First Code Blue

Perpetual Student · Oct 22, 2012

1. How do you handle situations where you find a pt unresponsive?

Call for help while assessing and start BLS, and other interventions once adequate assistance is on hand. Start CPR as promptly as possible. Don't be afraid to direct others in what to do to assist you. You need to be AGGRESSIVE. Learn to harness that adrenaline rather than letting it freeze you.

Under extreme stress fine motor skills deteriorate. Try to use big, simple movements

2. How did you feel after the fact?

Most codes at work don't bother me all that much. If it's a younger person, or someone otherwise pretty healthy it sometimes makes me pretty sad. There's only one I've been involved in that still gives me chills every time I think about it. That's not to say I don't respect the value of life, just that I've grown to accept that everybody dies. And honestly, I wish the pain and suffering would end for some of the folks who're still kicking.

Here's an excerpt from a post I made in response to a somewhat similar thread in January:

Some folks (even experienced ones) kind of freeze up and hesitate for a moment, particularly when it's a sudden and unexpected change. I'm one who generally jumps right into action without hesitation. I'll try to explain my thinking and how I avoid freezing up. The key in an emergency like this is team work. No one person can optimally manage a true emergency alone.
One model for decision making is the OODA loop (PALS has a modified version in its curriculum). In decision making you observe something, orient yourself to it, decide what to do, and act. The quicker you get from observing something (say low SpO2 and unresponsiveness) to acting the better off you're going to be. The best way to decrease that time is to consider what you would do in various scenarios. For example, know what you're going to do if your patient stops breathing. When you see the patient stop breathing don't think, just do what you've already programmed yourself to do. Thinking through how you'll respond to various emergency situations is one of the most important things you can do.
Always expect the worst and prepare for it. For example, if the patient's respiratory status is rapidly deteriorating it would be prudent to provide him with more O2 and prepare a BVM along with all the other interventions. Sure, you might not actually use it if less aggressive interventions (e.g. stimulation, repositioning, reversal of drugs such as paralytics or opiods, etc.) are successful, but it's better to be ready.
Intervene early and aggressively. If something's not right fix it before it becomes a disaster. For example, if you notice a disturbing trend in your patient's VS reacting early on and preventing it from turning into a code is ideal.
Don't be afraid to tell others what they need to do, esp. if it's your patient. Coordination is important. Someone needs to immediately assign roles.
Don't worry about looking like an idiot and allow it to paralyze you. Do your best to do the best thing for the patient. It's not about you, it's not about your coworkers; it's about the dude in the bed.

tee0220 · Jan 26, 2013

i have a question for new nurses or experienced nurses that have never been in a CODE BLUE ..

what are some of the things that you might find challenging ? and what are the things that you would change about the crash carts to me more user friendly?

NurseOnAMotorcycle, ASN, RN · Jan 26, 2013

Hi, Tee!

Most people's biggest challenge is that "WHAT DO I DO?!" moment. As long as you call/scream for help, you've done the most important part.

The next thing is that you'll wonder what else you should be doing.

If you're a student, take advantage of the practice lab and drill yourself (and your friends) until you do it on autopilot.

1. Call for help.

2. Check for pulse/breathing.

3. By then others have come to see what you're yelling about and will help you out.

4. If you have to ask yourself "Should I be doing CPR right now?" The answer is always YES!

Like the original poster did, it's good to get feedback afterwards so next time you will 1. get closure, 2. be more confident and 3. be able to do more in the next code if needed.

Evolving RN · Jan 28, 2013

When patients die, I do not usually get emotional. This was weird for me at first because I am a very emotional person. But I consider it a blessing because there is no need for excessive feeling in these situations. As far as how you handled the situation, you did what you were trained to do. Consider becomine ACLS certified. I just went through the training and new I am better equipped to handle a code situation. Also, depending on your resources, you may want to consider asking if you can tag along with the rapid response team for a day or two. My thinking is that it might help you to feel more comfortable with emergency situations.

