My first code today...

  1. So, I am getting very close to the end of my orientation- 1 more day before they cut me loose on my own. My orientation has been fantastic, I have had lots of interesting and varied diagnoses to take care of in the unit (we are Level III, ECMO capable, cardiac surgery, etc.). However, the one thing my preceptor has kept saying she would like me to see before I'm on my own was a code. Thank goodness, we rarely (if ever) code outside of the delivery room, so it was looking like that wasn't going to be possible.... until today.

    I was just finishing up with assessing, feeding etc. my second baby when my preceptor grabbed me and asked if I wanted to assist a neo with a chest tube insertion for a pneumo. Since I am always looking to get involved, I of course said yes. I was sterilely gloved and assisting with the insertion, which seemed pretty routine, right up until the kid started bleeding around the insertion site. I don't mean a little blood. I mean, blood on me, on the bed, on the neo, everywhere. Immediately our heart rate tanked and the (non-intubated) baby's sats dropped, even with blowby. The neo looks up at me and very very calmly says, "I think we nicked the pericardium. We are going to call a code now." Just like that. No drama, no fireworks, just people jumping into what looked like a finely tuned dance. I was still holding on to the sterile end of the chest tube for dear life, hoping the guidewire wouldn't slide in further and make things worse. We quickly got the chest tube secured and hooked up, and it began draining a ton of blood.

    By this time, the heart rate was in the 40s, and the neo pointed at me and said, "Please do compressions." My head was screaming, I don't know how to do this!!!- but then it was like my body took over. NRP must have sunk in somewhere, because the next thing I knew I was compressing and counting, somone else bagging. The baby was intubated, epi and a bolus were given, x-rays and an echo done, blood ordered, and all the while we're just counting and compressing and bagging along... And then the coolest thing happened... The heart rate came up! Sats were in the 80s! Wait... did we just save the kid?!?!

    It was the neatest thing ever... I mean, no neat in a good way, but neat in the way nurses think wounds and gross injuries, etc are cool. I guess I was most impressed with the way everyone just knew what to do, and did it. It was so calm, no yelling, no panic. When it was over, though, I definitely had to SIT DOWN! It took me a good 30 minutes to quit shaking and get over the adrenaline rush, and all day long the other nurses kept coming by my corner to check on the "poor new orientee who coded the baby," LOL. I just wanted to share... it was definitely an experience that I will never forget!!

    P.S. The last echo, right before I left, showed that the blood in the pericardial sac had been reabsorbed. The baby was very stable on the vent, and the chest tube was no longer draining blood. Yea!
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  2. 7 Comments

  3. by   EricJRN
    Good work! Congrats...
  4. by   RainDreamer
    Wow, what a day for you! Great job with everything!
  5. by   Gompers
    Great job, and I'm glad the baby did okay!

    I'm always amazed at how NICU codes seem to flow, too. Even though we don't actually have assigned roles, everything just seems to fall into place. Someone just starts recording, someone starts drawing up meds and boluses, someone is getting a new ETT or chest tube ready, someone is calling X-ray, if the parents are there someone is sitting them down and explaining things to them while someone else is calling the chaplain, etc. And the whole time, whoever isn't involved with the code is watching the OTHER babies, making sure that they are doing okay and have everything they need. It seems almost rehearsed but it's not - we just see what has to be done and not a whole lot of debate goes on - you just do what you have to do.

    We always make sure to grab the newest nurses when there is a code so they can watch and learn. We like to make them the recorders because it's something they can focus on, plus they really learn what all goes on because they're recording every step of the way.
  6. by   arv
    Seeing a patient's b/p & pulse on the monitor after having none actually ranks only behind my marriage and the birth of my son in the best things that have ever happened to me! We were on a Peds rotation for clinicals and there were only 2 patients (and 6 students!) So 2 of us got sent to ED. Have known for a long time that I want to work trauma when it is all said and done. That day just confirmed it. Anyway, shadowing a nurse seeing not a whole lot going on (bloody diarrhea - yeah! :wink2: ) when a MVA arrives. Pt comes in, fine, talking in ambulance and then crashes. Was observing (from out of the way) the organized chaos of the code dance when (after 3 nurses and 2 techs) was asked if I wanted to do compressions. No b/p or pulse for several minutes, was on vent but that was the only thing keeping him alive. As I waited for the doc's ok to start (letting the machine recycle to verify still no b/p, pulse) I suddenly thought...

    HOW DO I HOLD MY HANDS TO DO COMPRESSIONS?!? I DON'T KNOW HOW TO DO THIS!

    Doc said "Go" and I did. Pumped and pumped and pumped. Dr. asked how long we had been doing compressions and said he was only going to let it go another minute; just couldn't do anything for him w/ no blood circulating (I assume he must have been hemorrhaging internally, had no visible injuries other than a scratch on elbow) told me to step back (let the machine recycle) and low and behold - a pulse and b/p.
    Decent b/p too - 103/69. They stabilized him enough to get xrays but at that point clinical instructor rounded me up to head home. Doc made a point to congratulate me, nurses all clapped. It was without a doubt one of the best things that's ever happened to me. The only thing I regret is that was our last night at the institution, so I don't know what happened later. Confirmed to me though that ED/trauma is where I want to be.
  7. by   Alexalynn20
    What hospital do you work for? I live in chicago and want to be a NICU nurse. I start an accelerated program in Jan.
  8. by   LoveTheNICU
    Quote from Alexalynn20
    What hospital do you work for? I live in chicago and want to be a NICU nurse. I start an accelerated program in Jan.
    I don't work in the Chicagoland area, but feel free to PM me and I'll give you some info! Good luck to you with your program...
  9. by   am17sg05
    congratulations for a job well done!

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