Had A Medical Code on the Psych Unit!

[Meerkat]

I was assessing a new patient who was in for Bipolar and one of the techs came running down the hall, yelling, "We have an Emergency!" I was the only nurse for the floor that night---just the tech and me. So I find a patient on the bathroom floor. No breath. Steady Pulse. I told the tech to go call a code and bring resuscitation equip. Man I was scared! I have never been in on a medical code before, let alone run one! The patient took a few spontaneous breaths, very shallow. I forgot to try the sternal rub to rouse her, but after a few minutes her eyes fluttered and she complained of radiating chest pain thru her left arm. I didn't move her from the bathroom floor because she struck her head on the way down. EMS got there about 15 (!!!!) min later. I felt OK about the code but I'm a little bummed that my mind semed to work in slow motion during it. Any suggestions forme if this happens again?

[leslie :-D]

sounds like you did fine meerkat.

anyone's first codes are always scary.

just remember to ALWAYS concentrate on airway,breathing, circulation. if the pt. needs cpr, administer it. put on o2 at 2L/min. if there's an apparent head injury, check neuro signs. while you're doing all this, delegate someone else to call 911. try to note the time you called 911- one time in a code i was charged with delay of care: i had carefully documented every aspect of the code and was vindicated. the paramedics were eventually charged. most important, don't lose your cool. again, you did well.

leslie

[Orca, ADN, ASN, RN]

I had something like this happen when I worked in a stand-alone mental health hospital. One of our intake staff didn't ask the right questions about this patient's medical stability, and he was admitted to my unit - on four liters of continuous 02, my first clue that something was amiss. I was the only license on the unit, and an agency CNA was assisting me. After making my morning rounds, I began to set up my AM meds about 20 minutes into the shift. There was a tap on the door. "I don't think this man is breathing", the CNA said. Sure enough, he was in full arrest. I called a code and we got the crash cart, and called EMS. EMS arrived within minutes, but the patient was already gone. "If we found this guy like this on the side of the road, we wouldn't have even started CPR", one of the paramedics told me after the code.

We found out later that this patient was a DNR, and the hospital who transferred him to us didn't bother to forward it or inform us. This is the only patient thus far who has died in my care.

[Meerkat]

Thanks you guys :)

[TitaniaSidhe]

Sounds like you handled yourself quite well. Anxiety is to be expected esp. being your first time in that sort of situation. The most important thing is to stay calm through dealing with the situation & get worked up later. Sometimes way easier said than done. For my last code we had a suicide attempt by hanging on our unit. Got him free from what he used to do it, no resp, no pulse, instructed NA to call the code, started CPR. Another nurse came from unit across the hall, she took over CPR I got a line in & started NSS at kvo. Code team & docs finally arrived & took over from there. We managed to get a pulse back but no resp on his own. Family had him removed from life support 2 days later. *sigh* it was a very unpleasant experience. I stayed calm until it was dealt with & the patient had recieved all care...then I had my bit of freak out about the episode.

Never know what your shift will bring in psych.

[Marie_LPN, RN, LPN, RN]

Any suggestions forme if this happens again?

Sounds like you did fine.

I suggest mock codes, for practice, if your unit doesn't have codes that often.

Reason why i say this is that our psych unit RARELY has a code, and the last time they had a code, it was a big disaster, because it can be a couple of years in between the codes they have. They now have a mock code every couple of weeks.