First code the day before my 1 year amd can't stop thinking about it.

LifesAJourney · Jul 7, 2013

YOU ARE NOT A FAILURE. I REPEAT, YOU ARE NOT A FAILURE!!!!!!!

You can take this experience as a learning lesson and grow from it :)

I am a new nurse myself, so take what I say with a grain of salt lol. I do have some questions though. Since your patient was on a cardizem gtt, how long was your patient in afib? What was the previous rhythm before it converted into afib? The patient is already compromised because of the lost of the atrial kick due to the atrium ineffectively contracting. That in it of itself decreases cardiac output. Do you remember what rate range the patient was in? Anything above 100bpm is a rapid ventricluar response and further decreases the cardiac output. The patient is also at risk for developing a clot. Does your floor monitor their own patient's heart rhythm or is it centralized to a location like rhythm central where they watch the essentially even patient on tele heart rhythms? Regardless, did anybody call to notified you of an alarming change in rhythm? In my current role as a nurse tech until I transfer later this month, I also have monitor duties where I monitor the patient's heart rate in my unit and other unit. More so than not, when a patient is brady-ing down rather quickly, I notify the nurse and they are prepare to code the patient. There is only one time I had a patient code without a rhythm change, it was a respiratory code. However, that patient was in a sinus rhythm. I'm not sure how it would apply since your patient was afib on a gtt. Cardizem suppresses the cardiac function, hence it's use to convert afib to a sinus rhythm. I don't think it overly suppress your patient's status to cause a code, but just be mindful of the adverse effects.

Second, you mention that the patient's oxygen sats were low. We already know CO is low, so we don't have enough tissue perfusion and gas exchange. How did you guys address the low O2? What were his vitals like? How was the patient's outward apperance? Was this patient also a COPDer? Was the patient anxious? Any signs of respiratory distress (labored, rapid, shallow breathing)? Did you call RT? If oxygen was place through what method (NC, face mask, Non-rebreather) and how many liters of O2 used? Did it correct the problem? At anytime before the code, was the physician noted about the change in patient status? Any new orders given?

When you went in to hang fluids, do you check to see if the patient was still breathing? You know, just the quick check to see the rise and fall of the chest since he was having oxygen issues earlier.

During report, did the see any abnormal labs, radiology, or anything that may of concern you? If so, did the previous nurse address those issues with the physician before the end of his/her shift?

As for the code is, if your glasses were falling off during compressions, quickly put it in your pocket and continue doing compressions. Also, it is important for you to get on the bed with your knees against the patient. This will allow you to more to apply more downward force onto the chest. This is what they taught us during our skills day. I've done chest compressions in a code once and remembered to hop onto to bed and started pushing. Were ABGs drawn? Were you able to find out the results of the ABGs?

tugirl12 · Jul 7, 2013

Well I always check my rhythm in the morning which was no different this day. He was controlled afib with some p waves. When I checked that morning.

As far as the sats, he was a copd patient! 02 sats were 88-91%, but the orders said to have above 92 so I put him on 5l. And of course he was breathing when I went in. I could never check on patient without checking their breathing nothing abnormal, just sleeping.

To be honest I check my lab every am but I cannot remember any abnormal labs for the day that day AT ALL...all I remember is that was a really bad day my patient coded and another one fell and broke their hip. Oh and the yelling I heard was the monitor tech.

I know I did everything that I could but there is this little voice that is saying "did you?"

My charge nurse asked me "what could you have done differently?" I said "I don't know?" she said "nothing I would have done the same thing" I am thankful for her an that the experience happened with her. She is my favorite charge nurse to work with because she has so much knowledge and teaches me tricks for everything.

I'm just trying not to internalize it I guess that's where the problem lies.

akulahawkRN, ADN, RN, EMT-P · Jul 7, 2013

Sometimes you just can't "see" the code coming that quickly, so don't beat yourself up over it. Codes are usually pretty chaotic, so you just do your best and get done what needs to be done. CPR is just exhausting, so get close to the patient so that you can get your shoulders right over the rib cage. This will allow you to do the best compressions you can without expending too much energy. It'll still be exhausting though...

Given how you described things, I'd say that you did a good job. You did the right things for where you were and what you were doing at the time.

Chesam7 · Jul 7, 2013

Honestly, you will never forget your first code or first patient death. It's just something that sticks with you. Also, don't feel like you are a failure or the way you feel means you did bad. These things come with time and each time you do them you will feel better about it. Just back track in your mind what you did and next time you will do better. My first code was chaos n I felt the same way, nobody expects you to be perfect! Sounds like you did a great job so don't be so hard on yourself!

akulahawkRN, ADN, RN, EMT-P · Jul 7, 2013

Honestly, you will never forget your first code or first patient death. It's just something that sticks with you. Also, don't feel like you are a failure or the way you feel means you did bad. These things come with time and each time you do them you will feel better about it. Just back track in your mind what you did and next time you will do better. My first code was chaos n I felt the same way, nobody expects you to be perfect! Sounds like you did a great job so don't be so hard on yourself!

Quoted for truth... so to speak. You do remember your first code/death... and after a while, you'll remember your most recent and occasionally a few in between. The rest will blur over time. You won't always get them back, no matter how hard you try or how good the team does. You all can do everything perfectly and still lose the patient. It happens.

My first code was so very long ago... but I do remember quite well the events of that code. Same with my most recent, which was also quite a while ago, but I remember well the lessons that I learned between them...

mchssrn8813 · Aug 6, 2013

This happened to me while I was a student. I was giving my pt a bed bath, he was talking, then snoring...I untied his gown at the neck and he was fine. I left the room briefly ( literally less than 1 min) to get more washcloths and next thing I know a bunch of nurses run in after me asking me what was wrong, I look up and he's blue. My heart dropped....I felt like it my fault and I should have known something as wrong. He was my responsibility and he coded. Luckily he lived, the reason I didn't know something was happening was because as students, we don't carry Voceras (communication devices) so the monitor room got a hold of my nurse who was clear at the other end of the hallway and there aren't monitors in the room... I felt horrible. I literally just stood back and cried. To this day, I am convinced that is why I never got a call back from that hospital when applied for jobs. I work there now as a mental health nurse (what I wanted to practice anyway) but I never got a call back from the med surg floors I applied at. There s a rumor at my school that the clinical instructors kept files of students so I am sure that if it does exist, that day is in big bold letters.

sillylilly05 · Aug 11, 2013

I just thought I would post to let you know that you are not alone! This almost exact thing happened to me last night! Ive only been a nurse for a year and a half but only a floor nurse since april ( I worked in a doctors office). My patient coded on me while I was in the room. His blood pressure was getting really low so I told the nurse to call an ACT call. His EF was only 14% . But he was fine in the morning! we were joking around and everything and literally like 2 hours later all this happened. I took acls only 3 weeks ago. When he totally went blank on me, his wife ran out to the nurses station to get help and literally 80 people ran it. It was extreme chaos. One nurse was screaming at my to get the monitor/defib so I did but I couldn't figure out how to hook it up..i completely froze..and I got yelled out by her..it was so embaressing but I didn't even care at the moment because I was in complete shock..people were yelling things at eachother and it was just madness. Everyone said I did good for my first time (I feel like I did absolutely nothing) The doctor was asking about his labs..all I could remember was his magnesium was high but couldn't remember a thing else..Your story made me feel a little bit better..not because of what you went through but to know that it is normal to feel this way..i think we will both get better through these experiences..hopefully!