When a patient codes

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    Hi everyone, i have been on my own for almost a year and i have not been in a code yet (Don't look forward to it either). I was wondering if any of you have been in a code, if so can you go into detail the steps you initiate. I know for sure number 1 we call out to the charge nurse or overhead page all available staff to room ## IMMEDIATELY. I am quite nervous about this and i'm afraid i won't know what to do. I want to be prepared for a code, so any advice or tips are appreciated. Also who does chest compressions in the OR? The surgeon?

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    We had a code last week. Pt had an ivor lewis oesophagectomy. I was scrubbed and it happened when i went off to lunch after the long case. Patient had to be rushed back into theatre because they lost cardiac output. The anaesthetist was the one who gave compressions and within less then a minute the room was full of people who were ready to help including anaesthetic nurses, anaesthetists etc.

    The steps we initiate is to let everyone know via intercom that there is an anaesthetic emergency. Then we take it from there.

    And heres a vent i have about the whole situation....When i returned the thoracotomy incision was reopened and i had another nurse scouting with me. She seemed to think it was more important answering the surgeons pagers than helping me open sutures, get trays etc. Complete idiot and she even went off for a forty minute tea break in the midst of this crisis leaving me who had been scrubbed for five plus hours to do everything. I'm seriously considering reporting her.
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    When I was a tech a few years ago and still in nursing school, I worked evenings in the OR. An elderly gentleman came up for a cysto case around 10pm and coded due to a spinal that was placed poorly. Not too many of us were there. 2 OR nurses, myself, the surgeon, the anesthesia doc. A couple of PACU nurses came to help. People took turns doing compressions. When this guy first coded, someone started compressions and we got the crash cart.

    This guy lived BTW...I was so proud of everyone. In a way, I think it was better not to have too many people there. Granted, I was doing the documentation and it turns out that technically, an RN or licensed person has to do it. One of the PACU nurses went over it with me after we took him to ICU. The other nurses were busy administering meds and placing IVs(the original one crapped out) so not much choice I guess!

    I'll never forget that night..the nurses kicked butt. I left there at 2:00 am and had lecture at 8 am. Needless to say, I was a little late for class the next morning and I was praying the instructor wouldn't make some snide comment, because I would have said something not so nice.I had an adreneline rush for a good 12 hours and then I was just exhausted!
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    Quote from IsseyM
    Hi everyone, i have been on my own for almost a year and i have not been in a code yet (Don't look forward to it either). I was wondering if any of you have been in a code, if so can you go into detail the steps you initiate. I know for sure number 1 we call out to the charge nurse or overhead page all available staff to room ## IMMEDIATELY. I am quite nervous about this and i'm afraid i won't know what to do. I want to be prepared for a code, so any advice or tips are appreciated. Also who does chest compressions in the OR? The surgeon?
    You should have a policy and ideally do mock codes so that everyone understands what they are supposed to do.

    As far as CPR it depends on where the drape is. If the chest is prepped out then the surgeon or someone that is scrubbed will do it. If chest is not prepped then usually someone not scrubbed in will do it.

    There are a couple of roles here. I'll give you what I was taught many moons ago. If you are scrubbed your job is to protect your sterile field and get ready to support the surgeon. This includes anticipating opening the chest or aborting the surgery.

    If you are the circulator you support anesthesia until you get help then support the surgeon and the scrub. Once again anticipation is the key. Also police your OR. Make sure that extraneous personnel are kept out and watch the traffic. Be ready to help move the patient to attach external paddle. Hopefully the charge nurse will help you police the room.

    Outside of trauma I've seen 3-4 intraoperative arrests. Our procedure was pretty much as above. One of the PACU nurses would do recorder. Charge nurse directs traffic and delegates more resources. Usually another 1-2 anesthesiologists would come in and help at the top of the table. Scrub would keep field sterile. CS would bring in mini thoracotomy tray and internal paddle.

    Worst arrest - moving a TMJ patient to the stretcher when he arrested. Look anesthesia's eyes when he realized we were in a back hall with two dentists and an arrest.

    Best (relative) - Anesthesia looks over screen and asks "Can you step back for a minute so I can shock this guy?". Looked up and the patient was in V-tach. Absolutely unflustered. Thats when you know that you have a rock-star anesthesiologist.

    David Carpenter, PA-C


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