My first code-feedback appreciated!

[sunnybabe]

Hi. I don't post here often but I'm a PCT on a med-surg floor. I'm supposed to start my nursing program soon for Fall 2012. I was doing my rounds on my patients when I decided to check on this particular patient who wasn't feeling too well(vomiting alot). I checked on him often throughout this morning, trying to reassure him the nurse was going to give him some medication and maybe he could drink some water since he can't tolerate any of the clear liquids I tried to bring him. Anyway, I go in the room to check on him and just didn't look right. I can't really explain it(I know you're thinking-yea, duh guy is dead). So I start looking at him more closely for chest rising-nothing. I walk up to him and touch for his carotid pulse-nothing! Then, I start shaking him and yelling his name. So I then I panic and push down the CPR button on the bed, which makes his head drop rapidly(that would wake anyone up if they weren't dead!).

Meanwhile, I press the staff emergency button and call my nurse with my phone. She rushes over and starts yelling his name and shaking him. Once she tells me to call the charge nurse and says "omg", I realize that I'm having a code on this floor on my patient who was just normal, alert, and oriented. We were just joking a few minutes ago! So she freaks out and I freak out in the sense that she's trying to push the code button(but you have to pull, not push!), the charge nurse runs in and starts yelling for the crash cart. All I hear is yelling for the crash cart and I just ripped off the patient's gown and started compressions. So, I'm doing them(about 60-30 apart), still not believing this is actually happening. The crash cart gets to the room, and my nurse takes over the compressions.

I get out of the room to make room and RT and other people(doctors, code team, etc..,) comes in and I go back in and they start yelling for stuff like O2 connectors, suction tubing, etc.., I'm running back and forth to the supply room, grabbing stuff and trying to connect it to the right place in the room. I'm so nervous doing this because I know every second counts! I just left the room after I realized all the professionals had it under control. On my way to the supply room, I see my nurse crying and trying to compose herself. So, I went into a private room and one of the nurses asked me if I was ok, I said no and had a good 3 minute cry.

Anyway, the patient was resuscitated. I went back in the room to watch the code even though I really didn't want to because it really hurt me to see him like that. But I told myself I should see how a code really works. The code lasted about 35 minutes. I assisted in getting his stuff together and making sure the vitals were in before he left. His vitals were normal except for a brief moment when he was sleeping his 02 levels were looking low, but he was snoring(i believe he has sleep apnea) while I was taking them and I know usually his 02 levels are normal. However, when he was eating breakfast and alert, the o2 levels were fine.

I thought he had maybe aspirated on his vomit. Turns out he had a massive PE(I still need to research that!)

It was a good learning experience but it was hard for me because it happened early morning and I had many more hours to go. It was obvious they weren't going to send me home still we were at almost full capacity on the floor. So, I just kept telling myself, after having another cry in the bathroom, to keep it moving because I still had other people who wanted things.

It was my nurse's first code too, which explains why she freaked out as much as I did. But everyone says I did fine, that thank goodness I kept checking on him. My charge nurse was pleased. I'm glad he's alive but I can't stop thinking if the code was a waste because he's only gonna die again because I people don't make it from PE's, especially one that size. But I'm also excited because I saw a code and it was just intriguing once I wasn't the one involved but watching...

The code started as chaos but it quickly got together.I didn't think I would've had to deal with this on med-surg and just the other day I was thinking if I could ever work ICU or ER as a nurse because I know they deal with codes alot.

I think what affected me the most is that the patient and I got along well and then BAM, gone. I feel sort of bad for crying, but not many people saw me cry and I definitely tried to keep it together in that patient's room.

Any feedback would be great.

[RNMeg]

It sounds to me like you did everything you were supposed to do. PCTs as "runners" during codes are the best, because you know where everything is on the unit and can get it quickly because, as you said, every second counts. Most codes are chaos at first, and then our training kicks in and things move more smoothly.

If the patient was able to be resucitated and had stable vitals when they took him to ICU, he may well make it. I've seen patients with pulmonary emboli do just fine, although it does depend on where it is in the lung.

