Where do I even begin? As a new nurse... this is probably the worst thing that could happen. I've had families be extremely rude as well as MD's... but I don't think anything prepared me for my first code.
.. The pt has a pretty extensive hx. Bundle branch block, inferior/superior infacts, Ejection fraction of 35%.. came in for a radical subtotal gastrectomy, wedge biopsy of the liver and j-tube placement.
I had had the pt for the past two nights and thought that they were looking much better last night when I came on. They were sitting up, talking to me.. and asking for a few things..
..They were getting tube feeds from 7p-7a only.. and around midnight they started to get a little nauseated and started to vomit VERY little. I turned off the tube feeds.. checked residual (20cc) .. I flushed a little and then clamped the jtube. Told the CA to set them up a little bit further. I was going to help the CA give the pt a bath.. but they called another CA in to help. So I went to get insulin to cover fingersticks (including this pts.) ..and get stuff to draw AM labs. They got them bathed.. and in the time that it took to draw up insulin.. They called me to get in the room asap. I ran in there.. the pt was grey and o2 sats were 40%. Thankfully, the CA was thinking quick enough to grab the pulse ox... so I knew what it was when I got in there.. I told the ca to turn up the 02 and went to get the charge nurse.
..She went in the room and someone along the way told me to get the crash cart. I got back in the room.. setting up the cart and they were calling the code.
Of course now everyone is rushing in the room..and everyone knew they're role. I wanted to CRAWL under the table when the Dr asked who the pts nurse was. And I explained everything that led up to this moment. And he tried to make a complete ass out of me infront of everyone.. asking me why I didn't call if the pt was nauseated. If I called the dr everytime the pt was nauseated? .. and what IF i did call.. and he ordered phen. ...then everything they were doing would have been ten times harder.
So the pt ended up going into asystole. CPR started.. They got a pulse back.. intubated (and got 200cc of dark dark liquid) and then got ready to transfer them down to the icu. I was told to go report off to the icu nurse.. and in that time the pt started to brady down to the 20's and they ended up pushing atropine.
They sent them down and the pt ended up flat lining 4 more times for them.. And the aide that took the pts belongings down said that the pts stomach had gotten huge.
..perforated bowel? or bleed?
This night was extremely overwhelming.. and all I can say is thank god I"m not back tonight. I'm surprised I didn't throw up or freak out during the whole thing. I had no idea what to do.. and the only productive thing I did was get a manual BP when the dr asked.
The Dr came up later that morning and wanted to know everything that happened. I explained it all again.. and he was asking me over and over again like he was looking for something that I did wrong. And then looking at me for a long time like I was lying about something.
I know working in a hospital there's going to be codes. But I'd never seen a code let alone been a part of one. The sad thing is .. the pt was telling me just minutes before all this that if they would have known that they'd be this sick and not feel good they would have never had the surgery. =(
..thanks for listening.
..and ps. I've only been off orientation for a month..or a little over.
