help, experienced opinions needed!


Hi guys, i need some opinions from more experienced nurses. I have been a nurse for 2 years now, first on tele and then the past 5 months in a community hospital CCU. Recently towards the end of our shift, we had an admission coming in, and it was supposed to be a "code chill". I have never encountered one before (we get very few), dont know too much about it besides the 20 minute competency that we had to go through (which isnt saying much). It was my turn for admission, and the charge nurse asks me if im ok with taking this patient since ive only been off orientation for 2 months. Honestly, i told her i wasnt really ok with it because I felt like i didnt really know how to care for that type of patient, and that i really had no idea what to do. im all for gaining experience but i would rather watch an experienced nurse do it first before doing it on my own. Now i regret my decision and im freaking out; i feel like all the nurses think im incompetent and a huge baby, as if i cant handle anything. I dont want to be looked down upon as someone who cant take care of what needs to be done. I want to learn and always jump at the chance to learn new things, but i felt like this was waaaay out of my level at this point in my experience. Thoughts??


143 Posts

Next time take it! Ask charge if they perhaps could help settle the patient and walk you through what you don't know. That way you will have backup while you are getting a quick hands on in what you don't know =)

Specializes in ICU.

You can't learn about everything you handle before you get it - sometimes you just have to learn as you go! Take the complicated patient with the new diagnosis next time, and pull up the policy and procedure on that diagnosis and go through it very carefully. I guarantee you will learn faster doing it than just reading about it.

Specializes in MICU, SICU, CICU. Has 24 years experience.

Therapeutic hypothermia is done to prevent a reperfusion injury after ROSC. TH pts in the induction phase are two to one and one to one for the next 48 hours.

They need two core temps a central line and an aline. The temp MUST MUST MUST be controlled. Brady cardia and then SVT are very real possibilities if the temp drops below 31. If you are unfamiliar with the Artic Sun or Gaymar cooling unit you should not be responsible for this pt.

Shivering generates warmth and paralytics are given to maintain the temp of 33 C

Turn the warmer off on the vent. ABGs must be temperature corrected. Turn down the thermostat in the room.

If using wraps they must be readjusted and a skin check done every two hours to prevent a thermal injury.

TH turns lung secretions to cement and slows gastric secretions and peristalsis. These people at very high risk for pneumonia and SBO.

A hypothermia pt does not metabolize meds like a normal human and there is no research done on cooled pts. You have to be double super careful.

Electrolytes and ionized calcium must be sent every four hours. You will be replacing electrolytes like crazy. Hypothermia drives K Mag Phos and Ca into the cells.

The most precarious time is the rewarming phase when the electrolytes leave the cells. Rebound hyperthermia can set off the cascade of cytokines and interleukins and free radicals that destroy brain tissue.

Seizures are predictive of a poor neurological outcome.

One more thing, no one should neuro prognosticate until 36 hours post rewarming.


117 Posts

Specializes in Critical care. Has 13 years experience.

There is nothing wrong with saying you're not confident to look after a specific patient, especially when you've had very little exposure to them. However, as others have suggested, still try and get stuck in and help whoever takes the patient so that you can learn.