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.

thanks everyone for your words! It means alot to me! Let's hope my next 3 days in a row I have no codes...I will take a RRT any day :D

Specializes in Education, FP, LNC, Forensics, ED, OB.

Hope you have a great rest of the work week. But, I'm sure if you have something to come up, you can handle it.

Good job.

Specializes in Psych/Rehab/Family practice/Oncology.

Yes, I agree with most all of the responses here Morettia2. I think you did an absolutely amazing job, and I'd be proud to have you as a co-worker!

Specializes in Cardiac Nursing, ICU.

Wow! Jaw hits the floor!

Specializes in CTICU, Interventional Cardiology, CCU.

so yet AGAIN tonight had another CODE BLUE right at shift change. I walked onto the floor hadn't even swiped my badge yet, back pack still on, car keys in hand. It was 1900. I looked at my assignment sheet and went to grab a piece of paper to write my pt. assignment, don't even have a pen in my hand yet, when I see one of the stretchers roll by with a pt. from the cath lab, ok, so one of the day shift nurses follows the pt. to the assigned room, to recieve the pt. untill we get report. I am looking at the pt. assignment when I hear the day shift nurse screaming..."call the doctor"..I asked what's wrong..she said "pt can't breathe, pt. muttered in spanish something about Penicillin" (pt. spoke little to no english)..I just dropped everything didn't even bother calling a RRT b/c I knew where this was headed, mind you that no one is really paying attention b/c they are all busy getting report, when I picked up the phone and immediatly called a code blue. It came on the over head paging system and everyone is like..huh?.."Code Blue Interventional Cardiology"...all the nurses looked at me and said that pt. just arrived from the cath lab, he's fine. I picked up the chart, which was still in a folder, "pt. s/p ICD insertion" and saw that they had given the pt. ANCEF in the cath. lab as I was running to the room, still with my coat and backpack on, the only things i could not drop. I asked the family, thank god they had been there, if the pt. was allergic to penicillin, they said pt. was severly allergic. Nothing on the chart about the pt. having a PCN allergy. I also see a small note ,that if you blinked you would miss it, that the pt. is a dialysis pt. I asked the family and they told me the pt. hadn't had dialysis in 2 days. I took a step back from the bed b/c of all the commotion just to assess if there were any IVF and realized the pt had a Vanco IVPB along with IVF. None of this was in the report that the cath lab had given the day shift nurses before the pt. arrived to the floor. I immeadtly stopped the IVF and the vanco gtt.

I myself am deadly allergic to penicillin so when the nurse had told me that the pt. muttered something in spanish about penicillin, I just knew to call a code b/c this was going no where good. There happened to be a tele resident on the floor at the time ,before the code team showed up. The resident goes to me, "what should I give the pt", while she is thumbing through her Tarascon pharm book..I looked at her and said "Epi, SQ or IM b/c the pt has poor venous access and solu-medrol IVP, but you HAVE to give the Epi first "..I also told her the pt. had not recieved dialysis in 2 days and had IVF running, that I immedatly stopped... she looked at me and said, "yea do what she just said" . As I am ripping open the epi and one of the other nurses was drawing up the solumedrol, THANK GOD the code team showed up. The cardiac fellow came running into the room, along with the anestiologist from the cath lab, and saw me ripping open the epi along with the other nurse drawing up the solumedrol and knew exactly what was happening to the pt. with little to no questions asked. Mind you before the code team showed up it was me, 2 other RNs, and the tele resident, who was clueless as for what do do. When the code team showed up it was Respiratory, Nursing Director for Night Shift, House MD, Code Team MD's, cardiac fellow, cath lab anestiologist, some random MED students that just stood there and did nothing. Pt was intubated immeadtly, pt. was foaming at the mouth. Suction.. TLC inserted after 3 attempts, which is good, considering it took 10 attempts the other night on another pt. that coded. Anyway, this all happened in about 30-45 min. Pt. ended up in the CCU at 2000...after the pt. was transfered, The cardiac fellow and I were documenting the code and going through the chart, which wasn't much. We called the cath lab and asked why was there nothing on the chart about the pt. having a severe PCN allergy, and the fact it was only documented once that the pt. recieves dialysis and why the pt.recieved quite a bit of IVF when the pt. hadn't been dialyzed pre-ICD implant. THIS WAS OUR ANSWER:

Specializes in CTICU, Interventional Cardiology, CCU.

CON'T FROM PREVIOS POST...

