My First Code

[Bonnie Nurse]

Get your ACLS book down and study all the basic lethal rhythms and how to treat. You WILL be the first one in the room at some point, so remember that the first thing you do is call the code and start cpr. As soon as more come in the room, establish a code leader as soon as possible. As soon as the cart arrives, get those pads on the patient, determine pulse/no pulse, rhythm etc. Then take it from there. If ACLS standards are not being followed it is the code leader's responsibility to point that out. You'll get there. My first was horrible too. I didn't know where anything was and there were only two of us and no docs yet.

[nerdtonurse?, BSN, RN]

And when you're the first one on scene, you're going to have a split second of "oh CRAP." But then, move. Hit the code button, scream for help, get him flat and start compressions. Lock your elbows, rock from the hips, and know you're going to at least feel the cartilage creaking, and may hear (and feel) the ribs break. That's not bad. It means you're doing compressions hard enough to be effective.

And always, always remember -- nothing you do is going to make "dead" worse.

[Tampa121]

My first Code!! I was 23 yrs old, a baby, one year of Med/Surg, then working in ICU, on orientation. Someone said to me, "Grab the code cart," I did and got it where they could use it, I almost ran my own ft over! I said, to my preceptor, "What do I do". She said, Stand out of the way and watch and you will learn. I stood at the ft of the bed and could feel my knees actually shaking, actually my whole body felt like it was shaking, and probably was. The patient survived because of the expertise of the nurses, resp therapists and MD's. In 8 min, she was on her way to Boston, with Nurse and resp therapist in ambulance, with her. Back then, I don't think they had ACLS ambulances!! Since then, I became one of those nurses, due to thousands of Codes, 35 years worth! I worked in a small 8 bed ICU. It was magic, we all knew who was good at what and made music! We didn't have to assign the leader, we knew who she was ahead of time. I was good at CPR, back then, skinny, could staddle the pt and keep up my compressions, even, during transport to OR, CT, etc. Lynn was short, she was great at meds, Lana my head nurse, tall and lanky, handled defrib. Kathy B. always grabbed ambu and started at the head. By the time the doc and resp arrived, pt was ready for them. All this in a few minutes!!! Bed moved down a few ft. headboard removed, bed locked, etc. I remember it like I do the birth of my son! I learned so much from the nurses and therapists I worked with in that Unit. It was sad when our hospital closed. "We" worked there for 20 yrs in ICU, it closed 3 months before I hit 20 yrs. Sold to Lahey, then Kindred/Vencor. We had a great party and I still keep in touch with many of them. When, I got accepted to RN school, right after my hospital closed, my ICU buddies gave me a huge party! I read a poem I wrote about all they had given me, and gave them all funny gifts. I will forever be grateful to each and every one of them, they helped make me the nurse I am today! I have gone back to ICU work at Vencor/Kindred at the same hospital, and was again in many Codes. But, it was never the same! The team wasn't there! Stay where you are, and you will learn so much from your mentors. It was your "first" of many Codes to come and one of many lives you will help save. :redbeathe

[CASTLEGATES]

My first ICU code was wild; a year out... A co-worker stepped out for lunch and I was watching her patients since mine were relatively stable, too. This man had a CABG and more recently plastic surgery to repair the scar on his mediastinum.

I'll never forget he called out for me to step in and he looked at me saying "I've got massive pain running down my arm so I went into the describing 1-10 and all that rubbish while I checked his med orders.."give me a nitro" he said just as I found an order-good enough I gave it to him and remembered there was a standing order for chest pain but some unit standing orders don't apply to some docs (private hospital)... He then looked at me, very pale and said "I'm having a massive heart attack and I'm not going to make it" and his eyes rolled back, I watched the Swan readings as he was talking and saw some very ominous signs before all the waves merged together as one flat line.

Seconds later, I was on top of him doing compressions yelling out the door "does anyone know this man? Is he full code, chemical, mechanical...someone help"! I needed clarifications because I WAS doing compressions. I was guaging my compressions watching his A line and thinking "cool"! Turned out he was a full code (plastic surgery...likely full code)...and I rattled off his Swan readings just before he crashed so they had an idea of what happened just as the normal code took a different course. Seconds later after pushing drugs and I'm still compressing, a doctor poured a gallon jug of betadine all over my hands onto his chest pouring off the side of the bed as I did compressions. I had just noticed they intubated him but recalled my pausing for them to do so...it was all so fast and I'd been there 15 minutes already! My co-workers started gowning and gloving and masking me in segments then they started scrubbing his chest with betadine wands. I didn't know exactly what was happening but if it's what I thought, I always wanted to see this.... then the scalpel was produced and at three I removed my hands, stopped compressing and a mad dash to get at this guys heart ensued. The surgeon cut all those carefully sutured plastic works just as the plastics Dr came in and protested. He viewed the monitor but still (interestingly) had to be calmed and reasoned into understanding dead sutures avail you nothing!

