I just did chest compressions for the first time

[Silver_Girl]

I'm a new grad (started in Sept) in the ICU and I've seen codes before, but this week was the first time MY patient coded. It was a couple days ago but I still feel sort of traumatized by it so I'm venting here.

Background info: It was a 90+ year old lady (Cardex said 87 but the family apparently lied about her age in hopes that we'd be more aggressive) who was in the ICU for over a month, had COPD, hernia exacerbating the respiratory issues that was repaired during her hospital stay, the incision & PEG/PEJ sites were necrotic & horrible, super duper septic, kidneys stopped working, skin tears on every imaginable body surface, massive anasarca soaking the chux every couple hours, PEG draining black sludge... just a mess. Basically, everyone knew several weeks ago that this lady wasn't going to make it out of the ICU, but she had one of those families who would freak out over every little number change on the monitor and slept over in the waiting room every single night for the last month, and wouldn't consider a DNR/DNI. They were pretty notorious in our unit and would **** off just about all the nurses taking care of their mother by hovering and nagging and freaking out over everything. I had taken care of the lady a few times before and built some rapport with them just by being as patient and nice as possible, & explaining everything despite being VERY aggravated & humoring them, so that every day i was in the unit the daughter would ask "how come youre not taking care of my mother today?"

So we all expected her to code eventually, but I didn't think it would be necessarily in the last hour of my shift! I took care of her 3 days in a row, and she was having episodes of RAF, and her baseline HR went from 80s-90s SR to 110s-120s ST by the last day. And suddenly i look up and her HR is 59. I alert the docs and they say they are ok with it unless she drops her pressures, but a minute after they say that she does start dropping her pressure. she's maxed out on vaso already, i go up on the neo and we start some levo, and we have atropine handy, but her heartrate starts dropping to the 30s and she loses her bp alltogether. during all this the daughter is standing there suggesting that "maybe we should give her a little blood, she looks pale. can we draw a blood count to see what her red blood cells are?" until someone makes her leave. the attending is in the ER on his way up but doesn't make it in time. and he had said earlier today "I'm not doing chest compressions on this lady" even though she is a full code. but he's not there and someone else is running the code and they call for chest compressions even though we ALL know that it's not going to DO anything. so i start chest compressions on this lady and i hear her ribs cracking because she's a tiny frail 90+ year old lady and i feel horrible about it but i have to do it. they push atropine & epi. she was on bipap this whole time so someone takes over compressions for me and i hook up the ambu and start bagging her, but the clear bag doesn't inflate and senior nurses are saying it should, so they have to run & get another ambu bag which also doesn't inflate. but then someone says it doesn't have to so we keep using it anyway. and then the MD inserts an ETT and takes over the bagging. i do compressions again and her chest is essentially MUSH and it's horrible. she gets her 3 rounds, and 20 minutes later the MD calls it.

we start walking out of the room and the daughter starts screaming at me, about how if i had only put her mother on bipap from mist mask when she wanted me to her mother wouldnt have died & for everyone to stop touching her mother and get out of the room. i am in shock over having just done chest compressions on this old lady and in shock over her suddenly crapping out like that and in shock at her daughter blaming me for her mother dying, so i just say "i'm sorry for your loss" and walk away, and i hear one of the senior nurses who was my preceptor when i was on orientation say "she took such good care of your mother the last 3 days and youre screaming at her like that?" i am a rational person & i don't get hysterical, so i go to the nurses station & try to take care of the paperwork etc. but i can't stop shaking. and finally the attending comes up and hears about everything & apologizes for not making it in time and sees me standing there shaking as im trying to tape in the asystole strip and comes over & says that i couldn't have been a better nurse, that it wasn't my fault & it was just a matter of time, that the family is just dealing with the death in their own way and would be thanking me tomorrow when they've calmed down, and that i was nicer to them than any of the other nurses. the senior nurses were super supportive too & one of them made me go get water in the lounge while she took care of the paperwork. i was just in shock. and even though i KNEW that i didn't kill the lady, i just couldn't bear the thought of the daughter forever thinking that i killed her mother. but after an hour at shift change, i went over to the daughter & gave her a hug & my condolences and told her she couldnt have been a better daughter to her mother in her last days and from the stories she told me it sounded like her mother had a very full 87 years. she was obviously really sad but was calmer now and thanked me for taking care of her mother.

that was one of the worst things I've had to go through, ever. Sorry for the massive length, thanks for reading.

[jmgrn65, RN]

WOW, you did everything you were supposed to, Unfortanetly some people have a hard time dealing with reality. It sounds like you work with a great group of people very supportive. First code where you are actually involved is tough.

[suzy253, RN]

Hugzzz to you. You're right....this is all very traumatizing but you did an excellent job. It's always difficult, especially dealing with these types of families that don't acknowledge all that you did.

[TigerGalLE, BSN, RN]

Aw Silver_Girl you sound like an amazing nurse. Everyone knows you didn't kill her mother. The daughter was just angry about the death. That is normal sometimes. And I think it was wonderful that the Dr. was so impressed with you. What a great compliment it is for the attending to praise you that way. It must be obvious to everyone how awesome you are. I'm sorry your first code was so tragic. Most codes are tragic. And been shaky afterwards is so completely normal. That is from the adrenalin rush. I'm always shaky after something bad happens with my patient. I'm proud of you. You did a great job!

Hugs!

Tiger

[4x4country]

:nurse:you sound like a great nurse. I am in NS and jsut learned about vents & ICU so reading this post was very education and brought a lot of the material together for me. So thx for the knowledge and sharing the experience. This family is just dealing with the death of the lost the only way they know how. You are very sympathetic and that quaitly is the best to have in nursing.

[loopingrace]

You did a great job and handled such a hard time both for you and for the family so well. I'm glad you had the support of your co-workers in such a hectic time!

[BluntForceTrauma]

Sounds like you did a great job to me....it would have broken my heart to do compressions on a fril lil' ole lady.

By the way, was her daughter in the medical field at all?? Sounds like it by the comment about putting her in BiPap...just wondering.

[Silver_Girl]

Thanks for your support everyone! Even though I know I didn't kill her, it helps to have the extra reaffirmation from everyone. I was very lucky to have such supportive coworkers around during the code, especially my old preceptor who is especially sort of Momma Bear of me. I absolutely love the people that I work with; the senior nurses and attendings in our ICU are all really approachable and wonderful people.

No, the family didn't have a medical background, but the daughters learned a lot from their 1.5 month ICU stay by asking a lot of questions and being at the bedside 24/7. They had me explain things like CVP, albumin, and pulmocare. And they'd daily ask what the hematocrit, WBC, and K was, and suggest that we go down on the vaso, and ask me before leaving to tell the next nurse to go down on the vaso if the blood pressure was good. That type of family. The attending was super nice with them and had a good sense of humor, so when they'd act like that with him he'd go "so, what do you want me to put the vent settings at today?" and they'd back off. The family was nice, just very anxious and draining.

[Virgo_RN, BSN, RN]

Sounds like you did an excellent job.

[cardiacRN2006, ADN, RN]

I agree, sounds like you did a great job and managed the family well.

When they go to sleep at night, they will know that you did a great job with thier mother.