Code Blue!

Nurses Safety

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This is going to sound really silly as I've had CPR classes twice now! But I honest to goodness would freak out if one of my patients coded one day. I'm a PCA and I *know* it is bound to happen sometime and possibly during clinicals as well. I just wouldn't really know what to do first I guess.

For instance, what if your patient fell in the bathroom and they code...what do you do first? Get on top of them and start doing chest compressions? Or do you run out in the hallway, grab the resuscitation mask and then go? Do you do it without a resuscitation mask if no one comes? (I know that one's a little desperate as everyone's gonna come running during a code) Do I get off once more experienced personnel come along? I feel like I'd freak out and just be in someone's way, but I REALLY want to know what to do should the emergency arise.

This is going to sound really silly as I've had CPR classes twice now! But I honest to goodness would freak out if one of my patients coded one day. I'm a PCA and I *know* it is bound to happen sometime and possibly during clinicals as well. I just wouldn't really know what to do first I guess.

For instance, what if your patient fell in the bathroom and they code...what do you do first? Get on top of them and start doing chest compressions? Or do you run out in the hallway, grab the resuscitation mask and then go? Do you do it without a resuscitation mask if no one comes? (I know that one's a little desperate as everyone's gonna come running during a code) Do I get off once more experienced personnel come along? I feel like I'd freak out and just be in someone's way, but I REALLY want to know what to do should the emergency arise.

There are 2 rules to a code.

1) You are NOT the one dying!

2) If the patient does not make it,you did NOT hurt them because they are already dead.

A few years ago, on Christmas morning, a woman called in and said she was bring her husband having chestpain. On arrival he was quite ashened and nauseated. Did my assessment, put on the monitor & O2, have IV assess. The day nurse chart my assessment and I could go home(I worked 11p to 7a). The patient went into V-tach. We cardioverted him twice before being lifeflighted to a larger hospital with a cath lab. He is still alive to this day. He and his wife celebrated their 50th anniversary earlier this year. True story.

Hello, PinkAurora,

You must establish unresponsiveness before you act, because you do not want to do CPR on a patient who just happened to fall asleep on the floor.:)

I getting a funny visual on that - pt wakes up in the midst of a chest compression and says: "what the hell are you doing?"

This is going to sound really silly as I've had CPR classes twice now! But I honest to goodness would freak out if one of my patients coded one day. I'm a PCA and I *know* it is bound to happen sometime and possibly during clinicals as well. I just wouldn't really know what to do first I guess.

For instance, what if your patient fell in the bathroom and they code...what do you do first? Get on top of them and start doing chest compressions? Or do you run out in the hallway, grab the resuscitation mask and then go? Do you do it without a resuscitation mask if no one comes? (I know that one's a little desperate as everyone's gonna come running during a code) Do I get off once more experienced personnel come along? I feel like I'd freak out and just be in someone's way, but I REALLY want to know what to do should the emergency arise.

Look into your hospitals educational department and see if they offer "moke code blue" situations. Our hospital has these moke codes and they are very effective at walking you through the entire process from finding the patient down to how to yell for help!

I find it a bit difficult to remember the code status of all 100 residents on the three units I work on. Truth be told it will probably not make a difference, they rarely get better.

I completely agree with girl who works in nursing home. You DO NOT KNOW DNR status on 25-30 pts. And I wish there was a band of color or dots on charts or any other indications. But they are not there. you ask nurse you take report from - she knows ab. some pts who are hospice care, but probably not on all pts. and if you work in nursing home prn, you do not know pts that well.

In real life you do go and check the chart before starting cpr. But, to tell the truth, if i see somebody that bad and about to code, i check in advance just in case.

Chad--you may want to check with some of the nurses or administration about posting somewhere what patients are DNR's or not.....by giving inappropriate advice on here you could set yourself up for a legal situation....you do not ever leave the room, because if you ever got taken to court - they don't care whether you had 100 or 700 residents at the same time, they just look at the one single situation, EVERY other aspect going on at the same time DOES NOT MATTER AT ALL! It doesn't matter how short staffed or how busy you are. Never leave the pt's room to check a code status or anything...you call out and have someone else check, in the meantime you need to continue checking ABC's.....whether they are going to get worse or get better is not for you to judge, all situations need to be treated in the same manner. You'll learn important assessment skills in nursing school, just an FYI on legal issues...CNA's still have some legal issues to watch out for - you are responsible for your own actions if you've been taught them, being BLS certified you are held responsible for knowing better than leaving...i'm not trying to be rude, but you'd be surprised what you can get in trouble for....also it is illegal to use a title that you've not respectfully earned...i.e. SRNA, if you're not a student registered nurse anesthesist you cannot use this as your title.....SRNA's are already RN's, and if you are not a registered nurse and not a student of a CRNA program, it would not wise to use this as your title, even on a website.

