First code- sort of a vent..

[Cat_RN, ASN, BSN, RN]

Not 20 minutes before I had checked on pt. She was taking to me, no s/s distress, no change in condition, o2 was on 3L via N/C through a concentrator.

The next thing I knew the aide was calling to me for help, pt was not responsive. Went into room to eval. pt, she was indeed unconcious and did not appear to be breathing, absent of pulses and apical was just a few random beats, possibly just residual electrical impulses causing contractions at the end of death. Anyways, started CPR with ambu and compressions until the rest of help came as she was a full code. The first few compressions cracked ribs- pretty ghastly but overall the whole process wasn't as freaky as I'd imagined it. Ultimately she didn't make it- but literally, I had JUST spoken with this person not a half hour before! The aide said her nasal canula was on the floor next to her, but the pt. has taken it off before as she is confused, with no trauma to her. Could it have been that? It seems unlikely as she was only on 3L via N/C. She had to have been out for quite a bit, to get a line in her for atropine and epi, they had to go into bone.

I really don't know what happened. I had not given any meds so no allergy. I'm not overly anxious about it, pt was old and quite sick but GEEZ, that was fast! Has anyone ever had a patient ultimately be their own undoing, similarly by taking themselves off O2 in their confusion or ..? I just feel kind of helpless if these confused patients are going to be so unpredictable.. please just leave the O2 on your face alone! I'm sure it's highly unlikely that it was why she died but still. It doesn't help! I guess it's just what happens when you get old. You do things which end up killing you..

[Lola77]

you have just described my worst nightmare - walking in and finding a patient not breathing. I have been a nurse for about 8 months now and have never had a patient code. I have only been a part of one code - and all I did was stand there and hand over meds when called for. I am TERRIFIED of my first code. I wish it would just happen so it would be over with.

I guess it was just that person's time.

[highlandlass1592, BSN, RN]

What "terrifies" you? Is it a lack of understanding of what may take place, what your role might be? The idea of losing a patient? I have found over my career that when something terrifies me, in my case it's usually due to a lack of information regarding something. I have found if I can educate myself, the terrors go away. What can we do to help you with your fear????

[Altra, BSN, RN]

It's unlikely that less than 20 minutes of removing 3L of O2 led directly to her demise. Now that you've gotten through your first code you can think about what you've learned. Kudos to you for demonstrating the right response - initiating CPR, etc.

It does get easier, though some codes/patients will stay in your mind forever.

And psst... not an "a line" (that would be an arterial line) but an intraosseous (IO) line was established in your patient for IV (intravenous) access. They are quite useful for quick access in a patient with poor peripheral vasculature.

[Cat_RN, ASN, BSN, RN]

It's unlikely that less than 20 minutes of removing 3L of O2 led directly to her demise. Now that you've gotten through your first code you can think about what you've learned. Kudos to you for demonstrating the right response - initiating CPR, etc.

It does get easier, though some codes/patients will stay in your mind forever.

And psst... not an "a line" (that would be an arterial line) but an intraosseous (IO) line was established in your patient for IV (intravenous) access. They are quite useful for quick access in a patient with poor peripheral vasculature.

Oops that was a typo- I didn't mean 'a line'. I meant to just write 'line', since I didn't know the term intraosseous. Thanks

[mamamerlee, LPN]

Sometimes people just die - even in the middle of a conversation. Totally without any prior indication. If they are lucky, in their sleep.

This is no reflection on you at all.

[JulieCVICURN, BSN, RN]

Yeah, sometimes people just die. It's time. It's also possible that she went into flash pulmonary edema, which can happen as fast as it sounds, and someone can be talking one minute and frothing at the mouth the next. You didn't mention any pink froth, so it was probably just time to go.

[Cat_RN, ASN, BSN, RN]

Yeah, sometimes people just die. It's time. It's also possible that she went into flash pulmonary edema, which can happen as fast as it sounds, and someone can be talking one minute and frothing at the mouth the next. You didn't mention any pink froth, so it was probably just time to go.

Nope, not frothing, no sudden edema or any other outward signs of distress, just appeared to be asleep and not breathing. Very quiet, I was still on the same hall doing my morning meds. I heard nothing, no wet breathing or gasping at all!

[cb_rn]

Kudos to you for calling a code and starting CPR.

One night we had a new nurse fresh off orientation do an assessment at midnight and find a person (not a DNR) had expired. She did not call a code, she noted in the chart the person was dead and went about her rounds before informing the charge nurse roughly 2 hours later.

...

(I left at midnight and thus missed the rest of this saga in person but believe me we all heart about it ad nauseam as we had to redo competencies and have inservices out the wazoo)

I was glad not to be charge that night.

You will lose patients in your career and sometimes it will happen in the blink of an eye. I know it is hard to absorb and not second guess maybe what could have prevented the occurrence but please don't worry yourself about it. It sounds like it was just the lady's time to go.

[Penelope_Pitstop, BSN, RN]

What "terrifies" you? Is it a lack of understanding of what may take place, what your role might be? The idea of losing a patient? I have found over my career that when something terrifies me, in my case it's usually due to a lack of information regarding something. I have found if I can educate myself, the terrors go away. What can we do to help you with your fear????

I'm not afraid of codes. In fact, I'm the nurse who asks the other nurse who's afraid of codes to watch my patients while I participate in the code!

However, I think a lot of nurses will blame themselves for a patient's demise. Other nurses just don't like dealing with death. Some have had very bad experiences with patients coding. And still more hate the paper work involved as well as the questions the code team asks. And lest we forget nurses who don't want to have to deal with a grieving family, or nurses who grieve themselves.

