Black Friday, Code Blue

  1. 32

    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. 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 break neck 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?

    Woes 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 stabling 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 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.
    Last edit by Joe V on Jan 12, '15
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    About decembergrad2011, BSN, RN

    Joined: Oct '10; Posts: 479; Likes: 771
    Nurse; from US
    Specialty: 5 year(s) of experience in Oncology

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    66 Comments

  3. by   RNOTODAY
    Good Job. You Rock.
  4. by   blondy2061h
    It sounds like you handled the situation overall quite well and your patient will benefit from your effort! I am guessing from your user name you're a relatively new nurse. It sounds like you were very close with this patient, which makes it harder. I do have a few thoughts, though.

    1. It never really helps to run in these situations, ESPECIALLY if you're 8 months pregnant. If you had fallen or run into someone the situation would be way worse. A brisk walk is better. The extra 5 seconds probably won't make a difference.

    2. You use the word "screaming" a few times. This might just be your way of saying that you were speaking loudly and authoratatively. If not, that is the way you want to talk in these situations. Screaming and getting emotionally involved isn't helpful.

    3. If your patient didn't want to be intubated again, was a DNI ever addressed?

    Don't you hate how Pyxises break at the worst times? So frustrating. Even if it's not an actual code, don't be afraid to bust open the code cart if you need something like that stat.

    It does sound like you did well and worked as a team. Glad you got your patient taken care of quickly!
  5. by   Suey816
    WOW. You are a very good writer as well! I think my own heart was pounding.
  6. by   Anna Flaxis
    Hi there, what I am about to say is meant to be constructive feedback. I'm glad you knew the right actions to take in order to help your patient, and whenever you have an incident like this, it's important to debrief what worked and what could use improvement.

    Screaming (you use this word 3 times in your article), and running ("I resume running at a break neck 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") are not consistent with remaining calm, an essential component of responding to any emergency.

    Screaming at others during a code/rapid response is inappropriate, as this is not consistent with promoting good team dynamics, which are essential in an emergency situation.

    Running down the hallway as you describe places yourself, your unborn baby, and your co-workers at risk for injury.

    I'm glad you had the presence of mind to go to another Pyxis for Ativan, and that you knew there was more Ativan in the code cart, but your reaction overall sounds like you lost control. This is an area that I think you might consider working on.

    Remember, it is not YOUR emergency, it is the patient's, and so you need to keep yourself calm and composed in order to best serve the patient, and you cannot help anyone else if you do not keep yourself safe, so do not run or do anything to place yourself in harm's way.

    As an ED RN, I am part of the Code Team for our hospital. We have one rule that we always follow: We do not run to codes.

    This is for the same simple reason I stated above. If we injure ourselves then we can be of no help to the victim- i.e. if I fracture my wrist falling on my outstretched hand, then I cannot perform high quality chest compressions, ventilate with a bag mask, start a peripheral line, draw up or administer medications, or any other essential task I might be required to perform in an emergency. I become useless and of no help to the victim.
    Last edit by Anna Flaxis on Dec 1, '13
  7. by   Anna Flaxis
    Just wanted to add: What if you had fallen on your belly and gone into premature labor? Then your co-workers would have had 2 emergencies to respond to.
  8. by   OrganizedChaos
    It sounds like you did a great job but I would never run & I'm 9 weeks pregnant. I couldn't imagine running at 8 months. If there is an emergency at work, they know I'm not gonna run. If someone else wants to run ahead of me, good for them!
  9. by   Nursetastic
    I'm an ICU nurse and I often "run" to codes. My run is definitely a brisk walk as opposed to a run because, in all honesty, running through a busy, obstacle filled hospital is all but impossible. I read this article and was able to put myself in the OP's shoes very easily. I think a lot of the "running" and "screaming" used was for emphasis as opposed to being real descriptions of actions or behaviors. I've assisted in and run many, many codes and I think it sounds like the OP did a fine job. These posts are written with emphasis on the dramatic so that readers are enticed to continue reading. She was telling a story, not asking to be critiqued. It's no wonder she hasn't replied to any of you. She was sharing a very emotional experience and all she got was a lot of criticism in return.

    OP, well done. Thanks to your quick(!) response to the situation, the patient survived.
    Last edit by Nursetastic on Dec 1, '13 : Reason: Spelling
  10. by   cardiacfreak
    I don't think the other nurses were trying to be mean to the OP, IMHO I think they were only trying to offer her some very valuable advice in case the situation arises again, and we all know it will. The patient survived and that is the main objective. It never hurts to evaluate what you did in an emergency and see if there is anything you could do better or different the next time.
    Sometimes it is even hard for those of us who are experienced in code situations to remain calm, but I always take a second to tell my self, "Calm down, take a deep breath, you know what to do, this is why you are a nurse."

    OP, you did well, the patient survived. As a PP stated, don't be afraid to break open the crash cart if you need to.
  11. by   Anna Flaxis
    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.
  12. by   SwansonRN
    Remember to take a deep breath. Deeeeep breath. Seizures and codes are terrifying, but panicking only makes the situation worse. With stress levels that high, performance goes down. It's contagious so the rest of the code team will feed off of that energy, not to mention you will really upset the family. Also, next time see if someone can get the Ativan for you so you can stay with the patient. Someone who is seizing shouldn't be left alone. I really hope you don't think I'm being mean, just wanted to share my insight as someone who sees these instances frequently. Nicely written article and good job, just a few tips
  13. by   Do-over
    Law #3 of the House of God

    AT A CARDIAC ARREST, THE FIRST PROCEDURE IS TO TAKE YOUR OWN PULSE.
  14. by   Anna Flaxis
    Quote from SwansonRN
    Also, next time see if someone can get the Ativan for you so you can stay with the patient. Someone who is seizing shouldn't be left alone.
    I was going to mention that, too, but figured I was already being mean enough.

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