Black Friday, Code Blue

Friday was just a sad day overall. One of my patients, a woman who I have taken on and off since I was 20-something weeks pregnant, seized and coded and had to be intubated and taken down to the ICU. Since it was Black Friday, all of the staff there were the B team. Nurses Announcements Archive Nurse Life

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I was the most experienced nurse on my side of the floor. The other two nurses on my side included a travel nurse who is supposed to be seasoned but really has a LOT to learn, and a new grad RN who has been off orientation for two weeks. Thank goodness I'm the one who had this patient. I just...I need to get this out. It's been festering inside of me and I have to get it out.

As soon as I hear her son call out in the hall, "We need a nurse!" I know that it's my patient and I know that it's something bad. I run into her room and see her seizing. Of course, our medicine Pyxis has chosen that moment to be on the fritz and claim that we need to close a drawer that is definitely not open. I know I have to run over to the other side of the floor and override Ativan in their Pyxis. As I'm running down the hall, I encounter a group of doctors doing rounds and I scream, "[Room number] is seizing, I need Ativan and our freaking Pyxis is broken and I'm going to [next door] to get it! Get in there NOW!"

I'm tearing up as I write this because it just scares me that our Pyxis being broken could have cost her life if we hadn't had another on the floor.

I'm saying, "darn, darn, darn" as I override the Ativan, causing a discrepancy because I don't have time to count them, and I resume running at a breakneck speed, my stethoscope and badge swinging wildly, my co-workers shouting at me to be careful because of the baby, and me almost plowing them down as I speed past them.

I ran so fast and so hard that my throat hurt for hours afterward.

I've never trembled so hard as I do when I am pulling up the Ativan in the syringe. I get into her room and push the Ativan while the doctors are holding her head - she's biting her tongue and blood is dribbling out her mouth and her fingers are turning blue. Everyone is moving like it's slow motion, so I grab the code blue alarm and my co-workers come running with the code cart.

I scream at the pharmacist to get more Ativan out of the code cart, but she freezes like doesn't know how to get it open so I move 5 people out of the way and do the motions to get it open.

It doesn't feel fast enough, and I'm screaming at people to grab me a non-rebreather, call the pulmonary ICU team, call respiratory, call the internal medicine attending!

Rapid Response nurses arrive and I'm so happy I want to cry, but I settle for sitting at the end of my patient's bed, rubbing her foot and closing my eyes and not praying, but praying in the way only an atheist prays when they're scared someone is going to die. She is put on a monitor, we're cycling her blood pressure every 5, then every 3 minutes.

Everyone is asking me questions - what happened?

What's her history?

Does she have any allergies?

I rattle off the answers quickly as if I had memorized her life, and maybe for those brief moments I had. The mask is finally on her, her body is still, her vital signs are stalling out, but she's still not responsive, so the doctors decide we're going to intubate her. I assist in lifting her into position for the procedure.

My heart breaks for her - she's had to be on a ventilator before and it is her greatest fear. She never wanted it again. RR nurses push the meds she needs to relax for intubation, they get the tube in, and they figure out where she's going to go.

I'm on the opposite side of the bed, and my pregnant belly can't fit through the tiny opening between the bed and wall. It takes me asking 5 times before they move the bed forward so I can find the family and tell them what's happened. People always think the doctors have those conversations, and sometimes they do, but sometimes we do, too.

Her daughter in law is sitting in the waiting room, and tears are in her eyes as I calmly explain what happened, my heart beating in my chest, my body slowly winding down from the massive adrenaline rush, and my child kicking me inside, letting me know that despite my unintentional efforts to overwhelm her, she is safe and sound.

The rest of the family arrives shortly and I watch them file in behind my patient's bed as they follow her down to the ICU, the attending rattling off medical jargon that they don't care about right now.

Afterward, everyone told me I did a good job. They told me I rocked it out, and that I looked like a pro in there. We laughed about me being a "big belly running down the hall" at 8 months pregnant.

We laughed about my cussing at the doctors. We fixed the discrepancy in the Pyxis. I called to report to the ICU and finally ate some lunch.

But I tell you, I wish I never had to see or do these kinds of things. It breaks my heart every. freaking. time.

Specializes in Skilled Nursing/Rehab.

I have not read all of the other replies... just wanted to say that I greatly enjoyed your article, and your reply on page 2, OP! You are a very good writer. I wish you well with the rest of your pregnancy!

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Remind me NEVER to share anything on this site..

