Had a patient code the other night, he was my patient, 59 yo male, hx of chirohsis (SP?) among other things, iddm, sz disorde... Had a k+ of 6.1, md order kayacelate enema, i gave it, pt was axox3, vss, complained about the enema, didn't hold much in, called md to get a amp of d50 and 10u or reg order (i have absolutly no use for kayacelate unless it's a chronic problem, ie esrd), he orders it po, whatever, go to give it 30 minutes or so after i originaly saw the patient. he was laying up against the bed rail, not responsive, i repositioned him in the middle of the bed, thought he had a sz, resps were about 12-16 and erratic, sturnal rub, opened his eyes real wide, couldn't palpate a pulse, couldn't hear one, by this time ( i had called for help) pox machine was on, pox86% ra, pulse 40's. Put on a rebreather, pox up to100%, still not responsive, called the code, did a fs beofre teh code team arrived, it was 58 pushed an amp of d50, code team came, pushed an amp of bicard, "how bout some insulin" nobody listened, chest compression started, note that the code team is all residents except for the anesthesiologist. Compressions were adequate at best, hr in the 20's very erratic, epi pushed, more bicarb, more dextros (finally some insulin) 1st cvp in the artery, resident running the code starts to defib, she wasn't excellent at it, the one paddle was on the lead for the moniter, got a rate of about 75, lost it, defibed again, on the leads againg, uh hello?!?! Teh nsg super and i just sort of looked at each other like, this guy is already dead. more drugs pushed, 2nd cvp properly placed, intubated by resp therapst, anesthesia was in or, or somthing. few more defibs later, few more drugs and 45 minutes total code time he was pronounced. I finally get out of the room after wading through the mess of stuff, teh nurse i was working with tells me, as I'm dripping with sweat, "I did, this and this and this...." you shoudl of left teh rom when the code team came, i'm not doing anything else for you" If she was a guy i would of punched her in the head.
That was the first patient that I coded that din't at least make it to the Unit.
Aug 27, '01
Wow! Messy! I'm really sorry!
I'm glad you stayed in the room--the WORST thing for the nurse to whom the pt. is assigned to do is to leave the room! Who else is going to tell the team what's happened? (Assuming they'll listen!) How're you supposed to chart if you're not there? Tell that other nurse to drop dead!
One of the very best things about NICU is that we don't call "codes". It's not that we don't have them, just that usually everybodies there already. All we gotta do is say "I NEED A DOC AND AN RT HERE RIGHT NOW!"
I think Kayexalate--sp-- works better if you can get it in the top end, but I think you did the right thing for this dude with the D50/insulin compo.
Usually after one of these things, I feel like I need some lidocaine!
Hang in there, kewl
Aug 27, '01
Some times the "joys" of woroking in a teaching facility are jsut overwhelming aren' they?
I don't understand why your "partner nurse" felt as if you had not done anything.....I guess it made her feel important. Oh gee whiz, I bet you would have rather been out on the floor than in where you were.
I am so sorry that you and your patient had to go through all this. I guess the new docs have to learn....somewhere else I wish sometimes.
Jan 28, '06
I had a scarily similar pt recently. Almost the same, but had amyloids (protein deposits) on his heart instead of cirrhosis. After 40 minutes of messiness, we got a rhythm, but he crashed again before he was in the MICU room. I would have had a breakdown if anyone had insinuated I didn't do everything I could. Especially since the pt asked me to pray for him less than an hour before he died. That was creepy enough, but boy am I glad I prayed!
Hope you have found your peace. Thanks for caring!
Jan 28, '06
Old thread alert!
This thread is nearly 5 years old.