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..
You did all the right things. Death can happen very quickly where elderly people are concerned. I walked a patient to the bathroom, walked him back to his bed, then watched as he actively started the dying process. Hospice had been called in earlier that day. The RN hadn't even opened his case yet. Then I called the hospice RN to come and do it quickly as he was actively dying. All of this happened within 15-20 minutes. The family didn't believe me when I told them he was actively dying. Not until the RN came and told them did they believe it. His process was completed in about 90 minutes.
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.
This is very helpful. Thank you! It does seem so basic, but I know I will forget everything simple and important! Thanks!!
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.
This left me with my mouth wide open. She literally noticed a patient had expired (im assuming a change from previous shift) and didnt notify anyone. I am a new grad myself and I hope that nurse isn't stll around. Unbelievable.
Specializes in Medsurg/ICU, Mental Health, Home Health.
This is very helpful. Thank you! It does seem so basic, but I know I will forget everything simple and important! Thanks!!
That's why you'll have "old hat" nurses like me around to help you. You think I came out of school knowing these things? It took me a great many codes to figure this stuff out, ya know!
(And when did I become an "old" nurse? I don't know, but dear Heavens, it's what I am!)
That's why you'll have "old hat" nurses like me around to help you. You think I came out of school knowing these things? It took me a great many codes to figure this stuff out, ya know!
(And when did I become an "old" nurse? I don't know, but dear Heavens, it's what I am!)
I found your post to be very helpful, too! Thanks!!!
Specializes in Med/Surg, Neuro, ICU, travel RN, Psych.
One hospital that I worked at, we had a patient die that quickly and unexpectedly as well. He was great when I had him, was actually going to go home the next day. Night nurse was in the room talking to him, he was fine, no complaints. About 30 minutes later, someone went in the room and found him expired.
Strangely, I have been a part of four "sudden death" codes in my one year in nursing.
None were my pts, but I was the only RN in sight for all three, so guess who got yelled at to come help? :)
The first one, the LPN had checked on the pt 5 minutes prior. She walked back into his room to answer a question he had asked about a blood test that had been drawn, and found him in high Fowler's with green emesis coming out of his mouth, unresponsive, not breathing. She started CPR, we called the code, set up suction, and got 700 cc's of green emesis out of his mouth, throat, and surrounding area immediately. Got a pulse back but one of his pupils was blown. He died in ICU later.
The second one, a pt was surrounded by family (who he had just reconciled with after years of not speaking) in his room. Family said the pt took a deep breath... and never took another one. They called for help, we coded him, never got him back.
The third one, a nurse just found a pt unresponsive, no idea how long she'd been down, but it was less than 30 min. because that was the last time someone checked on her. Pt was in v tach, we'd shock her, she'd go into bradycardia, then slip back into v tach. We did this for about 25 minutes. Doc called it after the fifth or so shock because she apparently wasn't going to come back into a usable heart rhythm.
The fourth one, we had a pt standing at the window, looking out, and he just fell over, unresponsive, not breathing. His room was close to the station so everyone heard the smack of his body hitting the floor.
Maybe my floor has just had some bad luck, seems like a lot of unexpectedness! All of the pts were sick, obviously, but nothing made us worry about them to that degree.
Also, a word of advice, consider putting together an emergency suction kit - all the stuff you need for suction, the canister, the tubing, the wall suction unit, etc - in one place so you can grab and go in the event of a code. 90% of the time you're going to need suction at some point in the code, and that's the one thing I'm always scrambling for because it's not on the crash cart!
I've seen a lot of folks expire in the ER, sometimes they just decide to go and that's that. My Uncle died at the hospital where I work, was up for discharge, his wife left, and he just died. Better there than at home. Some folks wait for family and some wait until family leaves. Some are full codes and some are DNRs. We just go with it.
I've been in many codes and taking PALS and ACLS made me much more comfortable in them. I was sent because as an LPN I can do much of the work except for pushing meds. I can pull meds from the cart, I can start lines, hang fluids, run EKGS (and unofficially read them), draw blood, and tons of other things. I can do a lot of things but when I came out of school just making beds and giving bedpans was a struggle.
BTW if I ever have to start an IO I'll probably puke. It was bad enough on the dummy in PALS, but on a person! Of course I'll puke after the codeLOL.
Specializes in multispecialty ICU, SICU including CV.
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??
I have been in on many codes in the ER, however those are generally easier to deal with as they come in as a code and we never see them up and talking, however I have also been there when were up and talking and they have gone south very fast.
The one code that sticks in my mind was a pt that came in with low back pain, I had taken her to x-ray and CT, she had just got done using the restroom and I helped her back into bed. 3 min later the daughter calls from the room saying something was wrong, the nurse and I go in there and pt is unresponisve, we call a code, and I started compressions, 25 min into the code radiology calls us to say her scans showed a AAA. I remeber standing there squeezing the blood bag, because we ran out of pressure bags trying to get fluids into her.
We worked on her for an hour, it has been 2.5 years and we still talk about the code in old rm 14 (our hospital has senice been remodled and the room is no longer there), that was the 1st pt who I saw alive up walking taking and laughing and 5 min later was gone.
So there are codes that you go over and over in your head.
Specializes in CT stepdown, hospice, psych, ortho.
This left me with my mouth wide open. She literally noticed a patient had expired (im assuming a change from previous shift) and didnt notify anyone. I am a new grad myself and I hope that nurse isn't stll around. Unbelievable.
Yes, this was a change. At this particular hospital you didn't chart an assessment until midnight because the shift before did 1500. No vital signs until midnight either so the CNA didn't know. The patient was alive when the trays were picked up after dinner. What happened after that, we don't know. I'm not saying it would be terribly unusual for a busy nurse to go in and find a patient with no pulse and no respirations but uh call a code? try a little cpr?
The nurse? She didn't get immediately fired but did a couple of other really bizarre things and ended up never coming back after one of her shifts.
guest2210
400 Posts
You did all the right things. Death can happen very quickly where elderly people are concerned. I walked a patient to the bathroom, walked him back to his bed, then watched as he actively started the dying process. Hospice had been called in earlier that day. The RN hadn't even opened his case yet. Then I called the hospice RN to come and do it quickly as he was actively dying. All of this happened within 15-20 minutes. The family didn't believe me when I told them he was actively dying. Not until the RN came and told them did they believe it. His process was completed in about 90 minutes.