It's okay to feel upset or sad when you code a patient, especially if it's someone you connected with. It sounds like you had your "moment" after the code and then were able to continue your shift and meet the needs of the rest of your patients. That is the mark of a true professional. Well done! :redbeathe

[xoemmylouox, ASN, RN]

It sounds like your did a great job. I don't think codes ever get easy to deal with. I still get the butterflies in my stomach and a tear in my eye when it does not go well.

[nurseprnRN, BSN, RN]

good job, dear. you kept your head, did what you learned to do and did it promptly, and supported the efforts of those with more expertise.

you are also due a kudos (yes, it's a singular word) for that little voice that kept telling you all morning to keep an eye on this guy because something wasn't right. you were correct, and because you were checking often you found him very soon after his acute event. so many aides/techs are so task-list focused that they don't develop that third eye.

good work. glad to see you in nursing school soon!

[lalopop86]

I want to give you "props" for not panicking and acting immediately. I am a nurse tech and a nursing student who has never seen a code and I always wonder if I will know the right thing to do. It sounds like you did a great job of monitoring and acting fast:yelclap:

[Anna Flaxis, BSN, RN]

What makes you think he's just going to die anyway? People survive PEs all the time. I've taken care of many people with big giant saddle PEs, even.

I'd also like to commend you for listening to your gut and checking on this guy often. This is probably the reason he survived.

[sunnybabe]

Stargazer, I'm not knowledgeable about PE's so when the nurse mentioned it and everyone said that he is most likely die, I thought he would be gone for sure. It's nice to know that he could very well survive. He was young too-only in his 40's.

[evolvingrn, BSN, RN]

Lot's of people make it with PE's at this point in the game , now they know and can start the heparin he might do fine. Your frequent checking on him saved his life. WTG

[bjaeram]

You saved his life! The nurse or others may not have found him in time to get him back! GREAT JOB!

[delilas]

You have a nurse's voice in your head :) Not everyone can identify the signs of a patient going south; it's so easy to brush off subtle signs because they are sick, after all!

I've actually experienced a PE once in my life, and treated several patients with them. Like a lot in the textbooks, it's a little overdramatized. It is an emergency, but prognosis for them is generally good once they're identified. PE's are a traveling clot that gets stuck in your lungs - so all those times you've cursed putting those damn stockings on someone (or is that just me? ) this is something they help prevent!

You did well - it's hard to stay cool during your first (or second...or fifth) code, and you kept your head in the right place and put the patient first. Kudos!

[sbostonRN]

Great job!! I have only been in a code once, when I was shadowing in the ER as a nursing student. I think it's totally different when it's your patient who you've been taking care of all day, and you have the opportunity to intervene early. Kudos to you for starting CPR early and getting the others to the scene quickly. It's difficult to keep a cool head in those situations. Plus, the fact that you did so great will give you confidence in future situations.

[Good Morning, Gil]

Sounds like you did a great job! Especially since you're the one that discovered him, felt he didn't look "right." Sometimes, that subjective data is all you have, even if everything else looks good. You saved his life; if any more time had elapsed, the outcome could have been much different. True, you don't know what his outcome will be, and it may be a poor one anyway, but you did what you could. I was going to say: where was the nurse? She should have run in there, calling people to help as she was running in there, but as it turns out, it doesn't sound like she handled the stress as well as you did.

Hopefully, she'll learn from this one, and do better next time, but it's really important that you remain calm in an emergency so you can think clearly, which you did. You didn't cause the patient to code, so there's no reason to panic; all we can do is prevent everything we can (by intervening early if possible), but sometimes, and you'll learn as you gain more experience, people just code and/or die suddenly without warning. This isn't typical, but it does happen. Once you're in a few codes as an RN, you'll feel comfortable. It's pretty routine actually, and when it's your patient, you're able to give some possible causes to the doc as you're doing compressions, pushing drugs (get ACLS certified when you graduate), etc.