codes

we've had a few interesting ones lately. we had a vent dependant (home vent) patient that insisted all day that she was dying. there were no changes in her assessment from previously, in fact there was discharge planning in place for the next day. however, at 6p during end of shift I/O rounds, the patient was cold, cyanotic, hypotensive, and with a rapidly decreasing loc. the doctors were notified, the vent was working properly and and ekg showed nsr. while standing at the bedside the patient coded. asystole. code proceded as usual. pulses came and went, never saw any fibrillation. (patient was allready trached) code was called by the Intensivist attending. Myself and another nurse proceded to postmortem care, pulled IV's, foley and was placing patient into a clean gown. when the other nurse lifted the arm she palpated a distinct brachial pulse. we then noted faint breath sounds and heart tones. the attending was called back into the room (he was speaking to the family) and a code was called again. this occured over a 20 minute time period. this time, the patient did not resume breathing and have a return of pulse. we were all quite perplexed. the doctors have not been able to explain. the equate the resumption of breathing to an "apnea test", but the pulse is unexplained. too long to be "drug effect."

I've only been involved in one code and heard about the other.

The first was a neonate, just born from a C-section. The baby was blue, heart rate of 50 and not breathing. The typical interventions of tactile stimulation, suctioning, etc did not work. We lost the heard rate, subsequently intubated and finally began chest compressions, adminstered epi, etc. Our "codes" in OB aren't ever really broadcasted as a "code 4" obviously because we are already there - but it was a scary situation. The baby made it.

The other was a no-name patient who arrived at our hospital, was only 15, pregnant, and coded right when we got her in bed and on the belts and after delivery of the baby. THAT was a full out code and we had to call it over the intercom, as none of us are ACLS certified. She was resuscitated and was transferred to the ICU. The problem was I guess she had severe eclampsia and possibly went into DIC. She recovered too. That one was particularly scary as that is way out of my scope of practice! Neonates is one thing, but adults?? Yikes.

Well many years ago .......

I worked in a CCU, I was new and it was a major hospital. When I started there I didn't know but a p wave was fit to eat. There was very little orientation back then and after two months I was put on code. I thought I was OK to do it as I had been in on several in the unit. Well no one told me that the Monitors on the floors were totally different than the ones in the ER. So I ran to this code and conected the patient to the monitor, turn it on, and nothing. I had no clue what was wrong and as there was only two of us on in the unit I couldn't get the other nurse to come up and help, when I called down he had no idea either. The doctor kept asking will someone please get this monitor working. Finally someone pressed an odd button and we were in business, what was the odd button you ask....lead selection. Lesson learnt, now I make sure I think ahead and am fully comfortable with all equipment. It was a very hard and embarassing lesson to learn and the patient survived despite me.

One time, when I worked in New York, we coded a man in the ICU and after we had resuscitated him, he stated he was someone else!!!This man kept insisting on us contacting his "wife". We called the wife and found out that her husband had died the week before. After we had contacted this woman, the patient we actually had in the bed coded again and did not make it. This story was absolutely true and I have thought about it many times since. I wish I had talked to this man more after the first code. I think that the man wanted to let his wife know he was okay... Scary to think about, but about 10 of us were present to see it for real... Sometimes as nurses we get to glimpse a part of things we might not want to believe in, but this event has helped me to be aware of supernatural happenings

Originally posted by babynurse7:

For all of us out there who have experienced a code situation, I think it would be intersting to share some stories. What was your best and/or worst experience? I am trying to get more comfortable with codes and would appreciate reading about other people's experiences. Thanks in advance for sharing

babynurse,

One of the many blessings of being a pediatric nurse is that we rarely lose a patient in a code. However, you are probably working NICU, and I work on the floor-I imagine your loss rate is a little higher. I've been through several codes over the span of my career (all pediatric). The biggest percent of the time in pediatrics, the problem is respiratory, so once the airway is established, all is good. Cardiac arrest is very rare, or at least I've not seen it in peds. As for "getting comfortable" with codes... I hope i'm never comfortable with them; that fine line between life and death should always nauseate us. But yes, you will become more comfortable so that you can think clearly, etc.

