4 hour code blue

Nurses General Nursing

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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

Specializes in CTICU, Interventional Cardiology, CCU.
This code started at 8:30 and ended at 1:30? That's five hours, not four. Amazing. Simply amazing. Glad you stuck to your guns. Enjoy the high while it lasts. Think back on this little miracle on those nights you want to walk out the door and not come back. Remember the life you helped to save.

You did a great job!

thanks..actually the entire process stopped at 1:30AM, we coded till 12:30AM, when the Interventional MD arrived and placed the baloon. The EPS MD said that the code ended when the Interventional mD showed up and the pt became stable...I was like Ok...but pt was extuabated today :saint::heartbeat:redbeathe

Specializes in CTICU, Interventional Cardiology, CCU.
yes we do which is a pain in the but I have asked many times for a monophasic defib for this reason!

Sorry was not paying attn when I answered..no we use monophasic at my hospital, which is an inner-city hospital that has alot of money, a Physio-control from like 1980..I asked my director a million times for a new one..we don't have a pacing button only a sync on the machine. and our transport defib is a 1979 hewlett packard that's bright yellow, and the leads don't even stay connected to the machine...but you would think that we would be more updated, funny how things fall thrpugh the cracks..oh I know I am going to walk into work tomorrow and we will have a new machine b/c the EPS MD freaked about how old our machine was and how we should have been shocking the pt at 360.:banghead:

yes we do which is a pain in the but I have asked many times for a monophasic defib for this reason!

Why would you want a monophasic? Biphasic has been proven more effective and you can crank a biphasic to 360. We do it very often.

I don't think the balloon 'solved' your VT, as it doesn't 'open' the coronaries, rather it facilitates their filling. An IABP isn't a substitute for PTCA. There was some other etiology, and Im sure the amiodarone gtt you started solved your arrhythmias.

Specializes in CTICU, Interventional Cardiology, CCU.
Why would you want a monophasic? Biphasic has been proven more effective and you can crank a biphasic to 360. We do it very often.

i don't know if you saw my corrected my self. I am sorry for any confusion

Specializes in CTICU, Interventional Cardiology, CCU.
I don't think the balloon 'solved' your VT, as it doesn't 'open' the coronaries, rather it facilitates their filling. An IABP isn't a substitute for PTCA. There was some other etiology, and Im sure the amiodarone gtt you started solved your arrhythmias.[/quot

I know a IABP isn't a substitue for a PTCA. I deal with PTCA's all night long. But untill the Cath Lab was able to do a PTCA and a full staff was able to work on the pt he recieved a baloon, which again was inserted at the bedside b/c the pt was so unstable..why do you feel the need to belittle me..I have only 9 months experience out of school and like I have said I have been in codes before but nothing like this Mega Code. I work with about 3 nurses at night including my self, and little to no staff available. So I am sorry if my terminology is off, I am still learning. Calm Down, I am just sharing what happened the other night. :typing

I apologize if you're confusing a teaching opportunity with belittling. I was trying to offer insight as to why he turned the corner(the amio) and the advantage of biphasic defibs and discuss those issues.

If you'd rather me just say 'gj on flogging the guy for 4 hrs and letting the IABP fix everything'. I can, but that does neither of us any good, and its not why I read this board.

Specializes in CTICU, Interventional Cardiology, CCU.
I apologize if you're confusing a teaching opportunity with belittling. I was trying to offer insight as to why he turned the corner(the amio) and the advantage of biphasic defibs and discuss those issues.

If you'd rather me just say 'gj on flogging the guy for 4 hrs and letting the IABP fix everything'. I can, but that does neither of us any good, and its not why I read this board.

Let's call it a truce. I am still learning about what to do in a mega code. :up:

You did a wonderful job for what you had available at the time to you. And I am sure that many of us "older" posters here, remember being in similar situations at one time or another thru our careers and where we did not have what we needed.

Job well done, you deserve it.:wink2:

Specializes in ORTHOPAEDICS-CERTIFIED SINCE 89.

You have seen more in your 9 months that I ever have. To borrow from one of my favorite staff here you were a "joule" of a nurse to your patient. Congratulations on the great work.

Specializes in Trauma/Burn ICU, Neuro ICU.

Wow! I am in awe. Loved your story.

Specializes in Trauma,ER,CCU/OHU/Nsg Ed/Nsg Research.
Let's call it a truce. I am still learning about what to do in a mega code. :up:

Morettia- you did a great job (big pat on the back for you). As an experienced nurse, I would be proud to work next to you any day.

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