Frequency of codes in peds emergency?

[zubrowka1]

I need to sign up for my practicum by the end of the month and I’m mainly interested in peds emergency. I had a really great experience in my peds clinical when I floated to ER, but I recently thought about something. I don’t know if I would be able to keep my head cool if I had to code a kid because obviously it’s really f*d up if they don’t make it.

I’m an ER tech in an adult ER and I recently did my first compressions on a 77 year old. He didn’t make it but it was still an awesome experience... I doubt I’d be able to say that if it was a kid.

I’m in a large city so I have the opportunity to sign up for a level 1 trauma peds ER or an ER at a smaller peds hospital. I essentially have three questions.

1) How often does a pt code in peds emergency?

2) How mentally tolling is it when that pt doesn’t make it after you’ve personally worked them?

3) Would it be a better idea for me to stay away from the trauma center if I’d like to see less patients code?

[PeakRN]

It depends greatly on the specific ED and what the patient population looks like in the region.

It also depends on what you consider a code, we have at least one 'soft code' a week. Soft codes typically require less than two minutes of CPR, one emergency medication, respiratory resuscitation only, et cetera.

The PALS mega code we see maybe three times a year. Fortunately in the past two years all of our peds ED codes had ROSC and all but one left the hospital with no deficits.

I find peds codes in the ED to be very sad, but they don't really keep me down for that long. I carry far more emotional baggage from the non-accidental trauma and child sexual abuse cases than from the codes in the ED. I have a harder time with some of the codes and withdraw of care we have in the PICU, but these are kids and families that we have built relationships with, often for weeks or months.

The vast majority of peditactic trauma is NAT cases. If you are debating whether to stay in a large trauma center you really need to think about how you are going to handle that. Also keep in mind that trauma level doesn't necessarily mean that you will see more sick kids, it really depends on the region that you are working in.

Perspective comes with time, but peds codes aren't as bad as people think. I'd rather work in an environment where I care if my patients have a good outcome. I also get pictures from some of our kids who codes and are now doing great, and that makes a huge difference. I've worked kids who are now playing division one sports, who are nurses themselves, and some who have even started their own families. One of my favorites wasn't a code but a teen who stroked out and is now playing in a very renowned orchestra. I get to hang out this weekend with one of our super cute babies who coded and had a great outcome, and I'm very excited about that.

[Dacatster, ADN]

On 9/10/2019 at 4:13 PM, zubrowka1 said:

I have worked PEDS ER for 8.5 years in 2 large cities. Here is my experience

1) How often does a pt code in peds emergency? It varies. I could go a week without seeing one, I could see 2-3 in a shift.

2) How mentally tolling is it when that pt doesn’t make it after you’ve personally worked them? You have so much adrenalin going you don't have time for the emotions to get in the way. A good place would have a debriefing of it afterwards. You trust your co workers that you all gave 1000%. 

3) Would it be a better idea for me to stay away from the trauma center if I’d like to see less patients code? Actual if you want to see the most successful codes go to the trauma centers. You will see aloy and learn a lot and know how get successful outcomes. Not that rural ER can't but they just don't have the same benefits like PEDS neurosurgeons, cardiologist and on hand like the trauma centers would. You will have better outcomes.

Basically, more codes at the trauma center, but better percentage outcomes and confidence in your skills .