My First Code Blue! Still Trying To Process It

JBMmom, MSN, NP · Aug 9, 2022

Give yourself some grace, sometimes these things just happen. From the situation as you describe it, I don't see anything obvious that you missed. If he wasn't on a tele monitor, perhaps the rapid heart rate preceded the other symptoms and you wouldn't have known that. Patients can desaturate and decompensate quickly when they are in a fragile medical state.

I remember spending most of the 16 hours of my first ACLS class thinking "I hope I never have to do this, I hope I never have to do this", but we are trained for a reason and dozens of codes later it gets more routine but each is a little different and every time you become very aware that another person's existence depends upon you remaining calm, collected and relying on your training and your coworkers.

Chaos is the absolute enemy of a code. It's one of my biggest pet peeves in healthcare that the two hospitals I work at do NOT do mock codes or code training outside of ACLS/BLS. One being a teaching facility, it tends to draw a giant clusterF*** of people that can't get out of one another's way. The smaller community hospital where it could be just three nurses and a RT until the covering MD arrives, they run pretty smooth.

You as the primary nurse should NOT have been doing compressions or giving meds or time keeping. You should have been available to give the provider the best information about the patient that you can. And of course we've all had 7:36 codes where you've been out of report about four minutes and you know almost nothing. You do the best with what you have.

Take care of yourself. It might have been the first but it won't likely be the last code in your career. You'll become more confident as time goes on. Take care.

LonghornChic, BSN · Aug 12, 2022

Sounds like you did the best you could. In the past 6 years, I’ve had 2 of my patients actually code - both were during hemodialysis. Having recently switched to ICU nursing, I’ve helped code at least a dozen patients within the last 6 months. You become more proficient with ACLS after the first few.
Anytime I help with a code, I take over whatever ACLS task the primary nurse is doing (pads, CPR, meds, etc.) so they can focus strictly on providing info to the team.
Codes are never easy but a good team can literally be the difference between life and death.

No Stars In My Eyes · Aug 14, 2022

Lucky to be an LPN on the code team. My job was as recorder -- I grabbed the clipboard and got up to stand on a chair to watch and record what was given, when it was given, results shouted out, and anything else pertinent which the doc or nurse or resp therapist said.

1st code was weird -- the guy started breathing and moaning, yet they kept doing CPR, and I could hear his broken ribs clicking. I wanted to yell "Stop!" and "He's breathing and moaning, STOP!" Fortunately someone else noticed and said to stop CPR to check vitals. I felt as an LPN it wasn't my place to halt a code. I was still a newbie then, but if it had happened later in my career I wouldn't have hesitated to shout out.

I used to help check the floor's code-cart at the start of the shift, or after use. I was glad not to be an RN because no matter how many times I helped check and restock the cart, the thought of having to locate the right med and dose when called for, just freaked me out.

Tegridy · Aug 14, 2022

On 8/8/2022 at 4:55 PM, Dani_Mila said:

I've been a nurse for almost 5 years and this was my first Code Blue on my patients.

Quick hx on my pt who coded, he is a dialysis pt, anuric. He came in for GI bleed. MD r/o that it's possibly from his hemorrhoids since his hgb is at 10 and has been consistently up there. He is also being treated for PNA, receiving ABT (Flagyl) and PRN duonebs. He has a moist non-productive cough with poor cough effort, his lungs had been sounding coorifice, rhochorous, and wheezy for the past few days. MD is aware of this, he had his dialysis 2 days ago, removed an extra 500cc of fluids, he is also on Certizine BID. His O2 SATs has been sustaining in upper 90s with 4LNC. He also has a HX of A.fib, has a rhythm of A.Fib RVR, his HR goes up to low 100 to 140s, but at times it goes down to the 90s. He is getting treated for this as well with metoprolol. His BP had been running soft in low 90s and his BP med had been held couple of times. I was able to give his metoprolol on my shift because his SBP was on 100 in the low teens, BP med had parameters. Anyway, this pt was stable within his baseline for the most part of shift.

