Keeping your head...

[dankimal]

Hey all,

I’m investigating care giver response in the acute phase of high stress situations, specifically, the observed “freeze” response.

Imagine, if you will, a nurse walks into the room of a just bedded patient in a busy ER and finds the patient apneic and blue. The chief complaint was benign, and triage gave no indication that the patient had a critical illness.

The immediate emotional response of shock and surprise gives way quickly to action... the nurse yells for help, activates the code and begins assessing...

but in her head, although she’s seasoned and trained, it’s a frozen jumble.

Do you know this nurse? ARE you this nurse? I want to hear all about it.

thanks!

[emtb2rn, BSN, RN, EMT-B]

If the nurse in question doesn’t literally freeze, then I don’t see how there’s a freeze reaction. You can scream & freak out inside your head all day, but if you immediately react, then you’re good.

Also, how would you know if someone else is a “frozen jumble” in their head?

[JKL33]

Is this a situation that is supposed to be common amongst ED nurses?

I'm not sure I have witnessed hardly at all in the ED a perceptible/observable delay related to this emotional shock response. Maybe with regard to novices it is more common, but that is directly related to lack of information and experience; it's part of the definition of being a novice.

I also don't think that (while in action already) simultaneously assessing the patient and silently recounting what you know/read about the present CC, mentally going through basic Ddx as fast as possible qualifies as frozen jumble. It's very active processing.

Also ACLS allows for/recommends 5+ seconds for deciding that someone is apneic to begin with (probably not necessary if they're blue, but you get my point) and checking pulse. That isn't "freezing" either, it's actively assessing and within the appropriate length of time for doing so.

On 1/26/2020 at 11:20 AM, dankimal said:

but in her head, although she’s seasoned and trained, it’s a frozen jumble.

What is your definition of seasoned and trained?

Also, how you have become aware of the phenomenon in ED nurses. Personal experience? Direct observation/suspicion? hearing other nurses report this problem?

[canoehead, BSN, RN]

I try to consciously stop and assess for a second before I start working. (Take your own pulse first) It's easy to lose IQ points in a crisis, but falling back on the ABCs should get you through the first five minutes.