Seizure code blue

nrsang97, BSN, RN · Jun 20, 2018

You didn't screw up. You did the right thing. Good work.

bgxyrnf, MSN, RN · Jun 20, 2018

I'm one year into nursing and the other night I had my second ever code blue, my patient seized and O2 sats fell to the teens, HR skyrocketed, she was apenic and blue. I called a code, and all I could think about was respiratory support. I immediately grabbed the bag mask to start bagging but her sats started coming back up and the seizure stopped. The code team finally got there and she was fine again.
I didn't even think to make someone grab Ativan because all I was thinking about was that she stopped breathing, so I was so focused on respiratory support, I completely ignored the cause: the seizure. I feel so stupid and like I totally screwed up... the scariest part was that I was alone in the room the whole time because by the time the code team/docs/staff got there, he was recovering ï¿½ï¿½ï¿½ï¿½ï¿½ï¿½

A couple thoughts:

1) Grabbing Ativan does you no good unless there's a provider around to give you an order.

2) The seizure isn't going to kill the patient... sustained hypoxia will. The seizure does need to be treated but not as emergently as the cyanosis... though effectively bagging an actively seizing patient can be an exercise in futility.

3) One thing that I would certainly ensure is that there is a patent IV so that when the Ativan order comes, you can actually give it... of course, that's an action to delegate to the second nurse in... who oddly never showed up (kind of a weird place where people don't swarm a code or 'staff emergency' button or hollering for help)

What you gained was a fantastic bit of experience. Notice how the seizure resolved even without the Ativan? Most seizures do, as it turns out. What the patient needs during the seizure is to be kept safe, and tending to his airway certainly counts.

I've been an ED nurse for nearly 10 years and I've encountered my fair share of seizures... you did fine.

brillohead, ADN, RN · Jun 21, 2018

I'm on the cardio-pulmonary floor, and outside of Critical Care (obviously), our unit has the most Code Blue situations. When we hear a code called, one employee down each hall (we are shaped like a T with three halls) will stay on that hall to answer call lights, bed alarms, etc., and all others will descend upon the room with the code.

Sometimes the aide goes to help, sometimes the nurses go to help -- it kind of depends on what's going on with the patients in that hall and who is working in that hall. I'll usually holler out something like, "Nurse Betty, you stay here and keep an eye on the hall, Aide John and I will go help!" If the code is on the same hall I'm working on, everyone reports until more help shows up -- then a nurse or aide goes back to keeping an eye on the rest of the hall while everyone else deals with the code.

If the primary nurse is doing compressions when I arrive, I kick her off the chest so she can open up the chart, answer questions for the code team when they get there, call the family, etc. If the code team has arrived and there are enough people to rotate out compressions, I try to catch the primary nurse's eye and ask her what she needs me to do for her other patients.

There is no excuse for the rest of your unit's staff to not have been in the room with you within seconds of the code being called overhead (and even sooner, really -- a simple "HELP!" should have brought them running). And you did everything right -- good save!

Wuzzie · Jun 21, 2018

1. The lack of teamwork on your unit needs to be addressed immediately! Nobody should be left alone in an emergency situation. Ever! :mad:

2. It's good that you went straight to ABC's (CABs? :down: ) because without any one of those badness ensues. No such thing as death by Ativanemia.

3. While ABC's are good (see #2) it is nigh unto impossible to bag a seizing patient effectively and without injury to you or the patient.

4. Seizures are usually self-limiting except for when they aren't. That first minute of waiting to see what you're dealing with seems like days. :wideyed:

5. Patients look like death while in the middle of a seizure. Give it a second. They generally turn around very quickly after it is over. If they don't then intervene.

6. If spontaneous respirations return when the seizure is over do not get an ABG immediately after. The results will be horrifying but will improve in very little time. I can't tell you the number of patients I've transported who were unnecessarily intubated for post-seizure ABG results. :facepalm:

7. Pulse oximeters usually can't read on a seizing patient because of motion. Whatever the readout is is probably unreliable. :roflmao: (supposed to look like a seizure)

Going forward. The primary goal in the immediate treatment of a seizing patient, not in status, is to protect them from injuring themselves and wait it out. Call for help, move them away from furniture and walls, protect their head and yourself. Once it's over assure a clear airway, place them in the recovery position and provide supplemental 02 if indicated. Monitor them to make sure they are stabilizing and be prepared for them to seize again as often their seizure threshold is lowered. If anti-seizure medications are indicated (status or repeated seizures) IM Ativan or rectal Valium are good options when an IV isn't available or you can't access it due to patient movement.

So basically you did a great job! :up: