4 hour code blue

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I work on Interventional Cardiology/Cardiac Step down. I just got home from one of the worst nights any Nurse or MD has ever had.. I work at an inner city hospital that is one of the top cardiac hospitals in the US. Pt. was talking to me and another nurse when pt. said chest felt heavy and pt turned blue and stopped breathing, I looked at the monitor the HR went to 280 v-tach, pt's ICD was firing out of controll, then pt. went into pulseless V-tach then full out cardiac arrest pt's only 57 y.o.. we shocked the Pt. 50+ times over 4 hours , CPR cracked a bunch of ribs, ambu bag and this went on for 4 hours..pt. went in and out of pulseless v-tach. Respiratory Acidosis, we pushed so much NaHCO3 that we ran out of it from the code cart med tray which we had 2 of them and the pyxis supply.Who evver invented ACLS is my hero .Interventional MD put a Aortic Baloon in at the bedside..we used 2 code med trays we pused more drugs into that pt. than any MD said they ever had, drips galore, 3 pumps with 3 channels per pump..that's 9 drips I think, TLC placed in groin after 10 attempts, ABG's x's I don't even know how many,tubed the pt only for the pt. to start foaming at the mouth, then vent at the bedside..CCU had no open beds, the EPS MD was caled 30 min. into the code he was at home, he said he was doing 110 MPH on the garden state inorder to get to the hospital. one MD wanted to call TOD 30 min. into the code..we said no, then they realized that they had only been shocking the pt at 200 joules b/c I looked at the defib. machine and said Hey we might wanna shock him at 360 joules, :banghead:((ya think))..this all started at 8:30 pm. Great way to start my shift. We finished the code at 1:30 AM!!!! We cracked 3 ribs, MD's burnt the crap out of the pt's chest from the defib. paddels. cath lab on call was activated..Pt went to CCU, 25 min after pt was in CCU he was AAOx3..still tubed in Normal Sinus...I was happy that we didn't let the one MD call TOD..the family hugged all of us and said they are going to write a letter to the hospital and say how we saved the pt's life and didn;t give up when the one MD wanted to call TOD..the family asked for my name and said that if it wasn't for me pushing the fact that the pt had only been coded for 30 min. and we weren;t going to give up untill the EPS MD arrived and we were going to do every thign we could for the pt., the family said that the pt. had gone through this before at another hospital..that actually felt good that the family said we saved his life. But 30 min after our code was over there were 3 more codes in the ICU...the EPS MD said that was the longest code he ever had in his 20+ years of medicine and thanked all of us..he asked if it was my first mega code..I have been in codes before but nothing like this..he gave me a hug and said I can't even tell you how greatful I am that you didn't let the code team give up on this pt, and that you opened your mouth and wouldn't give up, he asked how long I have been a nurse, I said about 9 months. The MD said that there should be more nurses like me in our hospital. I was totally shocked he said that..I said thank you so much...needless to say I am BEAT!!:heartbeat:heartbeat

well done

you with the other team member safe that pt. life

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WOW JUST WOW. Your a great nurse. Hope you had a break.

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This is very inspiring.. Thanks for your sharing

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Specializes in Surgical, Medical, Heamatology, ICU CICU.

Hi am really speechless i do not know what to say to u but God bless u me i know what was the patient diagnosis was he going down or it was sudden heart attack lead to Cardiac Arrest? and were u thinking of DNR protocol that time Ethically.:up: thanks

