First patient death, first Code Blue!!!!

I too am a new grad passed boards in Jan, I dont know if I want to say if I am lucky or not, but I have been involved in 4 codes. The 1st one I just watched, 2nd one I observed--I take the back--5 codes and 1st one I did do chest compressions.

Anyways the point I was trying to make is in a code, someone is running it, and they tell you what to do, so you do kind of go on auto pilot. During one of my recent codes, I did volunteer some info, but minimal.

I dont know how confident I feel now as I just got done with ACLS today and now I am doubting myself. I passed the written test fine, but the mega code situation where I had to run one, eegadds I felt like a fool.

I am not jumping in to run one anytime soon, that is for sure.

I have worked 6 months so far in the MICU and have already witnessed TONS of code blues and deaths, basically just get someone that knows what they are doing, alarms will go off like crazy anyway so everyone will know something major is going down (well I guess not on a med surg unit) just scream for help if nothing else lol people really dont expect you to know EXACTLY what to do. Hang in there!

I've only had one code so far (Thank God) - It was the scariest thing ever. I felt as if I was an outsider looking in... I had to push meds. Boy my forearm hurt the next day =( It's not so bad b/c the MD heads the team and tells what needs to be done... =( Scary scary stuff... Really does get the adrenaline pumping though

1) If your employer offers ACLS take it. It will make a code much less scary.

2) Pick a role in a code and assist- recorder, meds, airway. Don't be the runner if there is anyone else that can do it. You need the experience to get comfortable with codes.

3) Realize most of the patients that code in a in-patient setting aren't going to recover. The statistics on code recover are abysmal. Don't get discouraged if your coded patients stay dead-most do. It wasn't anything you could have done better or faster.

Good advice from all the posts. I'd like to add something.

Our emphasis in nursing today is to avoid codes whenever possible. I don't mean walking away or ignoring -- I mean picking up on patient changes & calling for HELP before they go south on you. Trust your instincts. If it looks like something bad is going to happen, get some help. If your facility has a Rapid Response team make sure you know when and how to alert them & don't hesitate to do so.

As for codes - they are dramatic, for sure. But there is always someone leading this effort. Over time, you will gain more familiarity with the 'dance' of ACLS. Believe it or not -- in a couple of years, you'll be the one leading -- and (I'll just bet) doing very well.

"Our emphasis in nursing today is to avoid codes whenever possible. I don't mean walking away or ignoring -- I mean picking up on patient changes & calling for HELP before they go south on you"

This is it in a nutshell. There other day I had a patient go south on me and we had to call a code. In retrospect after going over the whole event with my preceptor and manager I can see that I myself wasn't totally in tune to my patients correct level of concsiciousness. My preceptor was though and we did everything we could but the pt still ended up coding and didn't make it. Pt had a seizure about 1 hour before the code and her prognosis on admission wasn't all that great but still I really thought the patient might have a chance since they were young and needed to make lifestyle changes. This event really taught me so much. After debriefing with my co-workers I know I'm not to blame but still I will always ask myself what if...... So like someone told me in another post, I must move on and learn as much as I can from this. This event will always be with me and I know it will change the way I give nursing care meaning as a new grad we are so wrapped up in the skills and the meds which we should be but we have to alway always always be assessing airway and LOC, I'll never take that for granted again.

We do not have a rapid response team at our hospital. To small.

Anyway lots of good responses. I get to take ACLS in the fall. My manger told me she had to take it several times before she felt comfortable and confident in the code situation. I am just hoping that day will come for me. It was really awesome to watch the nurses and R.T. that were totoally expierenced at it. Very impressive. I hope and pray I will be there some day.

I couldn't agree more with the recommendation to take ACLS. My first two patients that coded, I just stood there in shock, not knowing what to do. Fortunately, I had my preceptor with me both times. Now I have taken ACLS, I know what to do (at least in theory, :wink2:). Just having that knowledge to fall back on, helps keep the panic from setting in.

I disagree that one will always "instinctively" know what to do. Some people may, but not everyone does. It's hard when it happens, to know what to do first.

ACLS does require pre-course preparation. I studied a lot at home before class (maybe over-studied?) but when it came time for my mega-code, I knew exactly what to do. And, please be reassured, they have made the class more student-friendly than it apparently used to be. Lots and lots of repetition is included to help students succeed.

:)

pddk87

Codes can be scary if you let them. Dying is a natural part of living. Expected deaths (DNRs) can be just as disturbing as unexpectd ones. I agree that ACLS is a logical step. If possible, have your preceptor do a mock code with you. Learn the differant facets, charting, compressions, preparing/pushing meds, difibrillation, finally directing. The MD usually runs the code. But since he/she may not be present on the unit, you may have to take over for the first few minutes. If you can, go to Central Supply of Pharmacy with your preceptor and learn what is in a crash cart and how to use it. All crash carts in any hospital are the same so anyone from any unit can use one. If you do peds codes learn how to use the Breslow tape. It takes all the guess work out. Like anything else in nursing, the more you know and do, the less scary it becomes!

Remember A,B,C Airway, Breathing, Circulation!!!

It never gets easy but it is part of the job.

Stay calm, think, then react!!!

Good luck

I disagree that one will always "instinctively" know what to do. Some people may, but not everyone does. It's hard when it happens, to know what to do first.

Well actually, once you do it several times, you will in fact act instinctively.

Get the basics down first. Memorize the BLS. ACLS can be added on to good BLS skills.

My advice: Run through it in your head! Step by step, everything you will do if:

- you walk into the patient's room and they're unresponsive on the bed.

- you walk into the patient's room and they're unresponsive in the bathroom.

- you hear another nurse call for help down the hall and its HER patient thats unresponsive.

- you hear a code blue called for the next unit over, and you show up to help.

- you're transferring a patient and the patient goes unresponsive in the elevator

etc, etc, etc.

Run through it in your head over and over again. This is what I do frequently with things which I fear I will not react instinctively for.

Oh, and go to every code you can.....even if its just to watch. You'll eventually get a good idea what goes next. ACLS is great too, but you'll lose it if you dont use it.

And don't forget that like a previous poster said.....most dead people STAY dead, despite our best efforts.

First of all, take a deep cleansing breath and blow it out. Feel better?

Now like "rbezemek" said, we're trying to avoid codes, sometimes though it's not possible. As you get further into practice you'll start noticing the "intangibles", those things that just don't feel right and start acting with your gut. Usually, we know when a patient is going south, but aren't convinced. Get help. Use other RNs, your charge nurse and start lobbying your hospital for a Rapid Response Team. They're going to have to anyway to get accredited by JHACO as RRTs are a new Patient Safety Goal for 2008, so it never hurts to get them on the road.

As for codes, the first I was in I ran into the room with the cart and my mind went completely blank...instinct went out the window. It's gotten better since then. ACLS guidelines are now more simplified than they used to be. Good BLS is the basis, everything else is just extra. But learn it and you'll feel better knowing that you've seen the scenarios, even if you don't have the algorithms memorized.

As for mortality, just to throw y'all off, the last 2 codes on my floor both came out of it just fine. The others I've been in though, not so much. My knees and back still hurt from the last one...

Cheers,

Tom

I'm a new graduate nurse and in clinical a few weeks ago there was a code in the ER where I was working. The staff that was doing the code knew this poor lady was already gone, but they asked me to take over with compressions. I freaked and froze up!! I didn't know what to do at all! Didn't know how to place my hands on her chest.....I just really forgot everything I knew. I'm glad they let me participate though, so when a another situation arises, I won't freeze like I did on this day. I felt really stupid!

I hope that during orientation at my new job....they will have mock codes to participate in. I need the practice!