Black Friday, Code Blue

Friday was just a sad day overall. One of my patients, a woman who I have taken on and off since I was 20-something weeks pregnant, seized and coded and had to be intubated and taken down to the ICU. Since it was Black Friday, all of the staff there were the B team. Nurses Announcements Archive Nurse Life

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I was the most experienced nurse on my side of the floor. The other two nurses on my side included a travel nurse who is supposed to be seasoned but really has a LOT to learn, and a new grad RN who has been off orientation for two weeks. Thank goodness I'm the one who had this patient. I just...I need to get this out. It's been festering inside of me and I have to get it out.

As soon as I hear her son call out in the hall, "We need a nurse!" I know that it's my patient and I know that it's something bad. I run into her room and see her seizing. Of course, our medicine Pyxis has chosen that moment to be on the fritz and claim that we need to close a drawer that is definitely not open. I know I have to run over to the other side of the floor and override Ativan in their Pyxis. As I'm running down the hall, I encounter a group of doctors doing rounds and I scream, "[Room number] is seizing, I need Ativan and our freaking Pyxis is broken and I'm going to [next door] to get it! Get in there NOW!"

I'm tearing up as I write this because it just scares me that our Pyxis being broken could have cost her life if we hadn't had another on the floor.

I'm saying, "darn, darn, darn" as I override the Ativan, causing a discrepancy because I don't have time to count them, and I resume running at a breakneck speed, my stethoscope and badge swinging wildly, my co-workers shouting at me to be careful because of the baby, and me almost plowing them down as I speed past them.

I ran so fast and so hard that my throat hurt for hours afterward.

I've never trembled so hard as I do when I am pulling up the Ativan in the syringe. I get into her room and push the Ativan while the doctors are holding her head - she's biting her tongue and blood is dribbling out her mouth and her fingers are turning blue. Everyone is moving like it's slow motion, so I grab the code blue alarm and my co-workers come running with the code cart.

I scream at the pharmacist to get more Ativan out of the code cart, but she freezes like doesn't know how to get it open so I move 5 people out of the way and do the motions to get it open.

It doesn't feel fast enough, and I'm screaming at people to grab me a non-rebreather, call the pulmonary ICU team, call respiratory, call the internal medicine attending!

Rapid Response nurses arrive and I'm so happy I want to cry, but I settle for sitting at the end of my patient's bed, rubbing her foot and closing my eyes and not praying, but praying in the way only an atheist prays when they're scared someone is going to die. She is put on a monitor, we're cycling her blood pressure every 5, then every 3 minutes.

Everyone is asking me questions - what happened?

What's her history?

Does she have any allergies?

I rattle off the answers quickly as if I had memorized her life, and maybe for those brief moments I had. The mask is finally on her, her body is still, her vital signs are stalling out, but she's still not responsive, so the doctors decide we're going to intubate her. I assist in lifting her into position for the procedure.

My heart breaks for her - she's had to be on a ventilator before and it is her greatest fear. She never wanted it again. RR nurses push the meds she needs to relax for intubation, they get the tube in, and they figure out where she's going to go.

I'm on the opposite side of the bed, and my pregnant belly can't fit through the tiny opening between the bed and wall. It takes me asking 5 times before they move the bed forward so I can find the family and tell them what's happened. People always think the doctors have those conversations, and sometimes they do, but sometimes we do, too.

Her daughter in law is sitting in the waiting room, and tears are in her eyes as I calmly explain what happened, my heart beating in my chest, my body slowly winding down from the massive adrenaline rush, and my child kicking me inside, letting me know that despite my unintentional efforts to overwhelm her, she is safe and sound.

The rest of the family arrives shortly and I watch them file in behind my patient's bed as they follow her down to the ICU, the attending rattling off medical jargon that they don't care about right now.

Afterward, everyone told me I did a good job. They told me I rocked it out, and that I looked like a pro in there. We laughed about me being a "big belly running down the hall" at 8 months pregnant.

We laughed about my cussing at the doctors. We fixed the discrepancy in the Pyxis. I called to report to the ICU and finally ate some lunch.

But I tell you, I wish I never had to see or do these kinds of things. It breaks my heart every. freaking. time.

SwansonRN said:
Also, next time see if someone can get the Ativan for you so you can stay with the patient. Someone who is seizing shouldn't be left alone.

I was going to mention that, too, but figured I was already being mean enough.

It's interesting that people react to "scream". The person who orients new hires at my place says "It's ok to holler at people during a code". She means that someone sometimes must take the reins, tell others do this & do that, keep score, and otherwise be the decision-maker.

As for running while pregnant - please be so careful. Your baby is your most important focus. And why was a patient intubated against her wishes??

What a stressful event. We always " run " to our codes, but it means walk as fast as we can. I think some are taking the running thing a but too seriously.. How fast do you think the OP can run since she is 8 months along. Take some time to unwind..

Specializes in ICU.
Do-over said:
Law #3 of the House of God

AT A CARDIAC ARREST, THE FIRST PROCEDURE IS TO TAKE YOUR OWN PULSE.

Love this! I always take a deep breath in codes and remember - the worst thing that can happen is happening, there's no point in panicking about it now!

Specializes in Oncology.