THIS WAS OUR ANSWER FROM THE CATH LAB: well the anestiologist evaluated the pt. realized the pt. spoke spanish and little to no english, so we brought in a translator for the anestiologist and the pt. The anestiologist asked the pt. if the pt. was allergic to ANCEF (not Penicillin, not anything only ANCEF), the pt. said no.....(ok it gets better), then the cardiac fellow and I asked why was there nothing in the chart about the pt. not recieving dialysis for 2 days, and why did a certain EPS MD not dialyze the pt. pre or even post procedure, post espically b/c of all the IVF the pt. revieved. And last but not least The Cardiac fellow and I asked, did anyone assess the pt. post ICD implant b/c the pt. was in anaphylatic shock when the pt. arrived to the floor from the cath lab. Pt wasn't even on the floor for 5 min and in full blown anaphylactic shock. Did no one notice this when the pt. was in the cath lab and when they were transporting the pt. to the floor.

I chimed in with this statement which I felt was pretty damn relevant..."OK outside of healthcare professionals, not many people know what ANCEF is or what it is used for, you are telling me that you are asking a pt. that speaks little to no english, and had to use a translator, 'are you allergic to ANCEF' ,not penicillin, only ANCEF. That's like asking me if I am allergic to IV contrast dye, and I have no experience in healthcare, don't know what it is or used for and don't speak english, and not asking me if I am allergic to Shellfish." the other end of the phone was silent... Simple questions that NEED to be asked..

Let me say that the cardiac fellow and I spent alot of time filling out

quality controll reports, incident reports, code sheets and letters..i am not one to fill out incident reports at all, infact this was my first. I would rather comfront the nurse or MD insted, which I did, and got no answers.. but this time it was just pure neglect of taking an accurate history. There was no communication barrier, 2 simple questions..are you allergic to penicillin b/c this is the ATBX we use and it is has PCN, and did you recive dialysis today, or when was the last time you recieved dialysis...pt. ended up with severe pulmonary edema from the PCN, b/c pt was allergic and the IVF b/c pt hadn't had dialysis in 2 days and went into fluid overload. So 2 major things, that happened to become one b/c no one took the time to ask. I hope the pt. makes i though the day. That new ICD in't going to do much good if the pt. isn't breathing....

oh just a side note I know this is long but I had to get it out..my pt. that coded the other night, the pt. I posted about originally a few days ago, is doing great..went to stepdown and is laughing and talking..I only pray that this other pt. will pulll through..thanks for listening

The resident goes to me, "what should I give the pt", while she is thumbing through her Tarascon pharm book..I looked at her and said "Epi, SQ or IM b/c the pt has poor venous access and solu-medrol IVP, but you HAVE to give the Epi first "..I also told her the pt. had not recieved dialysis in 2 days and had IVF running, that I immedatly stopped... she looked at me and said, "yea do what she just said" .

If the patient had IVF running, wouldn't you want to give the Epi IV regardless of poor venous access (since he already has an IV in place)--better absorption and more predictable distribution of Epi given IV vs SQ or IM. Please correct me if I'm wrong.

Sounds like you've had a rough few nights at work, good work and what great learning experiences!

Specializes in ER.

Wow, I'm speechless.

Specializes in Me Surge.

You doing a great job and keeping a cool head in heated situations. A teaching moment: Ancef does not contain penicillin. It is a cephalosporin. 1% of persons allergic to penicillin will have a cross allergy to cephalosporins. Which is why anything with a CEF in it should be given with caution to those with penicillin allergy. The main thing is you realized the patient was having an allergic reaction and acted accordingly. Good job.

Specializes in CTICU, Interventional Cardiology, CCU.
You doing a great job and keeping a cool head in heated situations. A teaching moment: Ancef does not contain penicillin. It is a cephalosporin. 1% of persons allergic to penicillin will have a cross allergy to cephalosporins. Which is why anything with a CEF in it should be given with caution to those with penicillin allergy. The main thing is you realized the patient was having an allergic reaction and acted accordingly. Good job.

thanks for the tip :yeah:

Specializes in CTICU, Interventional Cardiology, CCU.
If the patient had IVF running, wouldn't you want to give the Epi IV regardless of poor venous access (since he already has an IV in place)--better absorption and more predictable distribution of Epi given IV vs SQ or IM. Please correct me if I'm wrong.

Sounds like you've had a rough few nights at work, good work and what great learning experiences!

the pt's lines were pretty much blown anyway..I just happened to open my mouth about the EPI..I was hoping the MD would have said IVP but I know that if I recieve PCN by accdent I always have to get epi IM or SC, just what happened to come out of my mouth first..I know IVP EPI would have been better. It was just the situation. Thanks for the tip!:bowingpur

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