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Specializes in CTICU, Interventional Cardiology, CCU.
Hi am really speechless i do not know what to say to u but God bless u me i know what was the patient diagnosis was he going down or it was sudden heart attack lead to Cardiac Arrest? and were u thinking of DNR protocol that time Ethically.:up: thanks

the pt. was s/p ICD lead revision or ICD replacement...I can't get the right ans. b/c I have heard 4 different things. But from all the info I gathered over the last few weeks, the original ICD the pt had for th last few years was one of the Medtronic ICD's ( I think that's the brand but don't quote me on that) that had the recall due to the leads fracturing and breaking off...I have had a great number of pt's that have had recall ICD, or just the leads replaced, in fact during my first week of orientation I had a pt. with a Medtronic ICD that the leads literally came right through the Left pectorial area and were exposed, and that was one of many pt's since I started on my floor 9 months ago. But the patient that you are asking about, the ICD replacement was done on Friday, since it was done on friday the pt. had to stay the weekend b/c the cath lab is closed on the weekends, and the ICD check was to be done monday. During the week if the pt. had the ICD insertion on say, a monday, it would be check the very next day on tuesday...back to the main point, it was a Saturday night that the pt. coded, so you know what that means..weekends+code blue+low staffing of MD's and nurses=disaster. That's why the EPS MD, as soon as he was notified, was driving a 110mph on the Highway to get to the hospital, b/c he knew it was a weekend and the only MD's on the code team are tele residents that are eager to learn which is good, some surgical residents (like 1 or 2 MD's), 1 cardiac fellow, maybe 2 respiratory therapists and the house MD(who is covering about 100 doctors and is the only House MD for the entire Hospital, you would think that in this century that there would be a better system at night), oh YEA and us NURSES. One nurse to do the code count and write down all the meds ,shocks, people, times, you know acls protocol, one nurse to draw up all the meds, and get the items out of the crash cart b/c the MD's just rip the drawers open and toss **** all over(which was me :banghead:)and I also had the awesome duty of this, "Nurse Charge the paddels, nurse press Sync, nurse I left my cell phone in the car can I use yours:confused:" We had another nurse who was running all over the unit doing god knows what, and one nurse from day shift that stayed 4 hours OT just to enter orders and be a runner for what ever we needed. As I stated before in the original post, I was not the nurse assigned to this pt. that night but as a team during a code you are the only nurses for that pt at that time.. but any way, so I had no idea of the pt. Hx untill after the EPS MD showed up, I looked through the chart for the H&P before the EPS MD showed up, but the H&P was written in jibberish. All I know is when I heard the pt. mutter those words My chest...., and I looked up at the bedside monitor and saw the HR was 280 and in that rhythym you never want to see, and with in 0.5 seconds the pt. turned blue and the pt's back began to arch up from the bed..I knew it was going to be a long night, screamed call a code. I grabbed the bed side clip board and looked for the care map every pt. has (it's a nurses H&P and what not) and it was missing, GREAT..nothing to tell the code team, and it was right after shift change so..usually if a pt. is on my floor they have an extensive cardiac Hx. I can't tell you what triggered the v-tach, it could have been a number of things, K+, Mg, MI, EPS MD told me that the pt. had a code like this in another hospital some time ago, so PMHx, but I have my theories about what happened and and I am going to keep it to my self for reasons.

But did I look for a DNR, YES I DID...our patient data bases that are on the bedside clipboard, which is our nursing admission, the first question is, "DO you have an advanced directive?" Most of my pt's have no idea what this means so I always follow up with "A DNR, Living will, something along those lines" and then the light bulb goes off and the pt. usually says yes or no. I ALWAYS ASK IF THEY ARE DNR....It is something that is very important to me b/c of personal family experience. But I can tell you that the family of this pt. actually came bck to our unit a week ago, and at night b/c they knew the night shift were the ones who ran the code, and brought homemade macroons, and italian cookies and thanked all of us, even gave us a card adressed to the "Angels of the Night"..The nurse whose pt. it was and I wnet up to the CCU last week to visit the pt and the the pt. is doing great, has some deficiets, but It felt good to see that pt. is alive and talking....:yeah:

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:yeah:SWEET:yeah:

Again great job, happy ending.

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Specializes in Paediatric Cardic critical care.

Sounds like it's all fun on your ward!