Scenario: I was stabilizing my pt's roommate as he desats to low 70s with minimal movement (not new), he recovers very slowly, sometimes you have to place him on a non-rebreather just for his lungs to catch up. Both of my pts are getting treated for PNA. After getting the roommate stabilized, I immediately checked on my pt because he was coughing, sounded very rhochorous and coorifice, audible without a stethoscope. I assessed my pt and he has this moist loose non productive cough that just won't clear despite his attempts. I encouraged him to cough, elevated the HOB further to help him, checked his telemonitor his O2 sat was still in the 90s. Kept encouraging him to cough and he stated "I'm trying". Immediately his eyes started rolling, his O2 sat went down to low 80s, I increased his oxygen but his O2 sat kept going down. I came out of the room and screamed I need a non-rebreather, one of the nurse went inside while I grabbed a non- rebreather. I immediately came back to his room and his O2 sats came down further to low 70s. One of my coworker initiated an RRT. I tried to place a non-rebreather on him, but his O2 went to low 50s. Pt became cyanotic, unresponsive, then no pulse was palpable. Code Blue was initiated. This happened within minutes. He went on PEA. Chest compressions was started by my coworkers. I was so overwhelmed, I couldn't do a compression as I am 37 weeks pregnant. Thank goodness my coworkers and charge nurse immediately came in to help out. It was very chaotic and overwhelming. ICU PA and ICU nurses (they responded to RRTs and code blues) came in and took over the code. He asked me a bunch of questions regarding my pt as to why he was here and what he is getting treated for, and how he became unresponsive. I was so overwhelmed I feel like I gave him the bare minimum. All I could do was stand back and watch and answer any pertinent questions they ask. The code lasted for 12 minutes and pt was able come back, but he was on Afib RVR and HR was in the 180s. He was sent straight to ICU and was intubated.

The whole situation was kinda hard to process. It happened so fast, his oxygen level went downhill immediately, he went from responsive to unresponsive and it went from an RRT to a Code Blue. After he was sent to ICU, the MD spoke with the family and his code status changed from full code to DNR, may intubate. I was thinking maybe he had aspirated from his mucus plug? It was so traumatizing, I feel like I could have done more in my opinion. What are your thoughts?

I think mine was a dialysis patient too, but this was like 11 years ago. I think the last five I've had were all dialysis patients. Seems to come with the territory.

JKL33 · Aug 14, 2022

On 8/8/2022 at 4:55 PM, Dani_Mila said:

I feel like I could have done more in my opinion. What are your thoughts?

Sick patient. You did fine.

My first code the code team came screeching into the room and some big guy yelled, "WHAT HAPPENED HERE!" as if I had personally strangled the patient.

All I could say was, ".....he has cancer...??"

You did very well.

It is definitely a shocking experience the first time around. You will process it in time and add all that you learn to your repertoire of personal nursing knowledge.

Take care ~

allnurses Guide · Aug 14, 2022

Whenever something likes this happens especially if it's the first time for you, You can ask your facility to provide you with a Critical Incident Stress Debriefing. This helps you to examine the details of an incident and process your feelings in a supportive manner. If your employer isn't offering this check the EAP program. It usually only takes one session with a therapist (sometimes two) and is a strong determinate for employee retention.

RN_2_CRNA, MSN, RN · Aug 17, 2022

I honestly don’t think I remember my first code but as someone who responds to RRTs and codes you did exactly what you, as the primary nurse is supposed to do. You were there for you patient, assessing them, calling for help when you needed it and providing whatever information you could. When I respond to any emergency I seek out the primary nurse because they tend to know the patient the best (even if they feel frazzled at the moment). Like others have mentioned it depends on the institution if you’ll have three team members or twenty show up. That is still your patient and you can advocate for them (tell extras who are not contributing to step out). Please take time to decompress after any event like this. If your unit/charge nurse/manger/social worker/medical team wants you can set up debriefs (what went well, what improvements could be made, etc). During RRT moments I try to talk the patient through it. It sounds simple but we all get caught up in the task of stabilizing them. They don’t know what we are doing and are scared. I try to give them little reassurances along the way. From the information you provided you did a great job on your first code. I hope you don’t have too many more of them.

HiddenAngels · Aug 18, 2022

On 8/8/2022 at 4:55 PM, Dani_Mila said:

I've been a nurse for almost 5 years and this was my first Code Blue on my patients.

Quick hx on my pt who coded, he is a dialysis pt, anuric. He came in for GI bleed. MD r/o that it's possibly from his hemorrhoids since his hgb is at 10 and has been consistently up there. He is also being treated for PNA, receiving ABT (Flagyl) and PRN duonebs. He has a moist non-productive cough with poor cough effort, his lungs had been sounding coorifice, rhochorous, and wheezy for the past few days. MD is aware of this, he had his dialysis 2 days ago, removed an extra 500cc of fluids, he is also on Certizine BID. His O2 SATs has been sustaining in upper 90s with 4LNC. He also has a HX of A.fib, has a rhythm of A.Fib RVR, his HR goes up to low 100 to 140s, but at times it goes down to the 90s. He is getting treated for this as well with metoprolol. His BP had been running soft in low 90s and his BP med had been held couple of times. I was able to give his metoprolol on my shift because his SBP was on 100 in the low teens, BP med had parameters. Anyway, this pt was stable within his baseline for the most part of shift.

