What is your most traumatic code

  1. I had this really traumatic code last week, on the Tele unit where I work. Put it this way, I am not use to seeing open heart surgery in a hospital room, that is reserved for the ICU and OR. Tell me your stories...
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  2. 12 Comments

  3. by   P_RN
    Not as dramatic as that but still horrifying.

    Lady in her early 60s had laminectomy/diskectomy and should have been kept just overnight for observation.

    The new RN assigned asked me to come in to the room to see if I could hear her BP.

    I heard NO BP. I felt nor heard NO pulse. The patient was still talking...and said she felt well. She said her husband had died last week and she probably should not have had the surgery but her legs hurt soooo badly.....

    As she was speaking within a minute or less....her voice trailed off......I called a code.

    A million and three folks showed up.....I had to crawl on the floor to access the IV site. My LPN tried clearing out the room. The doc had to sit on the foot of the bed to run the code. It was a VERY small room.

    We placed a STAT call to the house cardiologist. He never called back...but showed up within a minute or two and said the phone was busy.....a med student had taken it off the hook!!

    They called for the AED...they weren't standard on the carts yet....
    The ER wouldn't relinquish theirs....our CNS had to go down and TAKE it....

    They'd capture a rhythm then lose it.....finally after nearly an hour she was pronounced. Her surgeon NEVER showed up! He was in house and knew the situation....he NEVER showed up at all!

    THEN we found out she was the grandparent/sole guardian of 11 children under 16 years old. EVERY one of their parents were in prison!!


    That was the most horrible code I ever was in.
  4. by   nilepoc
    Man is about to be discharged from a cardiac sac, the nurse decides that since he is about to leave, he can take his tele off. The patient ends up staying in his room for another four hours, missing a dose of his meds, because he was really discharged all that time. Patient goes to the restroom, vagals on the toilet, and gets wedged between the toilet and wall.

    A family member who is there, hears the thud and runs into the bathtoom and yells for help. Now the code team is activated.

    The team arrives and is unable to extract the patient from his wedged position. Five minutes later, the patient is finally on the floor and compressions and the ACLS drugs get going. This isn't working, so now we throw him on the gurney, rush him to the ICU after tubing him. On arrival to the unit, they do a cardiac window and open heart massage. This keeps him going for another 15 minutes. Finally the code was called I believe after 45+ minutes. The guy was only 40 something.

    Throughout the code there were multiple rhythm changes and various therapies employed. It was quite a first code to see.

    Especially since I was only an extern.
  5. by   hoolahan
    OMG Nilepoc! What a first code!!

    I worked for 13 years in an open heart SICU, so saw lots of open chests, always cool (not for the pt of course.)

    But, my weirdest code was before working there, in a general ICU. A woman was on the floor, and rec'd a test dose of ACTH, to r/o myasthenia I think, or whatever other weird endocrine dx they use that med to r/o. So, the very first problem is, she should never have been on an unmonitored unit getting this drug!

    Next thing you know, her nurse discovers her cyanotic and seizing. She was seizing from hypoxia I'm sure. They coded her, and every time they were ready to transport her to the floor, she would arrest again.

    Came up to our unit finally, and we coded her repeatedly, the cardiologist even gave her straight levophed from the vial, well it came in a bristojet then, he had to give it b/c we all refused to push it straight.

    Anyway, we pronounce her. Everyopne is quickly exiting the room, and only a resident and myself are left. Jack was checking for heart sounds with his scope, and I was reaching over to turn off the vent. I saw Jack's face literally turn white. I said What is wrong?! He said I hear a heartbeat. I snatched the doppler, put it on her carotid artery, and sure enough, a lsow, staedy whoshing was heard. OMG I said, turned the vent back on, and called another code, yet she was asystole on the monitor. The doc had gone down to the family waiting room to tell the family she was gone.

    I run down there, open the door, there are dozens of teary-eyed family members, she had 11 kids!! 45 years old. I motiuoned for the doc to come out immediately. He looked at me like you insensitive b***h! He came out, I told him she had a heartbeat and we re-called the code. He looks at me and says OMG, what do I tell the family?. I'm like, I have no idea, but I wouldn't want to be you right now! He says, how about this, "The cardiologist has re-esatblished a rhythm." I said sopunds good to me, and ran back to rejoin the code.

