First code situation...any suggestions?

NurseAdida · Jan 20, 2011

I have been a med/surge nurse for about a year and a half now. Last night was the first time I have been involved in a code where I was the primary nurse. I work 11pm to 7am. I came on shift to 5 stable patients. The one I ended up transferring to ICU was 70 year old POD #3 from a joint surgery. No complications whatsoever, vital signs stable since surgery. At 11pm she was snoozing away resp even, unlabored, no signs of distress at all. I let her continue sleeping then the CNA did vitals at 3am, again they were stable but the patient slept through it. She is diabetic so I checked her blood sugar-80 and would still not wake up, I called rapid response then eventually a code....she was intubated and transferred to ICU. It all happened so fast. I am kicking myself thinking I could have done something differently. I left not even knowing what exactly happened with this patient. It wasn't overdose on meds/narcotics, narcan was given just in case even though she only received 10mg oxycodone all day. The patient had a history of a CVA 4 years ago but the CT after the code showed no bleed. I am just so confused as to what could have happened and what I should have done differently. Any ideas? I am just so torn up over this. feeling responsible, and am praying that the patient pulls through.

First codes are always scary...

It's hard to tell what happened from the information you gave. What were the last set of vitals? Why was a code called? Did she stop breathing during the rapid response? Did she have a PCA pump?

RNKPCE · Jan 20, 2011

FYI A CT that shows " no bleed" does not mean she didn't have a stroke. Embolic and Ischemic strokes do not show a bleed and they are the most common type of strokes. The CT helps to determine treatment. You could give thrombolytics to an ischemic stroke if they meet other criteria but never to a bleed.

wsuRN2009 · Jan 20, 2011

The last set of vital before I called rapid response were about 105/60 hr in the 80s resp 22 and 93% on RA. As the rapid response progressed the MD felt she could not maintain her airway anymore. Her lungs and respirations almost immediately became really wet sounding and she needed to be suctioned and that is why the code was called. She never stopped breathing or had a change in her heart rhythm, NSR. She was warm, pink, good pulses.

dthfytr, ADN, LPN, RN, EMT-B, EMT-I · Jan 20, 2011

Middle of the night, stable patient, asleep, no distress. I could have let the patient sleep till day shift! You had an intuitive feeling that something was wrong and acted appropriately. Suggestions? Take that hand you're beating yourself and use it to pat yourself on the back. I want you to be my nurse when I'm in the hospital. Only a year and a half experience? I stand in awe. Keep up the great work! :up:

systoly · Jan 20, 2011

Middle of the night, stable patient, asleep, no distress. I could have let the patient sleep till day shift! You had an intuitive feeling that something was wrong and acted appropriately. Suggestions? Take that hand you're beating yourself and use it to pat yourself on the back. I want you to be my nurse when I'm in the hospital. Only a year and a half experience? I stand in awe. Keep up the great work!

My thoughts exactly.

LaurenBoog · Jan 20, 2011

You did great! There are many unknowns in that situation but you caught it before it could get worse. Keep up the good work.

T14WFLY · Jan 20, 2011

She is a prime candidate for a pulmonary embolus. Sounds like you did everything right on your part. :yeah:

General E. Speaking, RN, RN · Jan 20, 2011

You could be my nurse anytime... :) Keep up the good work!

mama_d, BSN, RN · Jan 20, 2011

Sounds like your patient didn't really give you a lot of clues ahead of time from what you described.

Keep in mind that first time now = experience for later and try not to worry.

shoegalRN, RN · Jan 20, 2011

Good job!

I know the first one is always scary! But you did the right thing, called the rapid response, and got the patient transferred to the ICU. It's hard to tell why she tanked from what you listed, but you had a "gut feeling" and went with it.

Don't beat yourself up. You did great! I'm with the others, you can be my nurse anytime!

BluegrassRN · Jan 20, 2011

You did really well!

It is always a good idea after each code (or day at work, for that matter) to review what went well, and what you might do differently next time. Codes are scary and move so quickly, with so many people involved. It's nice to review them slowly in your mind afterwards.

If you really want some decent input, ask your charge nurse the next time you see her. She might be able to give you some pointers about what you might have done differently. Half the time in codes, though, when someone might ask me this, I would have little to no input. Sometimes there isn't anything really that could have been done differently.

In any case, it sounds like you utilized your rapid response team appropriately, and that you provided great care. Good job.