Scenario: I was stabilizing my pt's roommate as he desats to low 70s with minimal movement (not new), he recovers very slowly, sometimes you have to place him on a non-rebreather just for his lungs to catch up. Both of my pts are getting treated for PNA. After getting the roommate stabilized, I immediately checked on my pt because he was coughing, sounded very rhochorous and coorifice, audible without a stethoscope. I assessed my pt and he has this moist loose non productive cough that just won't clear despite his attempts. I encouraged him to cough, elevated the HOB further to help him, checked his telemonitor his O2 sat was still in the 90s. Kept encouraging him to cough and he stated "I'm trying". Immediately his eyes started rolling, his O2 sat went down to low 80s, I increased his oxygen but his O2 sat kept going down. I came out of the room and screamed I need a non-rebreather, one of the nurse went inside while I grabbed a non- rebreather. I immediately came back to his room and his O2 sats came down further to low 70s. One of my coworker initiated an RRT. I tried to place a non-rebreather on him, but his O2 went to low 50s. Pt became cyanotic, unresponsive, then no pulse was palpable. Code Blue was initiated. This happened within minutes. He went on PEA. Chest compressions was started by my coworkers. I was so overwhelmed, I couldn't do a compression as I am 37 weeks pregnant. Thank goodness my coworkers and charge nurse immediately came in to help out. It was very chaotic and overwhelming. ICU PA and ICU nurses (they responded to RRTs and code blues) came in and took over the code. He asked me a bunch of questions regarding my pt as to why he was here and what he is getting treated for, and how he became unresponsive. I was so overwhelmed I feel like I gave him the bare minimum. All I could do was stand back and watch and answer any pertinent questions they ask. The code lasted for 12 minutes and pt was able come back, but he was on Afib RVR and HR was in the 180s. He was sent straight to ICU and was intubated.

The whole situation was kinda hard to process. It happened so fast, his oxygen level went downhill immediately, he went from responsive to unresponsive and it went from an RRT to a Code Blue. After he was sent to ICU, the MD spoke with the family and his code status changed from full code to DNR, may intubate. I was thinking maybe he had aspirated from his mucus plug? It was so traumatizing, I feel like I could have done more in my opinion. What are your thoughts?

You did great, you were there, all codes feel overwhelming and usually happen fast. The only thing I would have done differently is sunctiomed him with a yankauer. If I still could t clear secretions I would have called respiratory sooner to do nasal suctioning. I’m glad your spidey senses were tingling tho. Once the patient stated he was trying but could t that was your call respiratory moment

oh and my first code … it was my patient’s birthday, I wished him happy bday at 1200. He died at 5am. Peed in my lap coded in my arms… and then Tele called but I was alone doing compressions yelling for help

nursecolley, ASN, BSN, MSN, RN, EMT-P · Aug 19, 2022

My first Code Blue was as an EMT on my first ambulance call. My patient had flipped his car end over end and flew out of the car. I was putting a C-collar on when he stopped breathing. We picked him up and put him on the back board and stretcher and threw him in the ambulance. My partner yelled for someone in the crowd of bystanders to drive the truck to the hospital. Unfortunately, the stretcher was not fastened into place when loaded, so it banged against our knees a few times. I was doing the breathing with an ambu bag, while my partner did compressions. I can still recall the patient throwing up beer and it pooling in his eyes. It's crazy what I remember about this call, but I'm so grateful for a partner who did not fuss if I didn't remember something, but was patient with me and the 'driver' who needed directions to find the hospital. I had many more codes in my career as a paramedic.

My 'first' Code Blue in a hospital setting as a nurse was a bit different. I had a patient who was admitted to a three bed ward at the beginning of the shift. His temp was in the 70-80's. He was barely responsive. I told my head nurse that I did not think he would last the shift and he needed a private room. I was a new hire at the hospital. Thinking back at that shift, I now know I should have suggested he go to ICU. Anyway, at first my head nurse resisted, saying that the empty private room on the floor was for a VIP who was coming. After an hour or two, my patient was given the private room. He had a buddy blanket placed on him, and I noticed that the higher his temp was, the less responsive he became. I called the doctor multiple times about the patient worsening, and he never came to the floor. I was upset about the lack of care I was vibing from the doctor. At 6 am, the lab tech came out and told me he was having difficulty drawing blood. I went in and checked his pulse. There was none. I pushed the code button and started CPR. After just a few seconds, the patient was revived. He was stabled by other responding doctors and nurses while the head nurse accused me of not recognizing the difference in whether someone is dead or alive. She also told me I should have stepped into the hallway and called a code verbally to just the floor. I was demoralized. I sat down and was documenting everything. Shift change came, and I was still writing. A few minutes later, a code was again called on my patient by the nurse who followed me. My patient did not survive that time. As a new nurse (who had 14 preceptors by the way), I know I made some mistakes. Please feel free to critique me. I would appreciate your thoughts on this post.