    We finally got a rhythm, however, that poor woman died several months later in a nursing home.

    Turns out, I discovered a few months later, we had some bad EKG leads. When the gel dries up, they don't conduct. That is why we kept seeing flat line on the monitor. But, she still had virtually no BP, but even so, I felt horrible. Of course the entire arrest should never have happened in the first place. She should never have rec'd that med on an unmonitored unit.

    My friend and I looked at each other after that code, and said, this one wil; be a lawsuit for sure. Sure enough, I was called for a deposition. I never had to go though, b/c my girlfriend was called first, and her account was enough info, that the hospital settled with the family, for pain and suffering, they should have also sued for malpractice, but they were so upset by being told she died and then she didn't, very, very ugly code. Hope I am never in that situation again.

    Couple other ugly codes in that unit. A man with burns to the upper areas of the body, was intubated, so much edema, the ETT was forced out, so the doc said. Anyway stupid anesthesiologist decieds another ETT is best, meanwhile we are begging to put in a trach, they never did, and he died w/o ever having an airway! The same day, a woman who was long-suffering post-op in the unit, kept bradying, this was obviously going to be it after a month of suffering, she was a surgical ***** (F'd up beyond all repair), when she finally brady'd, her dtr threw herself on the bed and refused to allow her to be coded. It was perhaps my second code ever, I didn't know what the he!! to do , thank godness someone did, she ran in and pulled the dtr off the bed. We did CPR, but she died. Now remember this was back in the early 80's. Pt'r rights were not realy popular then, and this surgeon refused to make her a no code. Now, with my experience, I probably wouldn't pull that woman off the bed myself!! Lastly, I should add that our morning report started that day with a pt who was DNY going flatline at 7:15, so 3 deaths in one day! One for the books.
  6. by   nilepoc
    Oh yeah, I forgot to mention the one where lidocaine was hung instead of a hespan bolus. You know they both come in red printed bags. That code didn't end until that whole 500cc was infused. Thankfully I only heard about that one. The patient got his cabg for free and a bka. I think he also stroked, he was in our ICU for a month recovering.

    The funniest code I went to was an anesthesiologist who had changed the program on his own PCA. He ended up bolusing himself and going apnic. Once the narcan was in, he woke up with the tip of an ET tube in his mouth, and screamed "don't you intubate me, NOOOOOOOO!" I never did find out if he got in trouble, but I know a nurse would have been fired. I did see him practicing again.

    Another good code that I did not attend, but heard about and was in house when it happened, was another anesthesiologist who was found in the GI lab trying to shock himself out of VT from cocaine use. He is also back in practice.

    Those three did not occur in my current institution.



    fun times eh?
  7. by   radnurse2001
    I was a nursing student at the time working on a renal floor. My patients blood pressure was low (and had been through the night) with dropping hematocrits. We sunk a NG tube down and got coffee grounds---explains it right? Wrong! We sent him to CT to see what was going on, He came back to the floor with the NG curled in his mouth. Blood pressure remains low---Pt has severe back pain---another peice to the puzzle. Upon trying (with my instructor) to reinsert the NG tube, He sits up, looks me straight in the eye, and wham----blood everywhere! Eyes, ears nose, you name it. It was so bad, all of our shoes had to either be thrown out or autocalved. Needless to say, I went home early that day, I was so traumatized that I concidered not going back, I actually had nightmares. The next day at school, my instructor asked me what I thought it was. My only answer was(after the majority of my evening was spent researching) ruptured aortic anyerism. A few days later, she got word of the autopsy and thats what it was. Have only seen one other one and that was after I started in angiography. It was, and remains to be to this day, my very worst code---but my best learning experience.




    Anne
  8. by   egmorgan
    I guess that is why they say to change the EKG patches every day, as the gel does dry up....
  9. by   kids
    My most traumatic code was probably the cleanest code I've seen. I was doing an elective ICU rotation the week before I graduated. Things had been going pretty good and I got to do some 'neat' stuff- did a doner (very textbook brainstem herniation), got to watch a bronc thru the teaching scope ect. They admited this obese diabetic ESRD with unremitting chest pain- on her dialysis day, K+ off the charts ect...cardiologist is up to place a Swan and I got to watch (oh goody)...I'm back in the corner under the monitors and behind the floroscopy machine. Cardiologist is having a heck of a time getting the line in - lady had no vessels left from all of the dialysis shunts. Just as he gets it in she codes. I spent the entire hour trapped in my corner before the called it. Yes, I got stuck doing a report to the rest of the class about it.