I believe that, regardless of outcome, there are good codes and there are bad codes. A nurse who is terrified for reasons other than inexperience can contribute to a bad code. That's why those of us who aren't scared and who know what we're doing (or are willing to help out and learn) are available. I don't think there's a darn thing wrong with being terrified of patients coding.

Highlandlass - I know that I used to be scared s***less because I didn't know what to do, but I got over it. I agree that ignorance encourages fear, but I also believe that even the experienced and well educated health care professional can dread and be terrified of a code situation.

[Tina, RN]

What "terrifies" you? Is it a lack of understanding of what may take place, what your role might be? The idea of losing a patient? I have found over my career that when something terrifies me, in my case it's usually due to a lack of information regarding something. I have found if I can educate myself, the terrors go away. What can we do to help you with your fear????

I have to be honest, too. I am terrified of being involved in a code! When I graduated nursing school, I worked in med/surg for about 3 years. I never had to code a patient of my own. I went to a couple of codes, but there were always so many people in the room that I wasn't able to get close enough to actually be involved. After my hospital experience, I ended up doing case management for an insurance company for a few years. So, obviously no codes there, either.

Now, I'm getting ready to return to bedside nursing in a couple of weeks as a per diem med surg RN. Since I haven't done bedside nursing in years, there are many things that I am anxious about, and codes are right up there on my list! For me, it's definitely a fear of the unknown. I mean for crying out loud, I've never even done CPR on an actual person, just on the mannikins in class! I think that doing the meds during a code would be so nerve wracking. Documenting everything, too. I'd be so scared that I would forget a tiny detail and get in trouble... I wonder if maybe there is a YouTube video or something that shows a simulation of a code??

[Penelope_Pitstop, BSN, RN]

I have to be honest, too. I am terrified of being involved in a code! When I graduated nursing school, I worked in med/surg for about 3 years. I never had to code a patient of my own. I went to a couple of codes, but there were always so many people in the room that I wasn't able to get close enough to actually be involved. After my hospital experience, I ended up doing case management for an insurance company for a few years. So, obviously no codes there, either.

Now, I'm getting ready to return to bedside nursing in a couple of weeks as a per diem med surg RN. Since I haven't done bedside nursing in years, there are many things that I am anxious about, and codes are right up there on my list! For me, it's definitely a fear of the unknown. I mean for crying out loud, I've never even done CPR on an actual person, just on the mannikins in class! I think that doing the meds during a code would be so nerve wracking. Documenting everything, too. I'd be so scared that I would forget a tiny detail and get in trouble... I wonder if maybe there is a YouTube video or something that shows a simulation of a code??

Doing the meds during the code IS nerve-wracking. In my hospital, an ICU nurse pushes the meds and a step-down nurse prepares them. These nurses are the designated "code nurses" and are aware of their responsibilities. If you're not ACLS, you should not be handling code medicines AT ALL, in my opinion (and you might not be allowed to depending on your facility).

I've been the nurse preparing the medication. The step-down nurse didn't have time to get to the code before we needed Atropine. But, I am ACLS-certified and was already ready at the code cart long before it became a code. Don't worry about the meds. I highly doubt you'll need to draw them up or push them at any point until you become ACLS certified, if you choose or need to do that.

As for compressions, as long as your CPR certification is up-to-date, just jump in and do it! Trust me, if you're not pushing hard enough or at the correct rate, someone will let you know. Compressions are kind of scary because you can break ribs and encounter fun body fluids, but they're relatively simple once you're in a rhythm. The worst part is being sore afterwards, especially on a larger person.

As for being unprepared, the best thing you can do in that situation is SEEK HELP! Initiating a code blue is what gets the proper people at the bedside.

If you're the patient's nurse, chances are your responsibility will be to hang out and fill the code team in on the patient's history and what led up to the code. Printing out most recent labs and having previous studies such as EKGs (as well as vitals over the last day at the very least) and H & Ps, that kind of thing, is what you'll be busy with during that time. If the patient ends up being moved to a different level of care, you'll have to call report. If the patient expires, you'll do paperwork and post-mortem care.

If it's another patient on your floor, ask what you can do to help. You may need to help with compressions, but a lot of time there just needs to be someone to move extra stuff out of the room and fetch things like IV tubing, blood tubes, and extra Atropine or Epi if you run out (we ALWAYS run out of Atropine). One time, my friend stood outside of the room and collected the coats of all of the residents running in. You don't have to ever set foot in the room to be helpful! And remember that the nurse who's coding his or her patient needs someone to check on his or her other patients!

Let's say you think your patient may be going belly up, so to speak. Alert the charge nurse, call an RRT if your facility has that, make sure there is a clear path to the code cart, and ensure there is plenty of room around the patient's bed for staff and equipment. Obtain vitals and keep the Dynamapp in the room. Make sure there is an oxygen set up and fresh suction equipment. Locate the Doppler and keep it at the bedside. Have a new bag of NSS in a pump ready to go for when you need it. Ensure that respiratory is available and that the patient has adequate IV access. Guess what? You're probably ready for most of the code interventions.

Tina, I know that was a lot of info, but it basically comes down to: GET HELP! There are people for whom codes are no big deal, and that is why those people are designated to respond to those situations. Also, DON'T BE AFRAID TO CALL A CODE, even if you're not 100% sure that is what's happening. It can always be cancelled.

As for the video of a fake code? I wouldn't look for one. No codes are "routine." Everything depends on the patient and the staff.