First code situation...any suggestions?

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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.

Specializes in Utilization Review Radiology Onc, Women's Health.

You DID do a great job. I think it's natural to think back and scrutinize everything you did.....esp. your 1st one. I'll never forget my 1st code....my legs were shaking so bad. They felt like jello. You got her to ICU, so kudos to you. The patient would be in much worse condition if you hadn't followed your instinct! Good job!

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Specializes in Med./Surg. and paramed. exams.

Job well done, as others have stated, learn from each and every experience. Sounds like you did everything possible.

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Specializes in Trauma Surgery, Nursing Management.

I am totally impressed with you. You really took the adage "Going to work to save lives" and put it into practice!

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Specializes in NICU.

10mg of oxycodone could have been enough to cause mild respiratory depression, leading to hypercapnia, leading to the need to be intubated. If she was already severely hypercapneic the narcan wouldn't help much. I'd love to see her ABG.

You did great by the way!

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I've only been a Med/Surg BSN RN for 3 years. I would have done the same thing you did--checked the vitals, assessed the patient, checked the blood sugar etc. With a joint replacement, the patient should be on coumadin , or a lovenox bridging so their INR should be therapeutic or close to it, so I don't think they had a PE. Their O2 sat would have declined, perhaps they would have woken up with dyspnea, and their heart rate would have increased as the heart would be trying to compensate for the decrease in available oxygen.

Another nurse suggested an embolic CVA--did the patient have a hip replacement, which could have released a fat embolism which caused a CVA??

Did she have a foley with low urine output, too high of an IV rate combined with a hx of CHF causing flash pulmonary edema? Perhaps you caught the situation right before the pulmonary edema so her vital signs/sats were WNL??

Keep us up to date if you hear any news. I always wonder what happened to all of my patients. It's just part of the job. You just have to learn to accept constructive criticism, realize that no matter how perfect you try to be (the fastest, the smartest, the one with the longest endurance) sometimes it's just not enough. That's what makes being a nurse difficult. Keep up the great work and keep your chin up "kid!":lol2:

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Specializes in psych, geriatrics.
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:

Absolutely

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Specializes in Public Health, TB.

Wet lungs make me think of flash pulmonary edema or an aspiration, both of which can happen it the blink of an eye.

I was working med/surg one noc about 18 years ago, making hourly rounds. One of my CVA patients appeared sleeping but was making a horrible gurgling sound. We had no rapid response team then, the RT had our only pulse ox and said she was too busy to come to the room.

I called and woke up the on-call doc, got an order for cxray and to drop an NG. I called the supe for help, dropped my first NG since school, and suctioned out about a liter of oral CT contrast.

Doc got there shortly after, intubated and sucking out a bunch more contrast.

The patient had had a CT with oral contrast earlier that day and apparently had aspirated a large amount. Never heard if she made it out of ICU.

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Specializes in Acute long term, clinical, office, etc.

Most important thing to remember, you acted and sent her to where she needed advanced care.You may not have been able to stop it.It may have been something which would have happened anyways.I have been part of a code recently with similar circumstances.Patient weaning from a vent. Had gone 19 hours x 3 days off vent doing well.Placed on vent at night to rest. On the fourth day 4 hours into the weaning so was sleeping but co-hearant. Withing 2 hours later we could not wake her.I called a RR. Luck we did not have to code her.Her CO2 was extremley high and RT put her back on the vent.The next day, the pt. never knew what happend and was wide awake and scarred as to why she was back on the vent.Our team starting kicking ourselves that we did not think about this two hours sooner to prevent RR but the outcome would have been the same...placed back on the vent.Sometime we do not know why or sometimes we think its one thing and its not.Be greatfull you acted promptly.:yelclap:

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Specializes in endocrinology, geriatrics, dementia,.
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:

I completely agree!!!!!!!!!!:yeah:

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So....the consensus was this was simple as hypoglycemia. I am completely dumbfounded by this. CBG at 0330 was 85 and lab draw during the code at about 415-430 was 26. What happened? Now I feel even more incompetent that I can't do a simple blood sugar. Can blood sugar really drop that quickly? Or patient be unresponsive with a BS of 85?? So confused....I felt like I did everything I could before I called the rapid response and it was just blood sugar. Really??? PS the patient ended up to be fine and went home a few days later. (I feel good about that) but still am feeling bummed about the whole situation. The charge RN also spoke to me about the MD wanting to write me up for the innaccurate blood sugar. How could that be blamed on me?

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