    Was 2 years out of school and working day charge on a rehab unit. I was taking report and the NAC comes down and says Mr. B (64yo) is throwing up blood. He had been with us for 6 weeks for hip rehab (pre-PPS obviously) long hx of 'ulcers' he had been having intermittant small coffee ground emesis since his admit. PCP was very aware and had him on carafate & H2 blockers. I said something to the effect of 'this poor guy, I wish they could get this GI bleeding to stop' and headed down to his room. I get there and he is sitting on the edge of his bed with his back to me leaning over a commode. I walk around the end of the bed, slipped and about fell on my a$$ in the biggest pool of frank blood I have ever seen. Mr. B says "I don't feel very good". I start yelling for a 911 call (he's not a code yet) get him into bed, slap O2 at 10 liters, Team Leader gets there as I'm trying to get a BP (none), sent NAC to direct ect guy is still havig projectile vomiting of BRB...Any way get him out the door, Team Leader and I both had to shower befor going back on the floor. I called to check on him later, they had put him in ICU for pallitive care (????). Seems he had a massive AAA tthat had eroded into his stomach. His daughter was a MD and since it was inopperable he was never told, no mention of it in his records and the PCP never said a word. UGLY
  10. by   e-nurse
    My first and only one @ noon on 9-11-01. Enough said. Pt didn't make it after 35 minutes.
  11. by   CashewLPN
    my most traumatic code would have to be the first one I ever had to deal with(I think all first codes are the worst)
    I was working up on ltc-- my third day in my first real post-grad job... I fed this lady, and then got her into bed... half an hour later, 2 of us were doing CPR while we were waiting for the NYFD to get there... all I remember was seeing that gray-slack jawed face, and doing chest compressions and feeling her old osteoporosis ridden ribs breaking as she was no code status... then, the MD refused to come to the LtC, demanding that the code be continued till this very dead lady got to the hospital so then she could pronounce her... Horrible.
    --Barbara
  12. by   thisnurse
    what a cheerful topic lol
  13. by   LilgirlRN
    When I worked in CCU, if a code was called one of us had to attend it. I had just taken ACLS, was basically a new graduate, been out of school for about 6 months. They called a code in the ER one night, I go to the code. I came around the corner and threw back the curtain to the room. There is a woman lying there, the ER doc is doing chest compressions. She has this HUGE belly, huge breasts....OMG, I think to myself, this woman is pregnant, very pergnant! Turns out she delivered by Csection 6 days before, was discharged with a fever and continued to run one at home, kept calling her doc's office only to be told that temps of 100.5 are common among women who had c-sections. She came to the ER that night with SOB. O2 sat upon arrival was 86% on room air, initially improved with O2 at 3 liters, then sat started dropping, they switched to 100% non-rebreather, sat just kept falling. The ER doc decides he needs to intubate emergently, meaning that he gave her no sedation, she screamed just before he got to the cords and went flatline. Of course we never got her back. She was 26 years old with a one week old baby girl in the waiting room with her 25 year old husband. When they did the post, they found her bladder to be full of pus, it was backed all the way her ureters to her kidneys. She had been septic and went into multi-organ failure. Needless to say her OB was sued. The hospital and the doctor both settled out of court so none if us had to testify. It was very traumatic for all of us who were involved, we all had little ones at home, made us all very sad to think of this baby growing up without her mom.
  14. by   deespoohbear
    We had a pt hang himself at our facility a couple of years ago. He was discoved by a nursing tech. He was the worse shade of blue I have ever seen. We knew when we took him down out of the noose, he was gone, but we had to try anyway. Flat-line from the word go. As working on this man (the ER doc was there running the code), this man's family physician walks past the code scene, which happened to be in the hall. The family doc asked who the pt was, and we told him it was Mr. Soandso. He said Oh, and walked on. Needless to say the man didn't make it, and the hospital was sued. I believe they settled out of court. What a mess!!!

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