So, I had my first code last night that was MY patient - I worked xmas eve 7p-7a and xmas night (last night). It was my second night off orientation... I initiated TPN on a malnourished HIV+ patient - one hour after the monitor tech (I'm on a tele floor) yells at me to check on the patient - she's torsades on the monitor - I run in the room, shes unresponsive. Its 0230 in the a.m. and I've had four hours of sleep in the last 48 hours. I call the code and everyone is in there in about five seconds. I felt helpless, shaking so bad trying to prep NS flushes and answer the doc's questions - definitely questioning in my mind EVERYTHING I did throughout the shift that could have lead up to this (did I push the dilaudid she's getting for pain too fast, did I initiate the TPN too fast, maybe I didn't pick up on subtle clues that a more experienced nurse would have...etc. etc.). And its christmas night for crying out loud. Got to know the family pretty well (had them both nights). They had just thanked me for being there for their mom on christmas night. I felt awful. And incompetent.
So fast forward to now...It's 11:00 a.m. and I still haven't slept yet - I've been researching online to try to figure out what happened to her. She was SR all along, I start TPN and she goes into torsades? Is it refeeding syndrome, or sepsis? Could I have prevented it? and on and on.....
I hope everyone is having a good holiday. As always, would love to hear anyone else share their stories/opinions/etc. re: first code experiences, tpn complications.
Dec 26, '06
The first code is always a tough one and unfortunately as you now well know...codes and critical illnesses happen regardless of it being Christmas or that you are just off orientation. I would encourage you to get some much needed sleep, and if you then feel you need to...look at it again with a clear and refreshed mind.
There are some things we have no control over please keep that in mind but do use it as a learning experience. Are there any of your fellow coworkers that could give you some insight as to what may have happened? I feel for you, please get some rest and hang in there!
Dec 26, '06
OK First of relax!!!!!!! THere is usually no way to determine why a patient coded. Your first code it expected you will be nervous and what you described is very normal. It will take you several codes to feel comfortable. Do not try and figure out what happened, it is life and death unless you are GOD it probably wont get figured out. So don't beat yourself up.
I do recommend for you to, when there is a code and if you are able get in the room and observe or be the person to document. this will help you learn and get comfortable.
DId the person make it? I am assuming not.
Dec 26, '06
Unbelievably she's in ICU back in SR - intubated on a vent not doing so hot of course - that was as of 0800 this morning when I left the hosp.
Anyway, thanks for your responses folks. I just needed to get it out to someone who knows what the heck I'm talking about. Trying to talk it out with my friends while watching their eyes glaze over just isn't working for me. I love this forum.
I'm going to bed. I have the next four days off and its about 80 degrees here in Florida. When I wake up I'm gonna work on my tan - preferably with frosty beverage in my hand.
Happy holidays guys!
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