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Discussion

Black Friday, Code Blue

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.

Featured Replies

  • Author
~*Stargazer*~ said:
You did? I don't remember reading that. What I saw was:

Stating that something is not a good idea and offering an excuse is not the same as acknowledging that it was a mistake and taking responsibility. A statement like "Yes, I did X, but (insert excuse here)" is making an excuse, not taking responsibility. Taking responsibility looks more like "Yes, I did X, and it will not happen again/I will do better next time/I have learned from it/etc".

If you did make such a statement somewhere and I'm just not seeing it, then please forgive me.

And yes, based upon your original post, where you described someone who was running and screaming, I would have been offering you counsel were I your supervisor. I'm uncertain why that makes you so defensive, if that is not how events really played out, as you keep insisting is the case. Can you not see how your original description of events, taken at face value, might elicit such a response from your manager?

I only wanted to make the point, both for you and for anyone reading your post, that running and screaming are not appropriate responses to an emergency (I acknowledge that you did clarify that you didn't literally "scream", but keep in mind that you admit that you did literally run).

Yes, I can assure you that I am reading your posts, and the reason I have continued to respond to you is that I am not sensing that you are understanding the points I have been attempting to make. It's clear to me now that you are not able to receive my feedback without getting defensive, and I apologize for my part in that.

Next time I will make sure my storytelling meets your high standards. I accepted your feedback the first time. You didn't need to keep telling me your POV over and over. Don't know why you're so invested to keep beating this decomposing horse carcass.

Again, I didn't ask for feedback, but accepted it at face value. You ever think that being hormonal and being told over and over the same thing when clarified might make someone defensive? Especially when they didn't ask for advice in the first place? I didn't think that there would be this much controversy over the word "scream." If it makes you feel better, let me state specifically that I don't plan to run like that again. I talked about my mindset during the encounter that led to me running. It also is about 10-20 yards from one side of the floor to the other - it wasn't like I ran for a mile. If you take that as an excuse, sorry. It all led to my decision to run, which I accept is not safe, but it happens.

I just think you've made a ton of assumptions and are splitting hairs. Which is fine, but it's kind of funny when my manager yesterday specifically gave me kudos on how far I've come since starting at the same time you're posting about my need for counsel. Thank goodness her perception of these events are what matters, and not you as a random internet stranger.

Have a great day.

  • Experts

Ok guys, let's stop beating up the OP.

OP, I loved reading your post, you are a great writer. It sounds like you did a great job for your patient! And congrats on the baby:)

\ said:
You did? I don't remember reading that. What I saw was: Stating that something is not a good idea and offering an excuse is not the same as acknowledging that it was a mistake and taking responsibility. A statement like "Yes I did X, but (insert excuse here)" is making an excuse, not taking responsibility. Taking responsibility looks more like "Yes, I did X, and it will not happen again/I will do better next time/I have learned from it/etc". If you did make such a statement somewhere and I'm just not seeing it, then please forgive me. And yes, based upon your original post, where you described someone who was running and screaming, I would have been offering you counsel were I your supervisor. I'm uncertain why that makes you so defensive, if that is not how events really played out, as you keep insisting is the case. Can you not see how your original description of events, taken at face value, might elicit such a response from your manager? I only wanted to make the point, both for you and for anyone reading your post, that running and screaming are not appropriate responses to an emergency (I acknowledge that you did clarify that you didn't literally "scream", but keep in mind that you admit that you did literally run). Yes, I can assure you that I am reading your posts, and the reason I have continued to respond to you is that I am not sensing that you are understanding the points I have been attempting to make. It's clear to me now that you are not able to receive my feedback without getting defensive, and I apologize for my part in that.[/quote']

Give it up Stargazer. I would be annoyed with your posts and I'm not 8 mths pregnant. Goodness gracious!

Good grief Charlie Brown.....

OP I really enjoyed your story. :nurse:

Quote
Give it up Stargazer. I would be annoyed with your posts and I'm not 8 mths pregnant. Goodness gracious!

LOL! I know right!?

Everyone on this site is a critic- why can't we just enjoy another person's anecdotes without giving all that unsolicited advice?

mamagui said:
Everyone on this site is a critic- why can't we just enjoy another person's anecdotes without giving all that unsolicited advice?

If one does not wish to recieve feed back then this is NOT the place to post things. I alwasy assume feedback is welcomed if the poster chooses to post their story here.

PMFB-RN said:
If one does not wish to recieve feed back then this is NOT the place to post things. I alwasy assume feedback is welcomed if the poster chooses to post their story here.

I think you assume wrong. People that want ADVICE will ask, others just need to release....

I am a little confused....I don't read where your patient actually coded. From what I get they just had a seizure. Seizures in themselves aren't typically dangerous or run worthy. She was probably unresponsive after because most people take a bit to come out of seizures AND you gave her 4mg of Ativan. That's kind of a lot for a seizure.

Calm quiet codes are the best codes. No one should be yelling or running. There should not be 20 people in the room. You need maybe 5 people...CPR person, Respiratory bagging, a medication nurse, a scribe, and a nurse directing the show calmly from the foot of the bed. A runner outside of the room is a good idea too in case you need something. If you can keep the adrenaline down it makes everything go much smoother. Fast and loud are caotic and counterproductive. Just a thought for the future.

I have a very good friend that nearly coded in child birth a couple months ago....hemorraging, bp 50/20, ect. She was in and out of it. After when she retold the story she just kept saying how calm everyone was and how nice that was. She said I wasn't scared because no one else in the room seemed scared. She knew she was very sick and people were working quickly around her but she didn't feel stress in the room. Her story was a huge reminder of what I already knew. Your stress level definitely translates to everyone on the team, the patient, and the family.

Quote
I am a little confused....I don't read where your patient actually coded. From what I get they just had a seizure.

This used to confuse me, too. I started out in critical care so for me code= no pulse. Seizures, unresponsiveness, and emergent intubations are not codes in the ICU, but in other areas of the hospital they may call code blue in these situations to get the support there faster. Can anyone clarify this?

SwansonRN said:
This used to confuse me, too. I started out in critical care so for me code= no pulse. Seizures, unresponsiveness, and emergent intubations are not codes in the ICU, but in other areas of the hospital they may call code blue in these situations to get the support there faster. Can anyone clarify this?

Yeah, I've seen this too. This shouldn't happen anymore with the advent of rapid responses, though. They should be called as rapid responses, in my opinion.

  • Experts

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.

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