Code Blue in the ICU

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Specializes in ER, ICU, Telemetry, NICU, Pediatrics.

Howdy ya'll...gotta vent or else I may just make some stupid decision like quit nursing and run a bar for nurses, LOL!

I work in a busy central ICU..this means that we do all MICU, SICU, CCU, Neuro, etc. In the last 7 shifts ( 5 of them together), I have ran about 6 code blues on patients that were kept lingering with up to 5 cardiac drips, vents, PEG's and multiple lines because family members were not given good direct information about the very real possibility that we are just making their loved one suffer. Now I know that there are modern day drugs and miracles happen all the time, however, when the poor 80lb 80yo male is having chest compressions for the 4th time that day and has been burned twice by the defibrillator, IN FRONT OF THE FAMILY and they ask why he is "crunching" when we do compressions....I get a little angry. These people have been told he is not going to get better and that we are now making him suffer and that it is inhumane to keep doing this to him. I was able to get DNR's for 2 people who were anoxic brains and the family asked for the code to be stopped because I gave them the truth and let them know that it is ok to let your loved one die with dignity and not suffer.

How come we as a people will take our dogs who have been run over and irreperably damaged to the vet to die in peace and yet we will make a family member suffer so? :angryfire I came home yesterday from the run of 12's and cried for over an hour, and I normally don't cry unless I am really mad. I know I can't change how people treat the death of a family member however I am willing to give full disclosure and trust to the person who is making decisions about their loved ones, so that they can know it is ok to let go when the time is right. I think a lot of nurses are scared of DNR's and scared to take responsibilty to talk to the family. This is sad.

My grandparents decided to have out of hospital DNR's when they had terminal illnesses and they both died at home peacefully with family around them and I was able to care for them until the end.

I guess I just got overwhelmed with the multiple codes on patients with little chance to recover at all......Thanks for listening to this ramble.

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Specializes in Utilization Management.

I don't blame you a bit, saernurse.

What bugs me is that patients will have DNRs and Living Wills stating their wishes, and then some family member in complete denial will come in and be allowed to totally override that person's decision, allowing G-tubes, vents, all the stuff that the patient did not ever want to have.

It's just not right!

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Yes, we see this so much! I know that it is hard for some family members to let a loved one go.... but the patient is going through so much pain and suffering! It is really hard to see your patient hang on for days...... and you as a nurse know that the patient is not going to make it..

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I , too, see this more often than is necessary. The problem is so multifaceted; patient, families, doctors, religious beliefs, etc. (not to mention, guilt!)

All we can do is speak the truth and constantly update the family with observations about their loved one. Sometimes it takes families a day or two or three...to come to terms with the truth to feel comfortable enough to make the DNR decision. And somtimes that is too late; we've already cracked more ribs with compressions, burned more skin with shocks, etc.

I've talked to the docs on several occasions and told them I would not do compressions if this particular patient coded, (although I probably would have in the heat of the moment), and this was enough to get the docs to talk to the family and encourage the DNR order. On separate occasions the patients died within hours of receiving the order. During those precious few hours I was able to spend my time explaining the dying process to the families and encourage them to talk to, hold, cry,etc with their loved one. We also offer to make hand prints and cut a lock of hair should the family want these. We then give them a "memory box" in which to store the handprint and hair as well as cards, etc.

I try to have the families bring their priest, pastor, minister, rabbi, etc., to the hospital to help them with the decision making process. Sometimes they need to hear that it's ok to let their loved one go.

Having said all this......it's still never easy and it still happens too often.

Melissa

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I'm sorry. I do think this is the worst part of nursing.

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Specializes in Step-down and Critical Care.

