CODE question

[JMDRN09]

I am a soon to be RN graduate. I work on a med-surg floor and have a question that not one of the nurses who work with me can answer. When a person codes where does the fluid that RT suctions out come from...most times it is dark brownish,coffee ground appearence. This is my theroy...I understand when a pt goes into heart failure their ventricles, for whatever reason, do not pump effectively and blood may pool or get backed up into the lungs. This causes congestion in the alveoli which then causes further congestion in the capilaries filling the alveoli with more fluid and congestion. I also think that the LES sphincter lets loose and stomach/GI contents may find their way back up thru the mouth needing to be suctioned to prevent possible aspiration. Please correct me and fill me in on this burning question. Any and all responsed would be appreciated.

Thanks!

[nerdtonurse?, BSN, RN]

It depends on what's wrong with the person. A patient with emphysema can have dark or bloody secretions; someone with flash edema has pepto bismol frothy red secretions; someone with an upper GI issue can have the coffee ground stuff going on. You can have trauma from the intubation. Best person to ask is the RT doing the bagging after the code. I love RTs, and the majority of them I know are glad to explain what they do or what you're seeing.

[JMDRN09]

Oh thank you...I will definately ask the RT person...I have sooooo mush to learn. The last particular person was end-stage renal failure with mets. When I came into the room he had apnic breathing (whats the other name for this type of breathing again) with his eyes rolled back and no carodid pulse. I told the RN she better find out if he is full code asap (she herself was a new grad...did not think she should have had a pt with such a high acuity..) and got him ready for CPR. He was a full code but unfortunatley he passed...

[FlyingScot, RN]

When I came into the room he had apnic breathing (whats the other name for this type of breathing again) with his eyes rolled back and no carodid pulse.

Apnea is the absence of breathing. A person who is not breathing is said to be "apneic". I think the word you are looking for is "agonal" which is breathing that is very, very slow, disorganized (almost gasping) and not compatible with life. Agonal respirations may occur after the heart stops beating but before the brain stem completely stops functioning. It usually does not last very long but is distressing all the same.

[JMDRN09]

OH YEAH....I thought that was what that was...agonal just couldn't place it. So when this type of breathing occurs it is detrimental to do something asap if called for? I see this type of breathing a lot with our hospice patients and you are right it is pretty quick to progress to death. Thanks so much for all the insight out there. I am so grateful for the information. I feel as if I don't know anything...how long does it take for a confidence to emerge in your practice post graduation? Also when you find your "nitche" does it happen like a "WOW" moment or do you tend to gravitate to your strenghts and let things just flow...

[Virgo_RN, BSN, RN]

This is my theroy...I understand when a pt goes into heart failure their ventricles, for whatever reason, do not pump effectively and blood may pool or get backed up into the lungs. This causes congestion in the alveoli which then causes further congestion in the capilaries filling the alveoli with more fluid and congestion.

Remember your left sided vs. right sided heart failure. The left ventricle pumps blood to the systemic circulation, so when pumping is impaired, pressure builds up in the left ventricle, and the backward effect is increased pulmonary congestion. "Blood" does not back up into the lungs, so to speak. The increased vascular pressure pushes fluid, not RBCs (too big) through the capillary pores and into the alveoli. With right sided failure, the backward effects include portal hypertension and peripheral edema. Again, the increased venous pressures related to the right ventricle's impaired pumping causes intravascular fluid to be pushed into the extravascular space. RBCs are too big to fit through the capillary pores.

[JMDRN09]

Oh thank you....I feel like I am sitting right in class...I am so envious of all the knowledge you all have. I hope to one day be your shoes. I really enjoy the heart and feel this may be a direction I may focus on in the future. Again thanks so much. I am definately going to be visiting this site more often. Everyone is so helpful in my understanding of what goes on with the body.

[dmc_rrt]

as an rt, i thought jmdrn09 had a good answer. the pulmonary edema can also act like a lavage and loosen secretions or tar thats is in the lungs.

[nerdtonurse?, BSN, RN]

Ewww, I didn't think about the tar. Good one!

[bellasage]

Wow.. I'm 3 yr post grad and feel like I dont remember anything!!!