CPR on the floors

You have intubated people on the floor?!

Sorry, I meant patients on vent with a trach. The trach came out, hence my use of the word "extubated". What I really want to know is how people feel about launching a CPR on the floor before the emergency team arrives. When you are standing there alone and in shock.

Do you feel that regular renewal of the BLS prepares us on the floors to act during those first few minutes?

Absolutely, even if you have an unusually high amount of codes on your floor.

Sorry, I meant patients on vent with a trach. The trach came out, hence my use of the word "extubated".

Why didn't someone just replace the trach? If you are going to take these patients on your unit, someone needs to be able to do this. If you can't do this, someone should be addressing this with your manager.

What I really want to know is how people feel about launching a CPR on the floor before the emergency team arrives.

Im not sure what you are trying to ask here.

When you are standing there alone and in shock.

Thus the reason for not only regular BLS renewal, but attending mock codes on your unit as well.

I actually did some research on this topic for a school project. I found research that said healthcare providers begin to lose some of the psychomotor skills in as little as 2 months after their BLS training. It varied depending on where the providers worked and how often they experienced code situations. As part of my research, I also read about interventions to combat this loss of psychomotor CPR skills. There are studies that have been done using mannequins to do brief skill refreshers in order to help providers maintain their psychomotor skills. It was all very interesting to read.

If you are genuinely concerned about the CPR skills of yourself and the nurses working on your unit, you should mention it to whoever is responsible for your education at work. Perhaps they could come up with a refresher for all of you.

BLS and ACLS in the last 2 states I have been to are a joke and I feel like it contributes to the poor codes I have responded to in various areas of the hospital. People that should never pass are passing.

I agree that we aren't practicing skills often enough, unless in a specialty or setting where codes are very frequent. That said, once I hit somewhere around my 4 year nurse mark on am intermediate unit, the discomfort/doubts diminished substantially. So I always felt part of it was being a newer nurse. But then we have the heart association and red cross and everywhere changing guidelines for ACLS and BLS every two years lately, or so it seems.

As far as the trach coming out, wherever I've worked before (4 different facilities) there were always 'trach kits' that contained a few trachs of each size and other good fun stuff for situations just as these. I always thought that was sort of standard practice, because of this, so the whole everybody being surprised looking at each other thing sounds really odd to me.

I once had an aide discover a new trached patient with it completely dislodged around 0400, while I was in isolation elsewhere. She threw one rite in no problems. :-) now that is an awesome aide!

Being a BLS instructor and routinely working pre-hospital codes I can tell you that I have seen very poor cpr skills among those who do not routinely "use" the skills; wether through a mock code or actual code.

In my opinion poor CPR skills are not stressed enough by most institutions and lead to unprepared staff who freeze up . Then the administration wants to complain about how the staff did not handle the code correctly.

Thanks a lot for your comments!

I am about to graduate from nursing school in a couple of weeks and in school we are taught to keep the necessary tools at the bedside to replace a trach if it becomes dislodged. I dealt with my first trach patient a couple of weeks ago, and at the hospital they had the same policy.

I think if I had a patient who coded, I wouldn't stand there alone and in shock. I would hit the code button and begin chest compressions. I know I would be panicking inside, but I would at least know to do that knowing within moments other more experienced people would be there to help.

Am I to understand the OP correctly, that a patient's trach dislodged and the patient suffered hypoxia long enough to progress to cardiac arrest?

Or are we combining more than one emergent situation into one?

A replacement of the correct size/type must be at the bedside of every trached patient. If these supplies are not at bedside, and/or the nurses on the unit do not know how to utilize them -- then trached patients have no business being on that unit.

As far as BLS ... two basic tenets of BLS and ACLS are to get help, and that teamwork is necessary to help the patient. The ever-increasing acuity of hospitalized patients virtually guarantees that you will need to utilize these skills from time to time -- as do those who work in every area in the hospital. Speak with your unit educator about some mock code practice - then practice!

Sorry - have to share. When I saw this thread, I flashed back to actually doing a code "on the (very wet and sloshy) floor" when I responded to a code in hydrotherapy. I realized that OP meant "outside of ICU" rather than the literal floor, but it had me going there for a while. Sheesh - that was a memorable code. I can still picture us trying to figure out how to use the defib without taking everyone out who was sharing the same puddle. It didn't end well.

Sorry, but I deal with a lot of codes, and people freeze. It's not a matter of "oh I've been trained, CPR is pretty simple, I got this" people that say it's that simple are not being truthful.

Don't beat yourself up, figure out what you can do better next time. Replacement ready? Bag valve mask where it needs to be, code cart ready? Etc etc.

Had a pt seize after getting "too sober" I inherited her and had her for two hours while she was sleeping in the Ed. The adult bvm kit was there, but someone had opened it from the back to remove the mask. Hence no adult bvm in a room on an apnic seizing pt. oh yeah, I was on lunch. You think that nurse who lunched me let me have it? Of course she did. M

When I said I checked the room and saw the bag hanging there she backed off.

Guess who checks every bvm bag to make sure "it's all there"

Learn, get better, move on.

When people are DEAD it's difficult to be at the very top of your game.

Edrn regional lvl1 trauma/stroke/heart/whateveruo'ded on ER.

NOBODY is a rockstar in their first,second,third,fourth.......code