My First Code Blue! Still Trying To Process It

[Dani_Mila]

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?

[HiddenAngels]

Oh my God!!  I’m so sorry this happened to you. I know for a while you kind of blamed yourself, we like to think we can know all and see all but dang.  This was touching (warm hugs)

[Dani_Mila, BSN, RN]

On 8/18/2022 at 12:48 PM, HiddenAngels said:

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

Respiratory were on top with him, they were giving him medications, breathing treatments, suctioning him, but the mucus is inside the chest, he just could not cough it up. He has been given medications to thin it but he just have a poor cough reflex. I spoked with the respiratory that night and she was like "it's expected his lungs sounds horrible for the past few days, getting him to cough is a piece of work, he will cough and then he sounds horrible again after an hour, no matter what we did."