had a pediatric code on time. Just resp. evey time the doc tried to tube the girl would sieze finally the doc went down the nose and he still couldn't get airmovement he pulled the tube out and had about 2 tsp of hamburger on the balloon. the original admission was siezure in school. she siezed during lunch and aspirated the hamburger. after the dr removed it she was fine

last year we had a 46 yr old male present to the er ( drove himself ) diapheretic, cool, c/o L side c/p going down L arm and up into L side of neck . put him on the monitor and he was in VFIB we shocked him ( pt awake ) he said hey dont do that again. then went BRADYCARDIC gave him some atropine, after a minute went back into VFIB shocked him again ( still awake ) said , i said dont do that again . anyway he was having an acute MI, we started activase, heparin, and ntg ..and flew him to oklahoma city and he had tripple by pass surgery.. he had a big family history of heart disease, father died at age 44 of acute MI and brother had died at age 50 acute MI.. he came in the er 2 months ago and it was great to see him doing so well..that i think has been my most memerable code...

True Story: about 15 years ago I worked in a Catholic hospital. This women was fine at lunch time and approx 1 hour before the Supervising nurse had changed her IV. I was charting on a post-op when one of the nuns came up to me and stated honey the woman in room 15 is cold and needs a blanket. well when I went to give her the blanket she had been gone not to long after the Sup. RN had been in there. But the MD wanted a full code which we did for about 20 minutes. after wards the nun came up to me and wanted to make sure I had given her the blanket.

babynurse-

Seen many codes in my 8 years of nursing and 2 years of nurisng school, I have lost count, don't know if this is bad or good. Worst experience-- ON call for SICU on Thanksgiving night (I worked 7p's), well come about 2300 the ER got slammed, and MICU was already at max for the number of staff, and SICU was not far behind, so got called in about MN or so, to get a patient from tele floor that had arrested, 3deg AVB rate of 20--> asystole-->whole nine yards-->rescusitated him, waiting for ICU nurse to come in to work (that would be me) to take him to the unit. Well I go in to work, go to tele, pt is on 20mck/kg/min Dopa at this point, Cardiologist was there, wanting to float TVP when we got to ICU, pt has TCP in place with good capture, get this man into elevator and if he doesn't proceed to drop his rate again, lose capture, coding him in the elevator, bascially turned up the mA.. Got him to SICU (which was full from the ER slamming party, and was overflowing into the PACU which is connected to SICU) kept him in tele bed, got him connected, vent setup, etc. No warning this mans HR shoots up to 160's, his just tachy away, well Cardilogist, wanting to float TVP to try and overdrive pace this man out of this SVT. Well the Cardiologist gets introducer in IJ, starts floating the TVP into RA and into RV, ramming this catheter down the introducer into RV, the man fibrillates, V-fib all over the place, of course the monitor that has the pacing capabilities (which is still on pt) doesn't defib also (hospital trying to save a buck), so we have to get him on the SICU crash cart monitor, and the Card. is screaming "shock him, shock him", so we defib this man without gel, no pads just paddles, stank, but it worked, well right after this the Card continues to mess with TVP, during this time we get pt on the fast patches/hands off defib pads, sure enough pt fibrillates, shock him, start the ACLS stuff, he comes out of fib for maybe 5 minutes, long enough for Card to finally decide that maybe just maybe he tickled this mans ticker to hard, well pt goes into fib again, shock he comes out for brief period, fibs again, third times a charms stays in it this time, we CPRing him, Medicating him, the whole nine yards for almost 2 hours from the time we roll into SICU, well right smack in the middle of this code the lady in the bed next to him gets a hold of her ETT and out it comes, so we got nurses(3 nurses for 7 pts in a 5 bed SICU, and my code man was singeled cause I never had chance to get report on what would have been my 2nd pt.) over there trying to bag her, we are calling another code cause this lady needs to be reintubated, well ER doc gets there an reintubates this lady, we continue coding my man who is still in fib, we finally exhaust all possible medical interventions(he was on Epi, Levo, Neo drips) and the Card calls the code at about 0330 or 0400 somewhere in there, and then the Card wants me to tell the family/wife-I said NO, its your job, I will go with you and help you tell the wife and daughter. What really breaks my heart is the wife never got to see him after we got him to SICU, cause we started coding him like 5mins after we got there.