Congrats OP you did a good job. You have great writing skills. As I was reading the story I imagined you in my head being firm and in charge as you were giving orders. Not literally screaming. :)

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~*Stargazer*~ said:
It is not my intent to be unkind to the OP. If she was simply using dramatic license, and didn't really scream at her co-workers or run "at break neck speed" and "almost plow down" her co-workers, then my apologies. However, I took the post at face value, and in that spirit, I cannot condone those behaviors and I think they deserve some reflection on the part of the OP. I cannot in good conscience just give someone an "atta girl" when they describe such behaviors as screaming at coworkers and endangering the well being of themselves, their co-workers, and their unborn baby.

That must be some "dramatic license";the intent was the implied. You took it at face value because it is not a given expectation that you would perceive a different meaning from what the OP originally implied.

But the OP did clarify in later posts though.

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decembergrad2011 said:
So for the last time, I totally admit my mistakes in this..

No, actually, you haven't admitted any mistakes. You've been defensive and offered rationalization. But, that's okay, I didn't really expect otherwise.

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Thanks for sharing your experience with us, despite any unnecessary comments that may have been made. I'm sure it was hard on you having to go through that and for the record, I didn't picture you literally screaming either.

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Specializes in Oncology.
~*Stargazer*~ said:
No, actually, you haven't admitted any mistakes. You've been defensive and offered rationalization. But, that's okay, I didn't really expect otherwise.

Are you even reading my posts? I said I should not have ran the way I did, and attributed that to my previous code in the Summer where the patient died and wanting to quickly get the needed medicine. I clarified that I did not scream or act belligerent. You've made more replies than anyone in this thread, and they are only to repeat these two points after I've addressed them, the first time rather graciously. You are allowed think I did something worthy of a reprimand here, and that's fine. I didn't get defensive until you made the point that you would feel the need to counsel me if you were my manager, even with knowing the clarifications. I think I'm allowed to think otherwise and respond.

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Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
decembergrad2011 said:

4. Ativan is in our code cart. I'm not ACLS certified so I have no clue if this is standard or something our hospital does. All I know is that it was in there. If I had known it would turn into a code, I would have broken into the code cart rather than running to the other side.

We have 8mg of IV Ativan on each of our code carts as well. It may not be standard but it's also pretty common.

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Sorry, this post is crazy making, I woke up at 5:00 in the morning thinking about it.....it sounds like a TV script? Ativan should be refrigerated (as Pepper the cat noted) and (I repeat) is not usually kept in crash carts?

Can anyone at least clarify the Ativan issue for me?

And gosh....pregnant women are not so medically fragile.....many pregnant women continue jogging, going to the gym, etc., far into their pregnancies!

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Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
brownbook said:
Sorry, this post is crazy making, I woke up at 5:00 in the morning thinking about it.....it sounds like a TV script? Ativan should be refrigerated (as Pepper the cat noted) and (I repeat) is not usually kept in crash carts?

Yes Ativan should be refrigerated, yes it is commonly stocked on cash carts. By no means is stocking Ativan on crash carts standard. I would guess half the hospitals I have worked in stocked it. Back in the day when crash carts were pretty much just tool boxes with no provision to stock refrigerated medication I never saw Ativan stocked Over the last 15 years or so, as code carts have modernized, it has become more common in my experience.

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Thanks PMFB-rn...I like to learn new things.

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Specializes in Oncology.
brownbook said:
Sorry, this post is crazy making, I woke up at 5:00 in the morning thinking about it.....it sounds like a TV script? Ativan should be refrigerated (as Pepper the cat noted) and (I repeat) is not usually kept in crash carts?

Can anyone at least clarify the Ativan issue for me?

And gosh....pregnant women are not so medically fragile.....many pregnant women continue jogging, going to the gym, etc., far into their pregnancies!

None of our ativan vials are refrigerated. They're stocked in the regular pyxis. The only things that are routinely stocked in our pyxis fridge are insulin and neupogen. Sometimes we have chemo, vaccines, and antibiotics with a short shelf life in there for a specific patient.

Believe me, it felt like a TV show! It was like everything that could make it out of the norm was there. A lot of funny details are missing, like the travel nurse coming into the room, seeing that the patient was in contact, then saying, "Oh, I need to gown up." She came back in full isolation apparel - the only one of course and she wasn't even touching the patient. I'm sure if I had added in this part I'd have someone telling me that I should have stopped to put on gear before pushing ativan though. ;)

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Tears from reading OP. You did a darn excellent job!!

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