first code/compressions

[buckeyeRNED]

I'm not a new nurse, but new to ED. I previously worked in babyland and have only done compressions on neonates. I'm fairly fresh out of orientation, but helped with a code that was near my assignment. I took over compressions for the nurse so she could do meds and write and the doc started yelling at me that I wasn't compressing deep enough. I don't have a lot of upper body strength, and I underestimated how much force it would take to get really effective compressions. In retrospect I should have gotten onto the bed for leverage, but the doctor intubating asked for a pause to be able to get the ETT in, and when resumed, one of the techs (who typically do the compressions in our ED) took over. They were actually able to bring her pulse back within a few minutes (two successful codes I've seen this past week). I just felt so useless, people were asking for things I didn't know where to look for them, and I just kept thinking "I'm a staffed nurse here. I should know these things." But I just don't, because I never had a full on code situation like that in my orientation. I just feel like I'm that incompetent nurse that everyone prays they don't have if they're in a real emergency situation.

Anyway, I'm planning to verse myself better over the crash cart and stock room tomorrow, and I feel like in future situations I will hopefully do better, but I'm beating myself up over it. Part of me is trying to be logical and tell myself, this is how we learn things. But the other part of me just feels like a failure. Please tell me it gets better.

[Anna Flaxis, BSN, RN]

When I do compressions, I usually have to get up on a stool. Even a gurney at its lowest position is too tall for me to be able to do effective compressions.

Yes, it should go without saying that you should frequently orient yourself to the resuscitation supplies. That's the thing about codes, is that they are unpredictable and you could have one at any time, so you should know where everything is and how to operate your defibrillator.

I'm sorry you had that experience, but it sounds like it was a kick in the pants to get you to do what you should have done already, which is to orient yourself to the resuscitation supplies.

I'm not trying to be cruel or hard on you, but you work in the Emergency Department now, and being prepared for the worst case scenario comes with the territory. When I orient a new person to our ER, the resuscitation and trauma supplies are the very first thing I cover.

[foragreatergood]

Part of ACLS training is to evaluate the compressions and encourage the staff member to adjust them if necessary. We have orderlies come to our codes and sometimes I have to tell them to lighten up - slow down and decrease depth of compressions. Just because someone said you had to increase your rate or depth doesn't mean you don't know what your doing.

Every code teaches you something.

Find your drugs/syringes and defib pads. Know where suction tubing/yanks are. Don't allow yourself to get so stressed that you cant function in a code. IT WILL GET BETTER.

[NurseOnAMotorcycle, ASN, RN]

Foragreatergood is right. Also,it is completely normal for people to take turns during compressions because it's exhausting and people get tired which means compressions get too shallow.

as far as not knowing where to find things: don't sweat it. Everyone knows it was your first code. I bet next time you'll find everything.

[rnkatie85]

It gets easier! It was your first one! But I do agree with learning where everything is located. we have step stools that we stand on and it helps you to use your whole body instead of just your arm muscles. But I still wake up the next morning wondering why my shoulders and upper back ache! Don't give up just yet, er is rough but you get used to it!

Good Luck

[Dragonnurse1, ASN, RN]

Our crash carts were kept locked with a tie and they were never opened except during a code. When a new nurse came to the ER there was a diagram of each drawer and you were expected to learn them. This might be an idea for the future for your ER. Chest compressions are difficult and different for every code. I have cracked ribs and sternums on one very elderly lady and have had one patient so full from fluid that I nearly had to jump up and down on his chest. If you can watch the monitor you can tell if your compressions are good. Do not worry - you will get better. My first code I was the last nurse to push "just one more does of epi" and I never was the last one to push meds again. The patient came back but remained in a coma for 3 weeks and then died. I felt like crap but the Doc on that night told me "that is not the worst that can happen", I did not want to know what was worse so I got forgot about that one.

Codes are always a mad scramble, there is no such thing as a "routine code". Meds will be different, some Doc's can slide in a tube while compressions are on going and some cannot get in a tube without knocking out teeth. Some stand back and scream orders and some are very soft voiced when asking for meds or whats been given. And when you run into your first "slow code" you will have a whole other reaction.

Bottom line - do not beat yourself up about it anymore, move on and be prepared for the next one. Remember each one if different and so will your experience. Oh yeah - I always got up on the stool or the stretcher for compressions as I was the shortest in the ER on my shift.