Living in fear of code blue

[cjblu]

I have been off orientation for about 2 mos now, and my new fear of the week is "what to do when my patient codes"...Of course, I know the basics from CPR class, and to grab the crash cart and ambu bag. But I think my fear is unreasonable, and it might hinder my decison making capabilities in such a situaiton. I have not even seen a code yet, and in my orientation, I got a very general overview of what to do. Does anyone have any interesting stories or advice about their first codes?

[LCRN]

Hello,

I was in your shoes about 6 years ago as a new grad on a respiratory care unit. We were an ICU step-down and able to accomodate 12 vented patients and 12 tele patients. We were able to do some gtts like dopamine, cardizem, dobutamine, pronestyl. I had seen codes run by the experienced RN's on my orientation but when I went to nights initially on my own I was horrified!!! I felt I was not ready to be on my own but my preceptor felt confident in my abilities...Then came my first code...

I distinctly remember I was charting at the nurse's station where the central tele monitor is and all the sudden an alarm went off. 431 was bradycardic with a rythym in the 30's...immediately I thought who's patient is that...oh no it's mine!!! I sprint to the room and it was a fresh transfer from ICU with a trach and a peg and an intractranial bleed that had made him be in a persistent vegetative state (RCU was called the veggie patch) but the family was full of hope and not ready to make him a DNR. I placed a BP cuff on him? I didn't think to check for a pulse first but as the 2nd RN came in the room she confidently guided the code...

-check for a pulse

-bag the patient

-no pulse, start compressions with the back board under him and someone else get the lifepak and place the leads on him

-IV access someone hang a bag of NS wide open

She shouted and delegated calmly until the physician came and still handled the meds and had someone else record. I admired her from that night on! and still do. I've since gone into ICU nursing and am now usually the first responder to the MET team calls and codes. I faced my weakness which has now become a strength.

If you hear a code called on your floor or another- and there's RN's to cover you I reccomend that you go to them. Observe the flow of things and assist by being a runner and getting some of the things they might need. Try and sneak in and blend into the wall...usually there are so many people in the room there's limited space.

Face your fears...

LCRN

[zambezi, BSN, RN]

I agree, try to go to as many codes as you can (but don't be one of those people that just clutters the room)...Try to take ACLS if you can- mostly just so you know what might come next...what drugs the code team is pushing,etc....try to pick a task...If you are a frist responder, start with your BLS basics- the ABCs...one time, try to be the airway person until RT gets there, another time, do compressions...

Early on, I tell all my new grads that I work with to be the recorder...that way you are there, have an important job, and have to write down what everyone is doing so you really get to see the order and the different interventions that are done...just make sure that you are through...If CPR is stopped- write if there is a pulse, write the rhythm, write drugs, etc- anything and everything that is done (with the time)...It is a good way to get the feel for a code...

lastly, don't panic- easy to say, I know, but really panic will only hurt things and make you unable to think...just keep repeating ABC to yourself- at least that will put you on the right track until the ACLS crew gets there to help out...

[Gompers, BSN, RN]

Early on, I tell all my new grads that I work with to be the recorder...that way you are there, have an important job, and have to write down what everyone is doing so you really get to see the order and the different interventions that are done...just make sure that you are through...If CPR is stopped- write if there is a pulse, write the rhythm, write drugs, etc- anything and everything that is done (with the time)...It is a good way to get the feel for a code...

We do the same thing in our NICU. Whenever we have a code (pretty rare lately, thank goodness) we pull all the newer nurses over, sometimes taking their patients so they can go help. We'll always make one of them the recorder, have one of them draw up meds, and another setting up for a chest tube if necessary. We make sure an experienced nurse is with each of them to guide them through the process. It's a great way to learn what goes on during a code, and what orders and procedures to expect. Once they've gotten more used to doing those things, then when they're the nurse in charge of that patient, they're not so scared doing things like giving compressions or pushing code meds.

[grinnurse, RN]

cjblu-

I feel the same when it comes to Code Blue. It scares the pants off me!! On our assignment sheet for our rotation, the Charge always puts whose responsible for what so at least I know what I will be doing until ACLS comes on board. I have also found it helpful to actually go through the crash cart just to make sure I know where everything is even though it is labeled.

I have found these posts very interesting so far just hope that everything will kick in from BLS when it is needed most.

[HyperRNRachel]

Talk to the education department at your hospital and see if they can set up a "mock code blue" for you. It is a nice way to walk you through what to do and what to expect. We did these at my last hospital, on an empty floor, using the CPR Annie dolls. We didnt just go over CPR, we started by finding the patient, yelling "code blue", setting up the O2 and ambu bags, and putting the patient on the back board. If you do not have an education department maybe ask your charge nurse if she can set up something up for you to help you get over the fear.

