First code O_O

[SaraO'Hara]

I was rotating on Med-Surg today (last clinical day this term too); a code blue was called in the ICU. A classmate and I were permitted to go watch - got to see the intubation, external pacemakers... I was just a bit surprised how calm everybody was.

The RT doing compressions was flagging a little bit, so the doctor asked around for who wanted to - and I got to :uhoh21: First time performing compressions on an actual human, but apparently I did a decent job; my classmate went next... unfortunately the patient expired.

If I recall right, his new grad RN found the pt unresponsive, no pulse / resps; started compressions and called a code. She was leaning against the wall looking rather like and talking about how she had felt all his ribs break under her hands.

[PageRespiratory!]

... I was just a bit surprised how calm everybody was.

...you will be as well. It's much nicer when all your hard work pays off.

[TazziRN, RN]

cpr pts rarely survive, and most of the ones that do only survive a few days. and it's very common for the ribs to break during compressions. yes, it means the compressions were too hard, but no, it's not detrimental to the pt's survival.

well-run codes are either calm or controlled chaos, where at first it seems like everything is wild, but on closer inspection you realize that each person is doing a job and they're all working together at the end.

[sharlynn]

Unfortunately, it's not like you see on television! Most codes are not successful. The younger the patient, the better the odds.

Actually, I remember two codes that were successful after all these years.

[Kerrigan 06]

It's always hard to see a patient die. It's especially hard if it was not expected and provisions hadn't already been made to let them die peacefully (of course this is not always appropriate!).

I'm a CCU nurse for almost a year, and I've seen and helped with several codes during my time at work and also in my ICU rotation during school. Only a couple of them have been on patients I had taken care of. A few months ago I was taking care of a patient all night, and then she coded unexpectedly right after I gave report. The new grad RN you described against the wall sounds like me, sitting in a chair outside the room just watching the proceedings, unable to walk away and wondering what I missed. (Turns out it wasn't anything I missed; she had coded without warning multiple times before.)

The experience of helping with a few of these adventures came in handy when I had my first "my own" patient code during my shift a couple weeks ago. Something gave me the feeling early in the shift that she'd be going soon, and I had already warned my charge nurse and her cardiologist, and placed the defib pads on her... when she coded 8 hours later, I came out proud of myself for staying calm. You'll get there, too.

[Daytonite, BSN, RN]

i wanted to address your comment about how surprised you were at how calm everybody was at the code. this is typical in the icu and ccu settings since these personnel are accustomed to having code blues. when i was a supervisor i was required to attend all code blues. it was typical that in the intensive care areas and the er that codes were carried out with great efficiency, calmness, minimal silence and great skill. many times code blues in the ccu were never even announced on the overhead paging system. on the other hand, i saw confusion and turmoil on other units where a code blue was not a common occurrence. the supervision staff often had to intervene to remind and prompt the staff what it was that they needed to be doing. a code blue, while being an emergency situation, should not be a reason for any nurse to be showing their upset. learn the procedure so you can perform it and it's steps correctly when or if the time comes. that is part of your job responsibility. you cannot be effective if you are having a emotional breakdown while the patient needs your help. have your emotional breakdown later in the nurses lounge.

also, performing actual chest compressions on a real person is very fatiguing as you found. not like the cpr dummy, is it? the breaking of ribs, unfortunately, does occur, no matter how correct your hand placement is and what you've been told in cpr classes. this is why cxrs are done as a routine following cpr or doing the heimlich maneuver. for the people who survive cpr, and i've seen and spoken to many in the ccu who did, a few cracked ribs were insignificant to surviving--believe me--they were very grateful to be alive. i've seen patients who were continuously coded all shift long in the ccu who did survive to tell about it.

[EmmaG, RN]

On the other hand, I saw confusion and turmoil on other units where a Code Blue was not a common occurrence.

In the hospital I'd worked for years prior to traveling, that was not the case (at least on our P shifts--- I can't speak to what occurred during the day). I think that had a lot to do with having so many experienced nurses from the supervisors to the code teams to the floor staff, and a team of incredible hospitalists who covered the house at night.

The only one I remember to be truly chaotic was when a nurse's father coded while she was working one night (he was a patient on her floor, too). It was completely unexpected, he had no history of heart disease and the reason for his admission was pretty routine and benign (don't remember specifically what his diagnosis was); however it wasn't the code itself that was chaotic, but rather what was happening on the periphery with her in hysterics (understandably so--- he didn't make it).

[Ms Kylee]

I've had 4 codes on my floor while I was working (and I just started 6 months ago). Luckily, all survived. Supposedly, my floor is the cancer floor, but we get everything. When a code is called I generally step back and let everyone do their job since I'm a NA and I really can't do anything to help....