I saw a fancy pair of wire cutters produced and they twisted and cut one by one in a matter of seconds, got the chest spreaders in there and cranked that opened for the surgeon to grab his heart and start squeezing. I was hooked! I kept looking at this man's hand inside another man's chest and decided right then I had to find a job that does lots and lots of cardiothoracic surgery!

Unfortunately he had a near full infarct of his left ventricle so there was nothing they could do....a massive massive multi vessel clot. Just as they were discussing whether to call it, I walked towards the door and asked "Where's Nurse X?" my co-worker said "She's outside telling the family he's being discharged tomorrow." UGH I had to stop that ASAP, took the nurse aside interrupting her "Yes, they're thinking he's stable enough we're sending him to the floor in about an hour..." I briefly explained what happened during her lunch and we brought the family in. I did tell them his last words; that's all I could do, really.

[FATKAT]

My first code was terrible! I was in my med/surg practicum, my patient was in with a respiratory thing when something broke inside him when he was coughing, he bled out right in front of me and not just from his mouth, but eyes, ears etc. Of course everyone rushed to his aid, but he was a DNR. Unfortunately his wife saw it all to, very traumatizing at the time, but I got over it and am still nursing. Just remember that life is a fragile thing, do and be the best you can be and enjoy every minute of it! :)

[nurse901]

That was great to read that. It seems like you handled the situation in the best way possible considering you are a new grad and it was your first code. Thank you for sharing that with us. It is amazing how you can have an adrenaline rush during situations like this and then when it's all over you feel alot of emotions. I remember when I first experienced a death in the hospital. It did not get to me until I got into my car to leave. I just started crying and could not believe that the patient I cared for all day had just passed away. You def look at life differently after you see something like you experienced. Thank you for posting this. I am a new grad and it was nice to hear stories like this. Good luck to you:)

[sweechic]

In nursing, you will see and do a lot that you aren't always truly prepared for. And that's ok. It's how we all learn. Your compassion shows in your post, and that is one of the most important character traits any nurse can possess. It's ok to cry. We've all done it.

My first code came when I was a nursing student in my RN year and was doing my first day of an ER rotation in clinicals. A man came in with chest pain, telemetry was started, he seemed stable. Of course, next thing we know he's crashing. My preceptor called the code, tossed a clipboard my way and hollered for me to "write everything down". Talk about an overwhelming experience. Not only am I experiencing my first code, I am now responsible for making sure all the necessary information gets documented. Thankfully, he recovered, and I was able to do what was needed of me. You know how sometimes you have those moments where you just have to jump in both feet first, react, and think later? Those are scary, but some of the best ways to learn. You never really know just what you are truly capable of until you have to do it.

It sounds to me like you are going to be a great nurse. Your ability to respect the frailty of human life and to truly care for your patients shows it.

[RedZeppelinRN]

My first job in nursing was a teaching hospital. Green that I was, when I had witnessed and participated in so many codes, I realized these were terminal patients and this was a teaching hospital. Felt a little deflated at first thinking I was really not doing anything for the patient, I realized many people are alive today because of these teaching hospitals.

[KMULL002, BSN]

For me, my first code was traumatic and the patient was admitted for something completely unrelated to the problem at hand. I was not sure what my role and/or responsibility was but I did my job by explaining to the ER doctor what was wrong with the patient and I performed chest compressions on the patient until the code team arrived. I was cool calm and collected during the experience but afterwards when it was all over I became emotional. I started crying. A very insensitive ICU doctor told me "get used to it you're in healthcare." That was an insensitive remark but I do feel it's kind of accurate because not everyone's life can be saved. I cried because this was my first code and the result was death of a patient that was close to my mother's age. I cried just because. Luckily my director phoned me just to make sure I was okay and my employer also has employee assistance counselling. I saw the counsellor because I wanted to be evaluated on how well I deal with stress and apparently I do a good job. There have been many codes since my first and I have not lost my kind caring spirit but I have always remained professional because in times like those the patient, family members, and/or friends are looking to me for the answers but sometimes all they need is someone to cry with. I have always been impressed with how well my coworkers come together as a team for patients in crisis.

[nerdtonurse?, BSN, RN]

The worst ones are when you have a "walkie-talkie" come in for something innocuous like a lap chole and they throw a PE or stroke out, or a person comes in for something like COPD exacerbation and has a massive MI. It's bad when you think, "crap, they walked in here, and now we're bagging them up..."

[iluvicu]

This is a nice article...Thanks for sharing.