AF-Wife · Jan 28, 2013

Our unit did mock codes monthly but it never compares to an actual code. It's sad but true, the more codes you are in the better you become. For the original poster, you did the right thing by calling the RAT. If you are the one who finds an unconscious adult patient with no pulse, immediately start CPR. Now with the new BLS guideline, if your oxygen is not set up and you're going to have to take more than 10 secs to set it up, AHA rather you not and just do continuous chest compressions. Codes are pretty chaotic and everyone on that team has a distinct role already. So just jump in and try to help. If a second IV needs starting than take initiative, if labs need to be drawn than do it, etc. I worked in the PICU so we didn't have a code team. All the nurses in that unit just stepped up, started recording or doing chest compressions during a code.

tokmom, BSN, RN · Jan 28, 2013

When I hear a code and am running to grab the crash cart, I'm mentally going through my head the pt status and the ABC's in my head and the order of. Once the rest of the team arrives, I step back and let the ED/ICU nurses take over. They are the alphas and I let them be there for the pt and with the MD. They thrive on the rush and I don't, lol. I'm happier recording, fetching or taking care of the family.

Some new grads feel they should have jumped in and 'saved the day'. I tell them it takes an entire team to run the code, not just the pushers and compressers. Everyone had a job to do, even those on the floor. They are responsible for taking care of the other nurses pt while he/she is in the code.

The last code we had, I prepped the pt with leads, board and was ready to start CPR when the code team arrived. I actually stepped out of the room and found the family crumpled by the door crying. My role wasn't in there doing compressions or barking orders but sitting on the floor with the pt family and holding their hands and explaing what was going on.

Sounds like you did a great job. Sorry to hear about the demise of your pt. Don't beat yourself though. Healthy people don't code and the odds of bringing them back are not typically in your favor.

akulahawkRN, ADN, RN, EMT-P · Jan 29, 2013

I had my first code blue today. Found my patient attempting to leave AMA but was found slumped over while he was waiting on a ride. I was shocked at myself for not being as emotional over the whole thing as I should. I pressed a RAT, men moved him to bed, pressed a code blue and by then everyone was in the room. What I didn't like was that I felt like all I did was stand around. I wasn't sure of my position, and didn't know who to ask so I could know what my role was. I jumped in and grabbed supplies as needed and was up for doing CPR when they called it. I just wish I knew what I could have done better in the situation. The charge nurse and the coordinator didn't have any extra words of advice and they said I did fine, but I just feel like I could have done more. Maybe I couldn't have, but I would like to think I could.
I honestly am not too worked up over this pt dying. I feel for his family because I have been involved in a sudden death on the family side. I didn't cry, I asked questions, my unit was very helpful and let me talk it out and hugged a few times. I feel like emotionally I handled it well, just wish I could have done more at the actual code.
So questions for you:
1. How do you handle situations where you find a pt unresponsive?
2. How did you feel after the fact?

First off, you did absolutely fine for this being your first code. You'll never forget it. If all you're trained for is BLS, just be a gofer, do compressions, or talk to the family, if any are present. I've done a few of them. I remember my most recent code... and the first one. The others are pretty much a blur. Most of them will die. The biggest thing you can do is establish that the patient needs help and get that help on the way as quickly as possible.

If you take an ACLS class, watch how the people that are re-taking the course do it. They'll show you that there's a rhythm to the whole thing, an organized chaos. You'll see where you fit in the team and what needs to be done. Eventually, you'll just be one of those nurses that people look to in a code because you know what to do. You may not be a rockstar at it, but you'll be good enough.

Now to answer your questions...

1. Assessed, determined unresponsiveness and absent vital signs... and got right to work. That, of course, meant following all the appropriate BLS and ACLS algorithms.

2. Personally, I usually feel fine. Why? I've done everything I can for my patient. Afterward, I might go have lunch or dinner. It's just part of the job.

It's not that I'm callous or anything about this, it's just that I've run a few codes and it's nothing new. It's pretty routine, even though it's been quite a few years since I've run my last one.

dah doh, BSN, RN · Jan 29, 2013

Sounds like you did well for your first code blue. Codes can be controlled or chaos. Your adrenaline and stress level usually go way up. To be effective during the code, try to do something productive: start with BLS & ACLS, CPR, VS, get the crash cart, start an IV, push drugs, code recording (most people hate that job), run for supplies, call doctors, etc. However, if you are the primary nurse, you need to communicate with the code team and doctor about the patient.

As to feelings about it, you learn to empathize with the families and offer support but to personally detach so you can still do your job. If you are close to the patient or family or perhaps when a child dies, it can feel different. I try not to take it home though. Also hug your family and cherish your time with your loved ones.