BTW - im not trying to be rude, just educating...thanks!

I am a KENTUCKY STATE REGISTERED NURSE AIDE. I have never misrepresented myself in the slightest, I am using the title that was bestowed upon me by the Kentucky State Board of Nursing. I also believe that posting a patient/residents code status might be a HIPPA violation that can result in heavy fines.

Ok sorry for misunderstanding, SRNA means student registered nurse anesth. everywhere else it's CNA. I'm pretty sure you can use a colored armband to note DNR status without violating hippa....but the law does state it is ok to place name and info on outside of room if for treatment purposes, seems to me DNR would be for treatment purposes??? worth looking into.

To put simply #1 check carotid pulse (make sure they really are a code blue), #2 call for help, #3 start chest compressions until help comes (don't worry about o2 yet help will come and set up ambu bag), keep doing it until team arrives and they will move pt, set up bag, set up cart, a doctor will be in there in minutes. That's all you really have to worry about at this time. Watch the experienced nurses run the code. The Dr will call for drugs such as epinepherine, sodium bicarb (for acidosis), atropine (for bradycardia), lidocaine etc. The RT will set up the intubation tray and have a light source ready, a tube with a stylet inside it (usually about size 7.5) with a 10cc empty syringe to fill the balloon and lube, an ambu bag, suction on with catheter and yankower on continuous setting etc..., two great IV starters will put 2 large bore IV's in the anticube so you can deliver meds...you won't be doing everything so don't worry. Just offer to switch off compressions if necessary or be a runner and go get lots of flushes and 3 or 5 cc syringes from the crash cart when needed etc...

Specializes in Emergency.
I getting a funny visual on that - pt wakes up in the midst of a chest compression and says: "what the hell are you doing?"

I hate to tell you how many times this has occurred....

Specializes in Emergency.

In the case of a SNF patient where you don't know the code status, it is inappropriate for you the discoverer of the patient who is not doing well, to LEAVE the patient to check the code status. What would be more appropriate would be to call for help and have someone else look at the code status.

Just the thought of someone leaving my Not a DNR person to go look that up, kind of gets me going. Yes the patient rarely gets better, especially if you take 4-6 mins to look that up...

Specializes in med/surg.

ok, 2 sides:

I work in a hospital, and for a code situation, all the bells and whistles come out. First thing: try to prevent the code. No, this is not always possible, but many times the patient will give some warning (BP drops, sats drop, tele goes brady, pt complains of chest pain, decreased LOC, etc.) Assess the patient and get others involved before a code. Let the nurse know these things right away. If the you do happen to find or witness a patient go down, yell for help. Assess for LOC. By this time, the room will quickly fill up, and you can stand back and watch and learn. If you are in the way, get out of the way. Let the more experienced ones show you how it works. It helps to watch a couple of times.

I used to work in a nursing home. No, you may not know everyone's code status. They are residents, not patients, this is their home, so no medical information will be available to you in the room. No bracelets, no signs on the wall, no DNR order tattooed on their forehead. Yell for help. In adult BLS, if alone, for AHA providers, you call before beginning CPR. While running to grab the phone, grab the chart. After full code status is confirmed, someone will need to call EMS. Your job is to perform BLS until EMS arrives. At the nursing home where I worked, there was no crash cart available. Not even an AED. I asked "where's the crash cart?" during my initial tour of the facility and got a funny look. Just BLS until EMS arrives. Then, it's their show. (I didn't work at the nursing home very long. I figured for as much as nursing home care cost, the residents at least deserved access to basic lifesaving equipment.) Also remember that even if a patient has a DNR order, the family can change their mind at the last minute, so they should be contacted pretty quickly to inform them of the situation and confirm the DNR decision. I don't agree with families that undermine the patient's decision, personally, but it is still their right to do so.

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