knew this stuff like the back of my hand *SIGH*, and now a days feel like a total doofus! LOL!

    So here I was, actually shaking as I entered the MEGA CODE. For those that have never taken ACLS, this is when you must be a leader for a code, and they throw you some pretty scary cases. You are not just responsible for CPR and AED/Defib, but the entubation, iv, meds (stating how much, how long push, etc). Okay..hi I am a floor nurse for an assisted living facility..not like I am running around tubing folks and doing IV's...but I was going to give it my best! (my answer to v-tack was "funny little squiglies" and normal sinus "more familiar funny little squiglies"...LOL!).

    We got an EXCELLENT ER MD that oversaw the mega code. A pure blessing! He would ask what you do and make the situation according to what you really would see or do! So here I am...around ER nurses, cardiac nurses, paramedics..then little old me! LOL! They are going off on all the meds, tubing folks like pros (well the nurses got a bit hung up..but they don't do it all the time like the paramedics do)..and then it was my turn......LOL!!!!

    SO I am asked, so what do you do...and I looked around and said "comedy relief!". I explained that I work in a assisted living facility that despite nurses pleas will not get an AED...and to be honest...he could give me a patient and I could honestly say "I would call 9-11, find the polst, and do CPR PRN". So he was so cool, said.."okay...lets pretend that your top administrators mother was just saved by an AED and you got one at your facility...lets go"...

    It was still a comedy after that...I went into how I would have to get the AED which was in the middle of my facility, if even put back, that was located at the direct opposite of my location and down stairs. I would run and dodge walkers and wheelchairs the whole way, jumping over them like a clutzy gazelle, get it...do the same thing again...get the thing attached..and oh my...POLST, DNR...LOL!!!!

    We had a good laugh, but really...I did okay. Memorized the algorhythms well so I knew what to give when despite never having to do it! But my mindset...at least I know, and can assist in situations where I may be the only other one there (please GOD make sure I am not alone with a ACLS kit!!! LOL!!!!!! OH that poor patient..broken teeth from tube placement will be the least of their probelms when I am done..LOL!).

    Oh yeah...I aced ..whew..I was really nervous!!!

    So, this leads me to a question... do you feel that all facilities, even LTC and Assisted livings should have AEDs? (not necessarily a code cart...but at least an AED!). We discussed this as a class at length..and we all feel that it should be there..heck, people may be DNR...but are all staff DNR???? OR family visiting???

    What do you think, and should it be mandatory that all medical facilities have one???
    Last edit by Antikigirl on Mar 7, '05
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  2. 6 Comments

  3. by   VivaLasViejas
    YES! I think all healthcare facilities, including assisted living, should have at least one AED and all staff should know how to use it. In fact, I think ALL public buildings should have them......it doesn't mean everyone has to know ACLS---that's what you call EMS for ---but studies have repeatedly proven that survival rates are considerably higher for cardiac arrest patients who receive early defibrillation. That alone should be reason enough for TPTB to purchase one.....and in a perfect world, they would.

    BTW, good job on passing your ACLS!!! :hatparty: WOOT!!!!!
  4. by   begalli
    Quote from TriageRN_34

    So, this leads me to a question... do you feel that all facilities, even LTC and Assisted livings should have AEDs? (not necessarily a code cart...but at least an AED!). We discussed this as a class at length..and we all feel that it should be there..heck, people may be DNR...but are all staff DNR???? OR family visiting???

    What do you think, and should it be mandatory that all medical facilities have one???
    Yes! Especially Assisted Living and LTC places for EXACTLY the reasons you stated...family visiting. Lots of CAD walking around visiting those places I'm sure!

    I think AED's should also be available on floors of a hospital where they don't do a whole lot of codes. We certainly don't need one in the ICU, but other floors and areas of the hospital would benefit, I think.
  5. by   Antikigirl
    THanks! I was so nervous I was unsure of myself..but I started laughing and feeling more comfortable giggling with the paramedics and RN's more skilled than I (at my expense..that seems to work for me..LOL!)..and I relaxed and only got 3 wrong on the exam! WOW!!!!!! Blew me away!!!!!