Best experience--

Working in cath lab on call, have to come on a Sat afternoon, for acute MI in ER, the lady agrees to be in drug study (this is at large teaching hospital), well we get her to cath lab, research nurse is there, gives me drugs to give the pt. give them to her, and now have to wait and hour, before cath her. Well hour goes by, and Intervetionalist egages RCA with the catheter and shoots the contrast, and the lady bradys and quickly very quickly deteriorates to v- fib.Of course we call the code overhead so Anesthesia will respond to intubate, and being Sat. there is no obviously no other patients, so the family knew something was up when all these people came running by the waiting room. Well all Intervention patients get the fast patches for defib as routine, we shock her, she comes out of it, does not last she refibrillates, she is awake during most of this, (thank god she doesn't remember any of it) saying quit (at least up until she was intubated) to the chest compressions, and feeling it every time we shocked her. We defibrillated her 16 times before all was said and done. She survived, did very well, came back the following week to have lesion in LAD fixed, this went off without a hitch. Very sweet lady... Well these are my two memorable ones....

Have worked in ICU for many years, now work in a cath lab, so have been involved in many, many codes.

My very first code happened when I had been a RN for about 6 months, working a med-surg floor night shift. I admitted a patient who had passed out at work with a hx of blood-tinged vomit. I got his admit done around midnight and tucked him in bed, family went home, plans were to scope him in the AM. About an hour later, he calls me into the room stating that he felt like he needed to vomit. So I handed him the kidney basin just in time for him to throw up gallons-upon-gallons-upon-gallons (or so it seemed to me!!!) of bright red blood and then become non-responsive, pale, cold and clammy, thready pulse, no palpable BP. I screamed for help. Help came, thank god, for I did not know what to do.

We got him to ICU, he immediately went to surgery to remove his stomach (an ulcer had eaten through his stomach to his aorta -- hence all the blood!) Despite my unpreparedness (is that a word?), this man survived and was even my patient several times when he came back to our floor several weeks later.

I became a very different nurse after that night. I made it a personal goal to never jeopardize my patients like that again. I always check every room to make sure suction is set up. I made it my job to check the code cart every night I worked to familiarize myself with the defibrillator. I went to every code called during the night (when I was able to go.) I became ACLS certified, and eventually an ACLS instructor. Three months after that incident I transferred to ICU.

I highly recommend to ALL NEW NURSES to familiarize yourself with the defibrillator on your floor. Remember some defibrillators will turn on reading the ECG from the paddles, not the leads. So if the paddles are still sitting on the defibrillator, they cannot be reading the patient's ECG, right? (This is a very common mistake in my hospital! - that's why I mention it.) If you are not ACLS, there are still things you can start before the code team gets there: Does the patient have IV access? If not, try to get one. If patient is not breathing or have a pulse, place backboard behind patient and start bagging and CPR. Someone should be getting patient hooked up to the leads of the defibrillator. Have someone get patient's chart in room. Make sure that patient's nurse is in the room (the doc responding will have questions!) I know many of you are probably thinking, "well, duh!" but I have responded to codes where there were 6 nurses in the room and all were standing watching the nursing supervisor try un-macrame the leads of the defibber while no one was even looking at the patient!

Always think for the best, but prepare for the worst!!!

You never forget your first. I was on orientation on a tele floor and I had a patient in for rule out Mynasthesia Gravis. He was stable except for his neuro status. He went down for a CAT of the head and was allowed to go unmonitored.

When he returned I was next door finishing a dressing change. The orderly looked in and told me he put the pt. back in bed. I finished in about 60 seconds and went in to hook him up to his monitor. Nothing! I checked the leads, messed with the gain. " What the f#*k!" I thought. An RN passed by an I yelled to her to come in here now! She did the same thing I did, then she check for a brachial. "Holy S*#T! He's cold!! Start CPR" She yelled!I did compressions and she ran the cart. The charge nurse came in a checked the leads too! We just couldn't believe it! This took place in the span of 45 seconds until we called a code. We never recovered a pulse and called it after almost an hour. We speculated he died down in CAT scan by how cold he was. We wondered what that CAT scan showed....

Then there was the code that never was. I was floated to step down to care for tele hold pts. I answered a call light and went in the room and looked for the cancel button. I found a little black button on the wall and pushed it. Next thing I hear overhead, "Code Blue, 8 South" I run out in the hall and me and 4 other nurses look at each other yelling "Who is it?" Then I realised what I'd done! Thankfully the residents were already just hanging out on the unit and the supervisor just had a good laugh.