Question about a code we had last nightRegister Today!
- by Kittypower123 Jan 16, '12Ok, so last night, a patient on the rehab unit where I work coded. The aide that was calling 911 informed me just as I was returning from lunch (he had JUST coded) so I ran to the room to assist. I took over compressions and when the paramedics arrived and took over, I ended up squeezed in the corner where I couldn't get out. When they intubated him, they had to suction and what came up was frank blood. This was only my second code, so I'm wondering - what could cause that? Is it "normal"? His nurse for the evening was in the room also and saw the same thing, she was disturbed by it too. We don't get a lot codes (thankfully - not my favorite activity) so I don't have a lot of experience with them. Any thoughts?
- Jan 16, '12 by turnforthenurseRNDoesn't sound "normal" to me. What was the patient's PMH? The frank blood could be coming from GI or the lungs, perhaps some sort of UGIB or varices? or a PE...I'm still relatively new with limited "code experience" but that's what I would think.
- Jan 16, '12 by Kittypower123He has a history of CHF, CVA, CAD, DM, HTN, can't remember everything else. Has a PEG tube with continuous feedings, MRSA in wound in R great toe, lost L great toe (DM), no pulmonary HTN that I know of, no history of PE or MI. In rehab for PT/OT for weakness following illness and treatment of toe wound. As far as intubation, paramedics confirmed placement with a stethoscope. He had a pulse when they took him to the ER, but don't know about after that - hopefully will get an update when I go in this afternoon. I'm really not expecting him to make it. Honestly, probably shouldn't have been full code to begin with.Last edit by Kittypower123 on Jan 16, '12 : Reason: grammer
- Jan 16, '12 by JennaJonRN"...As far as intubation, paramedics confirmed placement with a stethoscope. Honestly, probably shouldn't have been full code to begin with."
Confirm placement with steth? Interesting. Must mean they didn't hear ABD sounds.
This is why I advocate for COMPLETED Advance Directives.
- Jan 18, '12 by GrnTeamight have had an aberrant blood vessel in the bronchial tree, or might have been a more traumatic intubation than they thought. only times i've ever seen frank blood in lg amounts coming out of a trachea was when a trach tube balloon eroded through a vessel (patient died despite immediate very heroic efforts from the best team in the hospital who just happened to be making rounds outside her icu door when it happened) or with iatrogenic acute te fistula+esophageal varices (h***uva mess, also died)
- Jan 18, '12 by troop742And how did they confirm placement? Capnography is the standard, even an esophageal detector would have been OK. How many attempts were made to intubate? If the skills were not up to snuff, there could have been trauma to the airway. Another poster had a point, also, were there advanced directives in place?
- Jan 18, '12 by janfrnWe've suctioned frank blood from both mouth and trachea in patients during codes. It's not uncommon for patients with cardiovascular disease to have pulmonary hemorrhage secondary to anticoagulation either as the precipitating event or as a result of compressions. Aspirin therapy is a potent antiplatelet agent and most adults with any kind of cardiac issue will be taking it. This patient had CHF, CAD and HTN, all of which are significant here. And he'd had a CVA... so the likelihood of him also being anticoagulated is quite high. That would be my best guess - not that the intubation was traumatic or incorrect. I'd also suspect that the EMTs checked placement with a disposable ETCO2 detector, which is pretty much standard practice.
This sort of resus is always a traumatic experience for the people involved in the effort. The images tend to stick in one's brain for a long time. Hopefully the details will start to blur a bit for you soon.
- Jan 18, '12 by Kittypower123He didn't make it (not that I expected him to). Unfortunately, he was full code - no DNR, wife didn't want one (not sure why). Since I'm not experienced with codes, they could have used a disposable ETCO2 detector, but I'm not really sure, I only noticed the stethescope (granted there was a quite a bit going on). I have to say, I'm a big fan of DNRs for certain patients (like the 103 year old lady whose family seems to think she can live forever).