First peds code

NO50FRANNY · Jul 2, 2012

Visceral is a perfect word to describe how I feel when we care for a critically ill child. Similarly we are an adults ED so we see very few children, let alone really sick ones. Last week, parents bolting to the triage desk with their floppy, blue, 10 year old daughter. The triage nurse spots them, hits the emergency bell and races them to one of our trauma rooms. They had been sitting on the couch watching television and she rapidly developed anyphylaxis, she has several known allergies and asthma and her parents had administered an epipen with little effect. They were headed for the childrens' hospital about 5 minutes around the corner but fortunately, realised they were running out of time. Nearly in full respiratory arrest, I have never seen such a sick little person, she was working so, so hard to breathe.

I was unable to stop my voice cracking when talking to her parents, or the tears that came after she was stabilised and transferred. It was a different kind of stress that I haven't experienced before. Somewhere in my mind I just take on the worry of the parents, or feel upset for them, it's difficult to put into words. Watching that little body struggle like a goldfish out of water, awful. Fortunately, our amazing doctors were able to avoid intubation and stabilise her for transfer to the kids. I was so impressed with the primary physician, the way he spoke to this little girl and her parents was just beyond amazing (sensitive and kind but also very confident and precise) and the management of the resuscitation was flawless. I don't know exactly what it is that upsets me so much about sick little people but I think it has to do with their relative helplessness and innocence. Dealing with the neverending line of adults with their hangovers and sore throats, then a little person about to die. I think it just underlines how pathetic some grown ups can be! I feel this way with any sick kids, don't know how to get around it either.

hiddencatRN, BSN, RN · Jul 3, 2012

I work in a peds er. Even then, codes are still pretty rare. We had one horrible night where we had two back to back codes, both died. I was literally carrying the first baby to the room we'd set up for the parents to grieve when the second rolled through the doors.I have two very clear memories of those babies: one was the dad for one of the babies, the pleading look he gave me when the doctor started broaching the topic of ending resuscitation.The second, I was acting as family support, explaining what was happening, and I told the family that the baby wasn't breathing on his own and his heart wasn't beating so we were doing that for him and giving him medicine to try to start his heart again. The family asked me what would happen next if the medicines didn't work and I remember being really caught off guard by that question. I said "well...then he will die" or something like that.My first code was what ended up being an abuse case. Got rhythm back to admit to ICU and died there. Parent had a fishy story about what had happened, retinal hemorrhages, other signs of neglect,ended up having a bleed. It's sad. I feel worse for the ones who survive with the very poor outcomes though. There are worse things than death.

brainkandy87 · Jul 4, 2012

Wow, props to you on getting through that. Sounds like a complete nightmare.

VICEDRN, BSN, RN · Jul 4, 2012

6 weeks off of orientation: Fire calls out a self inflicted GSW to face in a child year older than my own daughter. State patient crying on scene, aox4, will transport to our facility for stabilization (and then transfer to children's). ETA: 5 minutes. Well, they lost her airway en route. I was stunned and shocked when they arrived bagging her and in full arrest.

I will never forget cutting her little shorts and panties off of her. I will never forget how betrayed I felt that she would not produce a single ectopic beat for us no matter how many rounds of epi and what not we gave her. I still think about her every time I see an ectopic beat.

I will never forget how I feared my own shock prevented me from giving her a good pedi code. I will never forget how humble I felt because I had expected one patient and got another (and I know better from 4 years in EMS).

I can still hear the sound of her mother's cries. It sounded like a wounded animal and I will never forget the look in her eyes when she reached in her purse and swallowed a handful of xanax in front of us (which turned into another drama).

After that, I got better with the pedi codes. One in 3 people I coded were pedi (from that somewhat rural ER). And I learned...not to take anything for granted and to embrace every second of life I get. And I learned to tell my kids how much I love them every time I see them.

thelema13 · Jul 4, 2012

We coded a 4 yr old that took a handful of her father's clonidine. They brought her in flaccid, purple and apneic. We bagged her until she turned pink again and intubated. Her mother and father were of Hispanic descent and were crying and moaning loudly, screaming in Spanish. As we are coding the little one, basically maintaining her respirations, and she is slowly starting to brady out on us. 60, 40, 35, and atropine seemed like it worked for 30 seconds and she would just keep bradying down. After the 3rd dose of atropine, she perked up to 110, and crashed right back down. PEA. Ill never forget doing compressions on her, I wrapped my hands around her chest and did CPR like I was resuscitating an infant she was so small. We got a rhythm back with about 60 seconds of CPR, had a secure airway, and we flew her out. Time from hitting our doors to flight was 47 minutes, and those 47 minutes were the longest of my life. Every second felt like a minute. Every heartbeat was not taken for granted. SO showed up with detectives, and they kept the father behind but allowed the mother to fly. I felt so bad for the father, he was shaking and crying and couldn't focus on any of the detectives questions.

I remember the mother running in, red in the face carrying her daughter in her arms, purple and completely limp. She was so diaphoretic. Scary, scary night. I don't have kids and I am glad I don't I would NEVER want to go through that.

She survived, she came back about 7 months later for a fever. The parents now keep all meds in a metal safe.

Trauma Columnist · Jul 5, 2012

Many pedi codes in the 10 yrs in level trauma center. First one was the worst: July 1996, 4 y/o tortured to death over a 90 minute period - idiot boyfriend punched the child full in the face and broke all her little baby teeth - I still get upset even typing this....so very sad.

canned_bread · Jul 6, 2012

First day in a tertiary paeds hospital. Ambulance called through prior to arriving stating 2 yr old, a drowning, no pulse when they arrived and now a weak brady, no spontaneous breathing. The toddler came in, found in a neighbours pool. Had been missing for about 30mins. When the child came in, I felt my heart kind of jump and because I was still "new" I asked "what can I do", and I became the documenter. Straight away it was action stations, there was no time for emotions or panic. It was ordered, focused, chaos.

Afterwards though, I was such a wreck I rang my preceptor because I needed a serious debrief and felt I needed to know the outcome of the child straight away, but of course no one could give me that. The child ended up passing as life support was turned off a few days later. I had seen defib and intubation on an adult before, and it was no where near as bone chilling as it was on a child. The little body like that, it all seemed like such an assault. I even questioned whether paeds was my thing. But my mum said "If it hurt you that much, perhaps you are indeed in the right place?" Which brought me comfort and made me think that's so true. If I love children THIS much, and want to help alleviate their suffering THAT MUCH, then yes, it's our calling.

One thing that I still haven't managed to get a hold of is "continuing as normal" for the rest of my shift after that adrenalin rush occasionally happens. It is hard to focus my mind on something else.

Kidrn911 · Jul 12, 2012

14 yr old asthmatic, ran out of shower butt naked in the middle of the day to get her emergency inhaler which was down the street. Collapsed in her yard. No phone, family ran 2 blocks to call 911. Mom 3 sheets to the wind. We did a round of epi in ER, she was gone before she got to us, naked with just a throw over her.

The thought she knew she was in trouble that she ran out naked and knew she was going to die sends shivers down my spine. This was at a Peds ER. I have worked level 1 trauma center peds er and this still is the worst.

Ironically, I started a new one this month, wasn't there an hour before we had a code.