HiddenAngels · Aug 20, 2022

On 8/19/2022 at 11:49 AM, nursecolley said:

My first Code Blue was as an EMT on my first ambulance call. My patient had flipped his car end over end and flew out of the car. I was putting a C-collar on when he stopped breathing. We picked him up and put him on the back board and stretcher and threw him in the ambulance. My partner yelled for someone in the crowd of bystanders to drive the truck to the hospital. Unfortunately, the stretcher was not fastened into place when loaded, so it banged against our knees a few times. I was doing the breathing with an ambu bag, while my partner did compressions. I can still recall the patient throwing up beer and it pooling in his eyes. It's crazy what I remember about this call, but I'm so grateful for a partner who did not fuss if I didn't remember something, but was patient with me and the 'driver' who needed directions to find the hospital. I had many more codes in my career as a paramedic.

My 'first' Code Blue in a hospital setting as a nurse was a bit different. I had a patient who was admitted to a three bed ward at the beginning of the shift. His temp was in the 70-80's. He was barely responsive. I told my head nurse that I did not think he would last the shift and he needed a private room. I was a new hire at the hospital. Thinking back at that shift, I now know I should have suggested he go to ICU. Anyway, at first my head nurse resisted, saying that the empty private room on the floor was for a VIP who was coming. After an hour or two, my patient was given the private room. He had a buddy blanket placed on him, and I noticed that the higher his temp was, the less responsive he became. I called the doctor multiple times about the patient worsening, and he never came to the floor. I was upset about the lack of care I was vibing from the doctor. At 6 am, the lab tech came out and told me he was having difficulty drawing blood. I went in and checked his pulse. There was none. I pushed the code button and started CPR. After just a few seconds, the patient was revived. He was stabled by other responding doctors and nurses while the head nurse accused me of not recognizing the difference in whether someone is dead or alive. She also told me I should have stepped into the hallway and called a code verbally to just the floor. I was demoralized. I sat down and was documenting everything. Shift change came, and I was still writing. A few minutes later, a code was again called on my patient by the nurse who followed me. My patient did not survive that time. As a new nurse (who had 14 preceptors by the way), I know I made some mistakes. Please feel free to critique me. I would appreciate your thoughts on this post.

I have 0 complaints for you, but that head nurse was waaaack. She is a typical blame shifter. You did great!

greener22, BSN, MSN, RN · Aug 22, 2022

My first code was so long ago that we didn’t have any type of postcode analysis or really even paperwork. It was in the Summer of 1988 and I had one year of MedSurg experience in orthopedics. I work the 3 to 11 shift and I was making my rounds on a fresh postop hip replacement who had been on the unit a couple of hours. When I went into see her she was complaining “it hurts it hurts” I went to the nurses station to get the PCA key so that I can give her a bolus of her morphine PCA. When I went back to her room she was in full arrest. Some of those details are a bit hazy and what I did next but I know that I ran out of the room as Yelled for help and for somebody to get the crash cart. Only no one was getting the crash cart so I had to go get it. Again this was before we had RRT .we only had code blue teams. So I took the crash card back into the room and an orthopedic surgeon who happened to be on the floor came with me and he initiated CPR. Somebody, I have no idea who, called the code blue team they arrived and took over. When I asked me what happened I told him all the details I just shared with you. It was discovered that her allergy bracelet had been removed and taped to the front of her chart, which of course was kept at the nurses station, and we didn’t have EHR. Everything was on paper. So her allergy bracelet indicated that she was allergic to morphine. She was on a morphine PCA! She did not make it unfortunately. But something I’ve always remembered from the report I was told later was that she had a massive MI. I’m supposing that when she said “it hurts it hurts “she wasn’t referring to her hip but rather her chest. now that I’m a nurse instructor I share that with my students and I make sure that they always understand it when a patient says that they have pain that you verify where the pain is and don’t just assume it’s for what they’re currently being treated for. I don’t know specifically what her allergy to morphine was, whether it was anaphylaxis, or if it was nausea, but she shouldn’t have been on it.

My First Code Blue! Still Trying To Process It

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