    Anyway..I thought it was a great thing to learn (or in my case re-learn) because it helps me to hone in on what a paramedic or ER nurse is going to need/want to know in order to get a move on, and not waste so much time having to sort everything out in order to make a choice in meds especially! I can now think about warning someone of certain histories or current treatments I may not have considered previously to have made a difference. Saw cases that reminded me of so many 9-11 calls I have made and how I actually did make a difference by getting the info out (if I was being listened to..LOL!). And heck, at least get them into a position because I know what they may do and how that recliner is really going to hinder things..LOL!

    I had fun...I think it would be great to teach it in a 'nurse friendly' way so that us nurses know what paramedics need to know for continuity of care . Of course mine class would be more comedy and also 'what they need to know and why"...but how fun!!!!

    And gee, go figure I think all places should have an AED especially medical! There is a great trend going on in my county where police now carry them YEAH!!!!!!! But alas, my facility has REFUSED them saying it would take too much training, to much money, and all our pts are DNR..and when I brought up the family or staff thing..they told me not to do CPR or anything on them because of liablity (yeah BS!!! I so will treat to the best of my abilities!)....They are ignorant, stubborn, money pinching, and totally WRONG. I will tell them that when I leave (hopefully soon, that home loan is almost complete!! YEAH!!!!!!!).
    Last edit by Antikigirl on Mar 7, '05
  6. by   apaisRN
    Something that makes me nuts is AEDs in schools. Laypeople are deciding that we MUST have one, we must keep children safe, and spend thousands of dollars that could have been well used elsewhere. Shocking a child is almost never appropriate. This makes sense to a health care professional - v-tach and v-fib are usually the end result of CAD and children don't have it yet! (although with the obesity epidemic . . .?) And then an assisted living facility doesn't have one. If all the patients are DNR that changes the scene a little, but visitors are still at risk.

    Anyway, sounds like a fun ACLS day! I have a class in April.
  7. by   mattsmom81
    ACLS is conducted as an interactive learning experience, and is MUCH better than it used to be, so nurses shouldn't ever worry about it. Its designed for everyone to learn now.

    ACLS back in the early 80's used to be a terrifying experience and the docs and paramedics purposefully made the atmosphere punitive...they didn't think nurses should be doing this stuff.

    I still remember a hotshot paramedic who had his own agenda and gave acute care nurses field megacode scenarios ...just so they could show us up. <sigh>
  8. by   nerdtonurse?
    In keeping with the "Code" theme....my uncle Jack told me this one....

    Years ago, Uncle Jack was a Duke's ER -- he'd gone to the cardiologist, and had an episode and almost died in the office. He's in the ER getting admitted. He was feeling a lot better after being cardioverted, but they were still going to admit him. It was the beginning of the ER rotation for some interns, who were introduced to Uncle Jack, and who seemed to be absolutely jonesing for someone to do something interesting.

    Two beds down is a drunk. Slurring his words, and wandered into Uncle Jack's cube twice (and he said he almost got drunk just sniffing the guy), only to be chased out by nurses. Guy keeps telling people he's not drunk, he hasn't had a THING to drink. Uhhuh buddy. We believe you.

    Well, with all the back and forth, he keeps pulling the telemetry leads off, and the system keeps reading asystole, all while the drunk keeps saying, "Ah hashent ha nuthin to drink...."

    Can you see where this is going?

    Guy pulls off his leads and flops back on his bed just as one of the interns goes by and sees "asystole" on the monitor. Somehow he grabs the crash cart, and tears into the drunk's room yelling code blue, whips out the paddles and BLAMO, shocks the fool out of the drunk. Drunk jumps up and starts screaming, "Alright, alright, I had a case of beer, jeez!"

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