Code blue

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Picture this: young-ish chronic trach/vent patient. You know him well. Hes been on your unit for months waiting for placement. You know him, he knows you. he has family, they don't come to see him much- they are broke and cannot afford to come see him- so you ARE his family.

The day starts out fine. Nothing out of the ordinary. Lunch time passes, you step off the unit to transfer another person out- come back to find that Mr Man is not doing so hot. You and RT work to get his sats up but not much is helping. Doc orders a CXR via phone- but that's it. Results are phoned to him- at this point sats are 91% so hes pleased.

20 minutes later, you walk in- notice a HR of 28 on the monitor in the room... "Hey, Sir, Are you with me? Sir" shaking him feverishly. No response.

"I NEED SOME HELP IN HERE!!!" you shout to your buddy nurse. She enters, you've already begun compressions, she hits the code blue button and yells for more help. Its a Saturday, so you do not get the usual influx of people.

The patient looks at you. He is awake. "You with me?" he shakes his head yes. "You're scaring us man..." He is a trach so RT is bagging him.

His heart rate begins to drop again, his eyes roll to the back of his head. Dr orders some epi. His rate is back up to 50's. Atropine is given. nothing really happens. Epi wears off- hes bradying down again. More epi. More atropine.

His wife is called, but does not understand the urgency and couldn't get to the hospital even if she wanted to.

Dopamine drip is started, lines are put in. Meanwhile- he is blue. Mottled. Cold. Mostly unresponsive. Seizing.

Code continues. You are hoping that this main can just be left alone and out of his misery that he has been in for months, years now. But- we have a duty.

Code continues. Labs are drawn, severe metabolic disturbances. More meds. More fluids. Nothing. 2 hours later, doc calls the code. You tell him you are hear with him, he is not alone. It is OK to "go". That he is not alone. His agonal rhythm eventually stops.

You have to tell his wife he was died. He is dead. She is not understanding this information well. Now, once he is dead- an wave of family swarms in. "why couldn't they be here when he was alone??" you ask yourself.

You know he is in a better place, but you still feel off. Sad. But, Mr Man looks more peaceful, laying there without his vent, IV, tele leads... More so than you have ever seen him.

You carry on with your work and make sure everyone else is OK. Incoming shift is shocked to hear the news, you finish your mounds of paperwork, go home, and think long and hard about the events that unfolded during your shift.

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The shock of having a code on one of your patients is always difficult to overcome. You will most likely re-play the events over and over in your mind for some time. Was there anything you could have done differently? Depends on your policy and procedures allowed by your facility. Perhaps he should have had 100% oxygen placed, it sounds like he was not getting enough oxygen and that may have kept his heart rate down. 91% may be OK for some people, but not him. He could have thrown a pulmonary embolus, which you would not have been able to do anything about. You responded appropriately, it sounds like the facility is low on manpower during the weekends, still emergencies are going to happen. Is there anything you could/should have done differently? If he was a full code I most likely would have asked the MD to have him transferred to an acute facility. It sounds like you had the appropriate medications to treat him, but he was not responding. Codes do reach a point where you have to accept the patient is not going to make it. The emotional rollarcoaster felt during and after a code is not easily describable(?). Especially when you are attached to a patient, it is so much harder. The only way to help you recover from this type of situation is to prepare yourself for any such re-occurance. Take an ACLS course, have mock codes so that even the weekend staff can respond better. Do you have a code sheet that information is recorded on? If not get a copy from an acute center and adopt it for your facility, it will help to review this after a code to see where the weaknesses are. Good Luck!!! Don't rake yourself over the coals, we all have lost someone who we were close to as a care giver.

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This is why it is not professional to get attached to the point that you feel you are "family". This is the reason you can't stop replaying this.

That and the fact that the doctor needed the cojones to call that code after 3 rounds of ACLS.

It was Mr. Man's time... he is no longer suffering.

But you are.

Please utilize your EAP.... get this talked out.

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Specializes in pediatric.

You need to debrief, in whatever way is helpful for you (typing it out, talking to someone, both??). I've only seen a code once, as a nursing student, and I will never forget the look on the guy's (dead) face. He wasn't my patient but it still had a strange effect on me. I called a girlfriend (a nurse) on my way home and felt much better just talking out loud with someone about the array of emotions I was experiencing.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

((HUGS)) It is ok to be bothered by a code. You can't let it overwhelm you but it is hard sometimes ...you genuinely LIKE them. It's ok ((HUGS))

Patients die...it is a part of life. Sometimes no matter how hard you try...they still die. Sounds to me like a pulmonary emboli. 3 rounds of ACLS on a chronically vented patient is a valiant effort.

Take a hot bath, have some wine...or ice cream or all three. Love your family. You still did good today!

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Specializes in critical care, ER,ICU, CVSURG, CCU.

esme12, said it best, I was thinking PE also, large ones, ie saddle emboli can not be resusitated successful ((hugs))

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This is why it is not professional to get attached to the point that you feel you are "family". This is the reason you can't stop replaying this.

I respectfully disagree, I have a few codes that have hung with me and I didn't know one of them at all. I do agree however you have to mind your attachments to your patients.

I also agree you need to talk this out and be kind to yourself. This is going to happen, what they don't tell you in nursing school is eventually some incident is going to give you a bit of PTSD. This is yours, don't ignore it. Start working on it.

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You are only human; it is okay to feel emotions after coding and losing a patient. (((HUGS))) This is why I am an advocate for debriefings after an event like that...for all who are/were involved, from PCT's to PT's, to RN's, etc. Some patients get to us more than others, especially those that we have taken care of for so long. Talk to someone on your unit, cry, get it all out, and deal with it in a healthy way.

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That man's death sounds like the best outcome for him considering what all was going on. And who the heck codes a patient in that condition for 2 hours?

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Specializes in pediatrics, occupational health.

Hey there,

So, I am wondering if it was the fact that your doctor coded for so long that was bothering you? I know that for me, when codes run smoothly, then I don't wonder about the code when I go home, but I think about the patient and what his loss to the family means. However, sometimes codes are not so "smooth" and man, that can stress out everyone! Those are the codes I replay in my head over and over - because I want to make sure that the next time we code a patient, those things don't happen again!

Of course I always shed a tear or 2 when one of my patients die, but - probably like you - I just remember that I am there to be the strength for the family, not the other way around. I think that compassion makes me a better nurse and the family can see that their loved one was important to me.

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Firstinfamily-

I suppose I should have added some additional info. He was put on 100% on the vent when I first noticed something was "off". Also, we were in an ICU. He had been with us long term due to placement issues. We knew him well. Before he got too bad i looked at him and had this feeling that "today might be his day..." it was strange. Im doing OK, I've had a few days off to recouperate.

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Specializes in Emergency, Telemetry, Transplant.

Did a doctor have a discussion with him about code status? You use the phrase "out of his misery." Did he want to go? I hope someone talked to him about his wishes….as a nurse we may need to facilitate that discussion between the pt. and the doctor.

Either way, talk to someone about about. It should get better with time.

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