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Discussion

Crashing pt

Hello everyone. I recently started working in the ED a year ago,and during orientation didn't get many "sick" pts. Recently I've had a few pts who have coded upon arrival. What is the role of the primary RN during a code in the ED?

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That depends on how your unit handle codes, resuscitation room roles and responsibilities.

At my ED we have a resuscitation room where a nurse is a documenter, who is responsible to being a team leader in the code; there is also a nurse left, who manages IV access, administering meds, collects labs/ evidence if needed and performs initial chest compressions; nurse right manages vitals, can IV access and assessment.

When I was on orientation, I was oriented to all three roles; if an emergency arises outside the resuscitation room, there's still assigned people as well as a charge nurse to help if that occurs.

Institution specific, but in my ER, the primary nurse generally records. We don't have a specific resuscitation room and any nurse can take any role.

The primary nurse can also run the code with the MD if comfortable. I will also try to order labs which seems to be overlooked til later. I always make sure we get a fingerstick.

We have the primary nurse do the documenting usually. Second nurse is usually iv/meds. Techs usually do compressions and if third nurse available, does the monitor/defy. Most times we have too many nurses in the room which adds to the chaos.

Once there is a team to run the code the primary nurse documents and fills in any role needed.

If you are alone in the room and they code you "push hard and fast on the center of their chest until help arrives" which is usually achieved by yelling something loud enough that someone else hears, though there is a "code" and "staff assist button" avail, and we all have phones. But nothing brings people running in my er faster than someone yelling. Once they figure out I'm not a drunk pt, they usually get things rolling. Then the primary nurse starts doing other things as help arrives and once a whole team is there they chart.

This of course is all how we do it, not how it's done everywhere.

Usually the primary RN documents, since they are ultimately responsible for the patient. In a pinch anybody can do it, although when I'm the primary I prefer to document on my own patient.

If I'm the nurse assigned to the patient I assign the roles. I make sure the patient has IV access, that the tech is doing compressions appropriately, I do medications and shock. Have someone else charting and someone else getting clothes off and placing the patient on the monitor.

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