I can tell you this, in a code blue situation fear seems to leave and is replaced with an extreme form of concentration. It is almost like all the training you went through is second nature and you go into autopilot. It is such a moment of clarity......and one that you will appreciate.

Rachel RN

[KatieBell]

Keep in mind also something a bit morbid, but if you have a code blue the patient is generally pretty dead. THe only thing you can do with a dead person is make him or her less dead. You can not make them worse. I agree that it would be good to have a mock code blue. At a hospital I work at we do mock traumas, where each nurse under a no stress sitiuation is given a scenario and must locate and set up all the equipment needed. It really raises the confidence level when we get a bad one in...

You'll do fine in a code blue...there will be so many people there, you will get a lot of assistance....

[snowfreeze, BSN, RN]

One thing I tell all precepting nurses, aids, techs about codes is....Relax, you are not going to make them any more Dead than they already are. Do your best and call for help. One day you will be the help someone else is calling for.

[missy2b]

One thing I tell all precepting nurses, aids, techs about codes is....Relax, you are not going to make them any more Dead than they already are. Do your best and call for help. One day you will be the help someone else is calling for.

Wonderfully said. On our floor, it is total team effort, and the "code junkies" love to jump in and take over before the code team arrives.

I had my first code on one of my first weeks on the floor. I was still on orientation. I walked in before the breakfast trays but after the pt had his vitals and wt done. I told him my name and that since he was laying on his side I would just listen to his lungs first. Hmm, no lung sounds. Plink, plink, stethoscope works. Well, Mr so-and-so, I am going to listen to your heart. No heart sounds. Hmm. No carotid pulse, either. Hmm. Went back into the hallway, flagged the nearest RN, who also heard nothing.(Amazing how we doubt ourselves, eh?) Long story short--code called, pt not revived. Techs insisted he was just alive a minute ago. Apparently died of some cardiac event and never knew what hit him.

As the years have passed, I can only laugh at my bumbling actions and think, God bless that man. May we all go so peacefully.

[Daytonite, BSN, RN]

My very first code blue was a patient on the medical unit where I worked at night. Looking back, the biggest problem was recognizing that the patient was coding. He looked so peaceful and pale and not much different from the way he had been earlier. It was hard for me to assess that he was coding. I called his name, shook him gently. No response. But that didn't stop me from trying again. I tried to palpate for a pulse and it seemed like I waited an awfully long time before deciding that it just wasn't there. Then, in the back of my mind I was thinking "are you sure?" I probably wasted time trying to figure out that, yes, this was a code blue situation. I pushed the code blue button on the wall and I guess I must have expected clanging bells to go off. At that point, it was like my mind was picturing the steps to take. I have a distinct recollection of having a kind of conversation in my mind about what needed to be done first, then second, was I forgetting anything?. The patient survived and was transferred to ICU! After the code and after I went home, it was the only thing on my mind. What did I do wrong? What should I have done? Not to mention, how emotionally upsetting it is.

My advice to you is is to follow the CPR protocol exactly as you were taught in CPR class. Do your ABCs and call out for help. Make sure someone is getting the code cart if you can remember that and to make sure that the hospital operator is notified of the code so it is announced and you can get help. Get CPR going and wait those endless minutes until the rest of the code team arrives. That is the most important part. Pretty much everything else that follows is just following the orders of the doctor in attendance and hospital protocol.

I don't like doing the rescue breathing, but hey, we signed on for this. In the days before we kept ambu bags at all the bedsides I used to carry a sterile 4 x 4 in my pocket to open quickly and place over the patient's mouth. No one wants to do the breathing part, so be aware of that and make sure the patient is getting air. Most people will jump to do the chest compressions, but you have to remember to open the airway, check for breathing and do the two breaths. I've seen big, burly orderlies with sweat dripping off their faces after 5 or 10 minutes of doing chest compressions--it is no picnic. It is very physically demanding and you are very likely to have muscular soreness the next couple of days yourself.

What I have seen over the years that is the hardest for new nurses is that hesitancy, just as I felt it years ago, to make the decision about whether or not the patient is actually coding. That is usually the topic that comes under discussion after the code is over.

[rpv_rn]

AHA standard for adult:

1. Determine unconsciousness. If no response, call for help first.

2. Assess ABC.

[Lorie P.]

i work on a med/surg floor 11-7 shift and most of the time, when we call the code, almost as soon as someone gets the crash cart in the room our code team arrives and take over..... just about the only thing that we have do is get the crash cart. have the chart ready for the doc and stay out of the code teams way...a rule my charge nurse came up with for our shift, is if you don't not have your hands on the pt. please leave the room and allow the code team to do their job.....usually there so many people in there i just stand and watch from the hall way.

remember all codes are different but after a couple you will see how the flow of one goes. sure we still get that rush when we here now hear this code blue .

also remember you are never alone.