Just want to address a few things:

1. I definitely did run fast. Yeah, not a good idea, but the last time I had my patient code, they died. It definitely affected me to see how quickly that happened. In a way, I forgot that I was a mother and only remembered that I was a nurse when this happened. My husband was mixed between being proud and being upset by my actions when I told him the overview of the events. This is my first child, so I honestly can say that I'm not in the "mommy" mentality yet. However, our unit is not busy or cluttered at all, so I was more at risk of tripping over my own feet than over anything else.

2. Someone did stay with my patient - the new grad RN that would have had a lot of trouble overriding Ativan in the Pyxis and finding supplies on a unit outside her home in those moments, and the nursing care tech. She also was very close with the family and served as a comforting measure to them. Like I stated before, the travel nurse is not really someone I can depend on, either, and she's even less tech savvy than the new grad.

3. I wasn't screaming like shrieking, but being loud and authoritative. It's hard to be heard over 20 people murmuring, the code bell, and vital sign machines cycling. *shrug* Take it for what it is because I am a loud person in general. But I've never been in a code where people were quiet, and if they are, they don't get things done quickly.

4. The patient was not a DNI and did want to have intubation if it was deemed necessary to maintain life. I work on a cancer floor, so we have no problem discussing these things. Being afraid of being on a ventilator and refusing to be intubated and placed on a ventilator are two very different things.

I just want to point out that I wrote this while I was crying and quite emotional reminiscing about this event in the early morning hours. I might have made different word choices if I had done more than let the words flow freely, but then the article would not have been as powerful.

ETA: My lack of reply wasn't because I had taken anything personally; I just hadn't rechecked the thread for replies until now. But I can assure you that I didn't lose control in front of the patient or family. I think I'm allowed to be emotional in the nurses' station and at home in front of my computer though. A little difficult not to be hormonal and emotional right now, but I do a good job keeping myself calm at work. I'm pretty sure someone would have given me a reprimand if I had been wildly inappropriate. I do appreciate the advice and guidance from experienced nurses, and I do like to debrief and see where I can improve in the future.

Specializes in Gerontology RN-BC and FNP MSN student.

Prayers work :)

Specializes in burn ICU, SICU, ER, Trauma Rapid Response.

I really enjoyed reading the OP. It is obvious to me that the author cares deeply for her patients and wants them to get the care they need. I admire her dedication to her patient. Her writing skills are also outstanding.

Speaking as a full time RRT RN any screaming staff would be immediately ejected from the room and the situation regardless of who they are. I wonder if the pharmacists was unable to open the code cart because a panicked nurse was screaming at her. Also, as others have mentioned, running around in these situations often leads to more injured people to deal with.

xoemmylouox said:
We always " run " to our codes, but it means walk as fast as we can. I think some are taking the running thing a but too seriously.. How fast do you think the OP can run since she is 8 months along. Take some time to unwind..

...then you aren't really running, are you?

The OP did confirm that she in fact, did run.

Again, the reason we do not run in the hallways is that this increases the risk of injury both to yourself and to others around you. If you injure yourself, how helpful are you to the victim?

Quote
It's interesting that people react to "scream". The person who orients new hires at my place says "It's OK to holler at people during a code". She means that someone sometimes must take the reins, tell others do this & do that, keep score, and otherwise be the decision-maker.

Yes, the word "scream" has a completely different connotation than the word "holler". Sometimes you do need to raise your voice to be heard over all of the noise. However, "screaming" implies an emotional component that "holler" does not. People scream when they are frightened, injured, or angry. People "holler" in order to be heard. Big difference.

decembergrad2011 said:
I do appreciate the advice and guidance from experienced nurses, and I do like to debrief and see where I can improve in the future.

Thank you for taking my thoughts in the spirit with which they were intended.

My comments have simply been based upon your description of events, and as I previously stated, if you were simply using dramatic license, then I apologize.

Raising your voice in order to be heard is sometimes necessary, and acceptable when things are noisy and chaotic. However, if you had really screamed at the pharmacist when I was in the room, I would have kicked you out.

And, if I were your supervisor and had heard about this incident (as you describe it), you would definitely be receiving some counseling from me.

I'm glad you care about your patients, that is very clear in your writing, and again, my intent is to help you improve in the future, not to bring you down or make you feel badly.

I agree with this post WHOLEHEARTEDLY!! During times like this we ALL do what we are trained to do...and in the heat of the moment, that can involve extreme excitement. I think the poster of this story did remarkably and should be commended...not critiqued!!

Specializes in Oncology.
weemsp said:
I agree with this post WHOLEHEARTEDLY!! During times like this we ALL do what we are trained to do...and in the heat of the moment, that can involve extreme excitement. I think the poster of this story did remarkably and should be commended...not critiqued!!

I think there's a lot of commending AND constructive criticism going around. They're not mutually exclusive.

Sounds like a very scary situation to be involved in, I have never had a pt code on me yet, I am praying it doesnt happen because I dont know how I would handle my own nerves. At what point did you go for ativan? Was she developing central cyanosis or her O2 sats dropping? Did she have a history of seizures? I take care of lots of pts with hx of seizures and have had a few tell me they were having an aura, and it wasnt necessarily a situation where I would have called a rapid response or a code, because even if they have a seizure, wouldnt you give ativan only if it was going on more than 2 minutes? You want to see what is happening to the pt during the seizure, make sure they are safe, have blow by O2.