Except for one code. Nurses came looking for the aide on the side of the floor that the code was on, and of course, came up empty. Everyone knows I'll pick up the slack, so they came to find me to get the patient's blood sugar. It was odd though... I came into the room and everyone made room for me to enter.. I felt like I was witnessing the parting of the Red Sea. I got the sugar, reported it (it was fine) and left. He was transferred down to ICU as a precaution.

Later on, the invisible NA said to me "I heard you got invited to the party." :uhoh3:

[NurseCard, ADN]

In the hospital I'd worked for years prior to traveling, that was not the case (at least on our P shifts--- I can't speak to what occurred during the day). I think that had a lot to do with having so many experienced nurses from the supervisors to the code teams to the floor staff, and a team of incredible hospitalists who covered the house at night.

The only one I remember to be truly chaotic was when a nurse's father coded while she was working one night (he was a patient on her floor, too). It was completely unexpected, he had no history of heart disease and the reason for his admission was pretty routine and benign (don't remember specifically what his diagnosis was); however it wasn't the code itself that was chaotic, but rather what was happening on the periphery with her in hysterics (understandably so--- he didn't make it).

How HORRIBLE!! I'm so sorry for that nurse..

I WANT to be one of those people who proceeds through a code with efficiency and confidence. After four years of being a nurse, I still tend to want to either just do compressions, or stand back and just watch (and provide necessary info if it is my patient). I don't have the skill or confidence to either administer meds or be the note-taker.... or start an emergency IV... and I wonder if I ever will. Codes are just... SCARY.

I have developed some interest in giving ER nursing a try and I would really like to become skilled in working codes. I know, I have to take the ACLS course, but is that really enough? I took PALS a few years ago and still, sadly, felt like I would be horrified and clueless if one of my kids coded (which thankfully has never happened!).

[Katnip, RN]

How HORRIBLE!! I'm so sorry for that nurse..

I WANT to be one of those people who proceeds through a code with efficiency and confidence. After four years of being a nurse, I still tend to want to either just do compressions, or stand back and just watch (and provide necessary info if it is my patient). I don't have the skill or confidence to either administer meds or be the note-taker.... or start an emergency IV... and I wonder if I ever will. Codes are just... SCARY.

I have developed some interest in giving ER nursing a try and I would really like to become skilled in working codes. I know, I have to take the ACLS course, but is that really enough? I took PALS a few years ago and still, sadly, felt like I would be horrified and clueless if one of my kids coded (which thankfully has never happened!).

The only way to get competent at codes is to do it repeatedly. Administering meds is just like administering meds in a non-code situation, expect that you say out loud when it's done.

Note taking is simple. Just write down what everyone else has done-they'll tell you, just write it and the time.

PALS and ACLS teach you what to do when you've got drugs, equipment, and personnel on hand. If one of your kids coded (which is highly unlikely and I hope never happens), you'd be doing BLS.

As far as being afraid of codes, look at it this way. The worst has happened, the person is dead; you can't make it worse, but you might make it better.

[nghtfltguy, BSN, RN]

codes are codes.. and each one is different..

i have cracked many ribs in the days when i was a paramedic... but.. depending on the pt.. i don't do it very often any more.. unless they are a lil old frail person..

and yes... actual human chest compressions is the most exhausting physical labor there is.. i don't care what any construction worker tells ya!..

it is hard!! and... well.. it sucks...

not all my pts die from getting cpr.. some do.. but it's about 50/50..... but then again i work mostly pre-hospital codes....

and now that im a nurse.. i don't really have to do the compressions as much as i used too.. i let my medics do them.. or students... or docs... or whoever... i don't like it.. its freaking exhausting!

[jbp0529]

The only one I remember to be truly chaotic was when a nurse's father coded while she was working one night (he was a patient on her floor, too). It was completely unexpected, he had no history of heart disease and the reason for his admission was pretty routine and benign (don't remember specifically what his diagnosis was); however it wasn't the code itself that was chaotic, but rather what was happening on the periphery with her in hysterics (understandably so--- he didn't make it).

Wow, how awful for that nurse who was working that night! I know if one of my parents was a pt in my hospital and they coded, I'd be hysterical too. Was she helping with the code, or just present in the room while everyone worked on her father? Either way, I would think that if she was truly that hysterical, perhaps someone should have tried to escort her out of there to someplace private so that the rest of the team could work w/o the distraction. But then again, I know families being present during resuscitations can be helpful with the grieving process afterward. So I dont know...

Hope someone let her go home early that night! How sad.