Unfortunatly it seems to happen like that; it'll be (quiet) for a few weeks and then on my unit (cardiothoracic critical care) we'll have 2 simultanious open chest on the unit where pt's have tamponaded post cardiac surgery. But then at the end of the day we're nurses and we have a sick way of enjoying these situations!! am i alone?

What's a blue code? I get lost in your language a bit sometimes living and working in the UK. We have a US sister on our unit so I know a code is a cardiac arrest. Do you have different colour codes?

Well done though; seems like you are a born nurse. Have you thought about critical care?

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Specializes in CTICU, Interventional Cardiology, CCU.
Sounds like it's all fun on your ward!

Unfortunatly it seems to happen like that; it'll be (quiet) for a few weeks and then on my unit (cardiothoracic critical care) we'll have 2 simultanious open chest on the unit where pt's have tamponaded post cardiac surgery. But then at the end of the day we're nurses and we have a sick way of enjoying these situations!! am i alone?

What's a blue code? I get lost in your language a bit sometimes living and working in the UK. We have a US sister on our unit so I know a code is a cardiac arrest. Do you have different colour codes?

Well done though; seems like you are a born nurse. Have you thought about critical care?

Code blue at my hosp and I think it is a national thing in the USA is a medical emergency..my hospital also had the rapid resonse system that is a pre-curser for a code...the RRT is called if you think that you may need help and want a team to eval. the pt. but latley it's been more codes and RRT's then ever. In fact I have had 2 in the last 2 night both my pts. I have an interview next week in the ICU..I hope I get the jjob!

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Specializes in Paediatric Cardic critical care.
Code blue at my hosp and I think it is a national thing in the USA is a medical emergency..my hospital also had the rapid resonse system that is a pre-curser for a code...the RRT is called if you think that you may need help and want a team to eval. the pt. but latley it's been more codes and RRT's then ever. In fact I have had 2 in the last 2 night both my pts. I have an interview next week in the ICU..I hope I get the jjob!

Good luck for that; I couldn't work in any other department now. I think you'd really enjoy ICU:bugeyes:

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Specializes in critical care.

I have a question, Perhaps I didn't absorb it from your post but after 4-5 hours of this, and subsequent acidosis etc, did he even have a myocardium left? What about his cognitive status, was there any anoxic brain injury? Would love an update regarding his current condition, cause it seems to me that God was trying to call him home!

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Specializes in CTICU, Interventional Cardiology, CCU.
I have a question, Perhaps I didn't absorb it from your post but after 4-5 hours of this, and subsequent acidosis etc, did he even have a myocardium left? What about his cognitive status, was there any anoxic brain injury? Would love an update regarding his current condition, cause it seems to me that God was trying to call him home!

I have only seen the pt. one day that I went up to the CCU to visit. I am asuming that there is some injury b/c of the long standing acidosis and all the durgs that were pushed into this pt. I heard the pt. follows simple commands, and will need extensice cardiac rehab. And I do oagree that God was trying to call him home.

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Specializes in CVICU, MICU, CCRN-CSC.
Code blue at my hosp and I think it is a national thing in the USA is a medical emergency..my hospital also had the rapid resonse system that is a pre-curser for a code...the RRT is called if you think that you may need help and want a team to eval. the pt. but latley it's been more codes and RRT's then ever. In fact I have had 2 in the last 2 night both my pts. I have an interview next week in the ICU..I hope I get the jjob!

At a **large superstore** they called a "Code Blue" overhead. Ofcourse the ICU nurse in me went on alert (habit)...and waited. I have heard them call a medical emergency at this store and they asked overhead for a CPR certified person to come to a certain area of the store. Turns out...code blue is to go get the shopping carts in the parking lot:chuckle:chuckle:uhoh21::banghead:

I don't know if it is a national standard or not...but for any medical professional it is enough to make our adrenline get going, even when you are grocery shopping. You would have thought SOMEONE in their upper management would have at least watched enough incorrect ER shows to know that Code Blue is medically related.:yeah:

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