I agree with everyone and I think some of these DNRs are also so broad and are not explained to the family in depth. I mean we have patients that the family does not want them intubated but please ponder on their chest and shock them over and over again but they still will not live. Or they do not want CPR, defibrillation, intubation but please push meds. I know that the family does not understand without CPR those meds will not do very much. I think sometimes it is for a comfort measure for the family to say that at least they did something to save their family member but when it "enough-enough?" I also find this very frustrating as a nurse and I do not have any issues with discussing this with families because I feel it is their right to know what we are going to do to their loved one.

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I don't know what your personal experiences are, but would ask you to be careful not to judge too harshly unless you have been in the family's shoes.

I have.

When my mother had her first cardiac arrest, I witnessed, did CPR, she recovered.

Years later when she had the second, I was not there. The ambulance crew coded her for something like 20-30 minutes and got a heartbeat back. She was intubated, etc. Initially, we stated that we wanted aggressive treatment, until we could see if she could recover. Vent, external pacemaker, drugs, etc. 12 hours out from the event she was going tachy and requiring multiple conversions. At this point the one doc looked at my family and asked "how long are we gonna keep doing this?"

Well, let me tell you, he was lucky he didn't get his block knocked off.

Keep in mind that 14 hours earlier this woman was Christmas shopping for her grandchildren!!!

After observing her, talking amongst ourselves and talking with the neuro doc and internal med doc, we decided after about 2-3 days to make her a DNR when it was apparent that she would not recover.

She died 10 days after the initial event, after a gradual reduction in interventions. (removal of vent, pacer, meds, etc)

I believe that my family and I handled the situation appropriately and that that doctor was completely out of line suggesting that we stop trying less than 24 hours out.

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Specializes in LTC,Hospice/palliative care,acute care.
I don't know what your personal experiences are, but would ask you to be careful not to judge too harshly unless you have been in the family's shoes.

I have.

.

Great post-it is very hard for many of us to be non-judgemental when delivering care. We can only make these hard decisions for ourselves and our loved ones and what we believe we would do may not be exactly what we do when in the moment...As I've gotten older my life experiences and maturity have enabled me to accept the things I cannot change.It still is hard to watch some of this crap happen but I know I have done all I could and then I let it go...I HAD to watch my family suffer-I don't have to take on the emotional burden of anyone else I care for....
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Specializes in ER, ICU, Telemetry, NICU, Pediatrics.

Kitty, thank you for your post. I guess it would have been wise of me to let ya'll know that these patients had been in our ICU for more than 3 weeks and that it was and is always hard to make a decision in that time. I always am as non-judgemental as I can be however it is hard to see someone suffer. I am sorry that you had to go through that and thank you for sharing that with us.

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Specializes in Step-down and Critical Care.

I can understand the frustration being asked to make a decision just 24 hours after the event. It is hard to be nonjudgemental being the field we work in on a daily basis and we see how some of these patients do suffer. I have been on the other side of the fence also and it is a very hard decision to make. You really need factor the of what would the patient want.. would they want to be on life support and have their chest beat on from CPR repeatedly and all these medications being adminstered just to keep them alive? That is why I firmly believe in a living will and advance directives for patients. I also believe talking to family members before anything happens about my wishes. I want them to know that I do not want my end of life sustained through artifical means. I want to be made comfortable and let go peacefully. I think communication is the key factor.

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Specializes in SICU.
I can understand the frustration being asked to make a decision just 24 hours after the event. It is hard to be nonjudgemental being the field we work in on a daily basis and we see how some of these patients do suffer. I have been on the other side of the fence also and it is a very hard decision to make. You really need factor the of what would the patient want.. would they want to be on life support and have their chest beat on from CPR repeatedly and all these medications being adminstered just to keep them alive? That is why I firmly believe in a living will and advance directives for patients. I also believe talking to family members before anything happens about my wishes. I want them to know that I do not want my end of life sustained through artifical means. I want to be made comfortable and let go peacefully. I think communication is the key factor.

EXCELLENT post.

It's extremely difficult for me to watch a patient needlessly suffer for days on end while the family agonizes over a decision. Clear communication and documentation of wishes could prevent a lot of that.

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