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.

Specializes in Med/Surg, Academics.

This has been an interesting thread...

After reading the bolded part at the beginning of the OP, I didn't understand the necessity of the posts on what she could have done differently. Not every "gotta get this out" post requires a formal debriefing on how one could improve. At least it was clear to me she just needed friendly ears that understood, which most posts provided.

To the OP, loved your writing, and my heart started beating faster reading it. Been there a couple of times myself, and I haven't been able to let go quickly, either.

Anyhow, about rapid response vs. code. Where I work, rapid response is someone going south, and you get residents. A code is no pulse or close to respiratory failure, and you get residents plus experienced intensivists. We have, at times, called a rapid that then got called a code during the same event.

Specializes in Transitional Nursing.

I think feedback is really important. If not to the OP (and I'm not speaking of this post specifically) then to the others who will read this post. I've learned so much from AN even if I am just a CNA, I will take many things from this forum with me to nursing school and to my career as a nurse and I'm really thankful for that.

I also think there is a limit to how much feedback and constructive criticism one person can handle though. I for one am not good at being the recipient of it, that is for sure! I'm always grateful for it in hindsight though.

Specializes in Skilled Nursing/Rehab.

The nice thing about the internet is... if you don't like it, you don't have to read it! :)

Specializes in Emergency.

Ok, I'm late to the party.

Emergency situations can be scary especially if you don't see them often. I don' t think anyone is trying to be unkind, but the fact is that drama is the enemy in any code.

If this post had been written by a nurse with more code experience it may have read:

"Today I heard my patient's son calling for a nurse. I went into the room and she was seizing. I put on the emergency light and asked for help, then I worked on airway management and placing O2 while Sherry went to get a doc and some ativan. She told me after that the pyxis is broken, we'd better get that fixed.

I reassured the son and noticed that my patient was not moving air well, so I did a jaw thrust. The doctor arrived and gave me the ok for the ativan, which we gave, but the first dose wasn't effective. I noticed the pharmacist was having trouble with the crash cart so I asked if she needed help which she accepted.

I noticed there were five people between me and the cart so I asked one of them to help the pharmacist and the other four to leave so we would have space to work. My patient wasn't getting better with our treatments so we called a rapid response, and man was I glad to see them. After giving my patient's history and updating the family I high-fived my team, charted, and went to coffee."

It's not very exciting that way... but it's what we do, so, when I hear a story with the high drams... well, I just kind of cringe and think "that sounds like it was a hot mess, glad I wasn't there.'

Sounds like you were doing the best for your patient. The serenity will come with time, just learn from this experience, and no running in the halls ;)

Wow....codeteamB.......your post is .....we'll I wish I were as eloquent as you but I am not...anyway thank you for putting the whole issue into true perspective.

Specializes in Oncology.

CodeteamB, I totally understand your point of view. I think one day my heart probably won't beat fast like this forever, but in a way I'm glad I captured it while it still does. Codes are not normal for my acute care floor, so they are usually "exciting".

I'm a writer at heart, a storyteller, and this was a piece of free writing that came from the soul hours after the event.

But yeah, no running anymore... I blame the hormones! I have had situations like this since returning from maternity leave and I do feel more in control and calm. Experience also doesn't hurt.

Your patient is seizing.. not breathing.. you are fighting with a Pyxis?

Stay with her,call the freaking code. Even IF the Ativan was the drug of choice... your patient needed the support of the code team.