First Code Blue

Nurses General Nursing

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Specializes in Adult ER.

well last night i was working in the high observation section of my unit, finishing up my orientation to this unit (i'm a new grad nurse) one of our patients coded first medical 25 then full code blue. all i can say was wow. this was my first time ever seeing a code with 4+ years of education and working on a unit. i was amazed at how quick people came and how many people came. it was the best organized disorganized meeting of people that i have ever seen.

i don't know what i thought would happen but i have to say it wasn't pretty. i mean i know that the main part is getting the patient breathing with a good heart rate i guess i had a different idea in my head of how a code would look. since this was my first code ever i got right in there as i wanted to see everything and to see how and what they (code team) were doing. everyone that was there said it was a "good code" as no defib was needed. my question to all you is what would a bad code be like as i am sure i'm going to experience many different types. my unit has a bad nick name and the running joke is that the micu has a code cart ready to go with our units name on it (because there are so many codes call).

thanks

dani

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Specializes in ICU, oncology/organ transplant.

Wow, well it sounds as if you handled your first code very well. We had a new nurse a while back who cried in the bathroom after her first code. I am sure I have not seen as many codes as most on the boards because I have only been a nurse for three years but they are never the same. A bad code could be so many things. It could be like you said when they don't have to defib, or it could be when no MDs respond timely, or your code cart isnt stocked. I work at a teaching hospital and everybody in the room wants to run the code! My advice, do what I do, get in every one you can to watch or participate. In my hospital we stock our own carts after the code.One time it took me over 2 hours to re-stock it because so many things were missing. By spending so much time with the cart it familiarized me with its contents. So when a doc starts hollaring at you to get leads or Epi...you have some idea of where to look.

p.s. I work organ transplant and we always joke with SICU that we should have our own elevators to trade patients because that is all we do.

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Specializes in Education, Acute, Med/Surg, Tele, etc.

The first code I ever saw was worse than the clown show at Ringling Brothers! I am so serious!

I come from a long line of fire medics and paramedics...and I know how a code should run and how organized it can be...but also know how disorganized things can get and it all goes chaotic after that! (kind of like what happens to our day at work with one code...just can't catch up after that!).

Most of the people I work for in regards to codes know this one rule...if the patient is not breathing, and doesn't have a pulse..they are dead, so anything you do after that is a bonus...just do your best. That makes things a little less adreniline on you..LOL! Just focus on your task...like for me it was usually resps/bagging or IV start (before I went back to hospital) so I focused on that and hoped for the best! If I focused on my task, then my teammates could count on me getting that task done and could go on to the next with confidence.

I know I have told this story once, but that first code...well interns at this hospital came in and this man was in asystole! There was a doc that climbed onto the bed to do compressions screaming at us nurses about not doing them (ummmm did you notice the electrode pads guy? We are about to shock if you would kindly GET OFF!). And I was near the foot of the bed where an intern was trying to assess pedal pulses with a doppler! Ummmm metal probe, asystole, shock???

I tackled the intern, the doc got shoved to the floor so no one was hurt (didn't they notice the yell shock and the machine doing its warm up noise???). So no doc was injured..the gent unfortunately died...but hey, hard to bring back from asystole sometimes...

But talk about a circus! LOL! I vowed to try to not have that happen again in my presence, and studied up so that if need be I can be a team leader prn! :)

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Specializes in Critical Care.
I know I have told this story once, but that first code...well interns at this hospital came in and this man was in asystole! There was a doc that climbed onto the bed to do compressions screaming at us nurses about not doing them (ummmm did you notice the electrode pads guy? We are about to shock if you would kindly GET OFF!). And I was near the foot of the bed where an intern was trying to assess pedal pulses with a doppler! Ummmm metal probe, asystole, shock???

I tackled the intern, the doc got shoved to the floor so no one was hurt (didn't they notice the yell shock and the machine doing its warm up noise???). So no doc was injured..the gent unfortunately died...but hey, hard to bring back from asystole sometimes...

Please clarify for me the reasoning for shocking asystole. Did you check in another lead and find fine VF? I was always instructed that to shock asystole was to cause more problems than it solved.

tvccrn

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Specializes in Education, Acute, Med/Surg, Tele, etc.

It was a witnessed asytole by RN and MD, so precordial thump and shock...yes the leads were checked (I even asked that too!). The precordial thump and shock were protocol there at that time.

I was basically doing the whole "be the wall" deal since I was a newbie and just witnessing...but I am sorry..it was absolutely hillarous despite the seriousness of the situation.

What got me more was an intern trying to get a pedal pulse on asystole! Or the RN that was trying to get a BP...LOL! Ummmm, save the efforts guys!

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Specializes in Critical Care.
It was a witnessed asytole by RN and MD, so precordial thump and shock...yes the leads were checked (I even asked that too!). The precordial thump and shock were protocol there at that time.

I was basically doing the whole "be the wall" deal since I was a newbie and just witnessing...but I am sorry..it was absolutely hillarous despite the seriousness of the situation.

What got me more was an intern trying to get a pedal pulse on asystole! Or the RN that was trying to get a BP...LOL! Ummmm, save the efforts guys!

After seeing all that I probably would have been :lol2: !!

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Specializes in Education, Acute, Med/Surg, Tele, etc.

Yeah..it was a riot actually...and sadly...but did teach me valuable lessons...LOL! Like don't try to get a BP on asystole, don't use a metal probe when shocking...and don't all the sudden climb on a patient when you don't know what is going on! LOL!!!!!!!!

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It was a witnessed asytole by RN and MD, so precordial thump and shock...yes the leads were checked (I even asked that too!). The precordial thump and shock were protocol there at that time.

Shocking asystole was hospital or ACLS protocol at the time? And I realize that ACLS protocol should trump hospital. When did ACLS ever advise shocking asystole (I'm asking as I don't know and couldn't find it)?

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one of our patients coded first medical 25 then full code blue. all i can say was wow.

sorry if this is a dumb question, but i am not familiar with the term "medical 25". i assume it refers to a patient crashing, but not a full code blue, is that correct?

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Specializes in Education, Acute, Med/Surg, Tele, etc.

Hey Topher..let me ask my hubby (who is paramedic)...it wasn't long ago that you did shock asystole, but I don't think it is the trend now...I forgot since that was the first and last time I saw asytole lucky for me!

I don't believe you shock it anymore..but the hospital did it for CYA ya know...like HI..we are doing something kind of deal....

I will find out...

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Specializes in Education, Acute, Med/Surg, Tele, etc.

Okay it is what I thought...you don't shock asystole except in the case of witnessed down time. Then you will go drugs and cardiovert if you are really trying..but it is basically drugs and cross fingers!

My hubby remembers this episode I went through and said...oh yeah they were totally CYA'ing! He was gone so why not? Shocking asystole doesn't hurt..but not going to do much...looks good on paper dependant! He said..."I think at the time they thought it was very faint v-fib..so what the heck"....

So there it is..dont' shock but what the heck? Clear as mud! LOL!!!!!!!!

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Nope you don't shock asystole anymore. If you do that during an ACLS test you automatically fail. We weren't given any second chances on that.

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