Living in fear of code blue

SarasotaRN2b · Jan 29, 2006

I used to carry a sterile 4 x 4 in my pocket to open quickly and place over the patient's mouth.

Can you explain why?

Happy-ER-RN, RN · Jan 31, 2006

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.

You actually do mouth to mouth on your pts! :barf01: No freakin' way would I do mouth to mouth in a hopital where an ambu bag is within a moments notice. Pts vomit when they code all the time and waiting 30 seconds for an ambu bag (or 5 seconds here in the ED where we are blessed with a bag hanging on the wall), is not going to make any difference in the outcome. Surely all floors have an ambu bag with fairly easy access though don't they?

You are a much nobler nurse than I!:)

Kristen_RN · Feb 2, 2006

I agree that the more experience you have with a code, the more comfortable you become.

I work in an ER, and I have seen many many codes in my 7 months of nursing. I will say that was my biggest fear going through my internship, but the more experience I got the more comfortable I have become. I am now one of those "code junkies". I just jump in and do what needs to be done.

You'll get it. It just takes time.

skittlebear · Feb 10, 2006

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

good story...thanks

Momto2Boys · Apr 11, 2006

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

This is SO very true. I have been at my job for a month at a LTC since I graduated and was scared of a code blue but I just acted out of instinct and did my duty as a nurse

Runningnurse · Apr 22, 2006

We don't get many codes on our floor, mostly because we're solid-tumor oncology and generally before folks get into that much trouble they've signed a DNR. I'm a pretty new nurse, and so far I've only seen two codes. The first I was still a student working nights, and someone's patient was "guppy breathing" with a HR of about 30...technically still had a heartbeat and respirations, but he was on his way to a code, so she called the code anyways and I basically just watched that time. My preceptor tugged me into a corner where we weren't in the way, and quietly explained to me exactly what was going on.

The next time, it was during report after a night shift, and I swear you've never seen twenty nurses all get out a tiny door so quickly before! Our breakroom was emptied in about 2 seconds flat. This time I took over the floor...made sure everyone's doors were closed and took care of any call bells going off while everyone else was with the code. (Again, there were waaaaaaay too many people at the code so I just got out of the way.)

In school they told us to either bag the pt or do compressions at our first couple codes...but NEVER to record or draw up meds. Until you are absolutely certain you know your way around the code cart drawers, or are incredibly familiar with the code sheet, it's not a good idea to take those jobs. And if it's your patient coding, you might be better off making sure your "brain" is in hand so you can give a lightning-fast accurate summary to the docs and the code team.

My other advice is to try and examine the code cart after the code is finished...since they're rarely open, post-code is a great time to familiarize yourself with the drawers.

Does anyone else work at a place where the code bell is terrifying? I think ours was designed specifically to spike your adrenaline...it's is the most -awful- noise you've ever heard. I swear, you'd know what it was even if you'd never set foot in a hospital before.

WV_heart_RN · Apr 26, 2006

i so know your fear!!!! i work a cardiac step down unit. we have a lot of code situations. i was sooo scared of having to help on a code.

i went through acls and several mock codes while in orientation but i knew they were not real. then one day..." code blue room373". i remember thinking" where is that, oh sh$t, that is one of our rooms." i jumped up and ran to room. i got in ahead of the crash cart( lucky me). i remember getting next to my coworker and was ready to start compressions when the doc came in and the code team came in.

i moved out of the way but my coworker hollered for the ambu bag and it wasn't on the cart(had fallen off). before i knew it i pointed at someone standing at the door" go get an ambu bag now!"

the doc started asking for meds to push so i cracked the cart and fumbled my way through the latches on the drawers to get what was needed.

please note: i had no idea i would react that way. i just did!!

the patient came back and i was helping his nurse get all the drips started the doc ordered. someone else was making notes on what we were doing. i walked into the nurse's station to check for some meds for that patient and one of the best nurse's on our floor said," hey mandy, good job in there. i'm proud of you." wow! i just smiled and said thanks but i was busting inside.

i really truly ran into that room and did all that stuff. it was a reaction. i had to process it later.

my point: don't be scared. what you need to do will come andit you are nervous your coworkers will help you out. mine did that day!!

RedJuly · Mar 6, 2009

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.

I am a new grad RN and in my 5th week of orientation I had my first code blue. I witnessed the pt stop breathing and it was so scary. I was beating myself up for what I felt was a less than stellar performance before the code team arrived. He did make it. Your post made me feel better. Thank you.