My Patient Coded Yesterday

[Temcam7409]

I'm a new grad nurse. I have been on the floor for three weeks, yesterday marked the last day of my third week into my orientation process when my patient coded. I am on a Med/Tele floor caring for 3 patients but my preceptor is monitoring the tele strips (I'm not ekg certified yet).

Out of my three patients I had one "problem child" and two patients admitted with fractured hips. The one I was leased concerned about was the gentleman with a hip fracture who was alert and oriented. He was the one who coded and it came out of NO WHERE right in front of my vary eyes. I gave him a multivtamin and asked him if he was interetsed in getting the flu vaccine. He said he was. I went to the pyxis to get the vaccine, came RIGHT BACK and while I was trying to find the lot number on the vaccine vile, he started complaining of being too hot. He didn't look right. Diapheretic and loosing his color. I checked his temp: normal. Called my preceptor and told her to come immediately. She happened to be in the room next door and dropped everything to come help me. Then her tele phone started beeping and we were told his HR was 33.

Called the doc, doc ordered 500cc bolus of NS. For about 15-20 min we administered the bolus (he was a frail 95 y.o. male with a 20 gauge IV). BP and HR started to get better and we thought we were in the clear... Then he started tanking again and stated "I don't want to do this anymore". Another nurse ran into the room who was monitoring the ekg strip from the nurses station and said "He doesn't have a P wave!"

My preceptor called the doc and told him he needed to come ASAP. We called a code on him and before I knew it, 2 docs, 2 RT's, 2 flight nurses (came to try and get a better line in him), 2 ICU nurses and several nurses on my floor swarmed him. He was a full code. They cracked open the code cart and started a dopamine drip on him, got a stat echo, and put the pads on his chest, all of this was a blur and I could feel my heart beating in my chest. When he was stable enough, he was taken down to Cath lab.

That day, his triponins were 1.29, so he was put on 12.5mg of metoprolol. When I gave him his metoprolol, his HR was 64. It was a 25mg tab, so I cut it in half and showed my preceptor the other half. He coded at 630pm, I gave him a lovenox shot that morning and the 12.5mg of metoprolol and two norco around 2pm (nenver did get around to that flu shot). He also had his SCD's (pressure socks) on all day.

That day all he complained about was his hip pain and some gas. PT had him up and tried to have him weight baring at the bedside, but he was too weak. He was living independently up until this fall which is what brought him into the hospital. He was originally medical status and then switched to tele status after the triponin number. PT and INR were within normal limits.

This was the scariest day of my life. He is the nicest gentleman ever, I can't let it go in my mind. I can't help but to feel responsable, somehow. They're thinking he was having a PE, so he was placed on a heparin drip, continued on the dopamine drip, and went in to have a pacemaker put in today. He never complained of chest pain. I just don't understand how this could have happened. I feel just awful because he was MY patient and he didn't deserve to go through all of that termoile.

I'm afraid of something like this happening again. I did my preceptorship in the ICU, so I'm not a stranger to intense situations but this time it was different because he was my responsability and it came on SO quickly and out of nowhere. What if I hadn't been in the room? There are monitors at the nurses station, but many nurses get "alarm fatigue" and don't pay as much attention as they should to every little beep or alarm that goes off for the entire floor.

Thank you for letting me vent.

[tcvnurse, BSN, RN]

The first one is always hard. Probably did throw a clot before the MI. I hear what you're saying, that you're afraid something like this will happen again.

It will.

It doesn't get easier exactly, every time someone crashes it is kind of scary. But you learn to handle these things.

I am glad he had a good nurse to watch out for him.

[NewbieNeedsHelp]

Man... I watched someone die of an OD in the ER during my preceptorship. Right before it happened he was just swaying help me help me why won't you help me... And then everything just fell apart and I cried in a storage room for 20 minutes and thought about it another 2 weeks. I couldnt sleep without seeing his sad jaundice eyes... My point is, we're human and it is immensely sad. I blamed myself for this man coding and ultimately dying for a number of reasons, reasons that I won't mention and that don't really matter in the long haul....but just like you, little details that I make myself go over and over again in my head...

I was told something the second time my patient coded, this time on the tele floor I work on as a new grad... I was told, all you can do is your best.

I think it's really beautiful that sometimes we are the last interaction a patient has.. It's all a matter of perception. Try not to beat yourself up about the little details.

You are a good nurse.

[xtxrn, ASN, RN]

There's an old M*A*S*H episode where Potter is telling one of the docs (Hawkeye or BJ---Frank wouldn't care- lol) there are 2 rules in medicine-

#1- People die (or go bad)

#2- Doctors (or nurses) can't change rule #1

It's hard, scary, and nothing you did :)

Hang in there :heartbeat

[HouTx, BSN, MSN, EdD]

One of the most valuable courses in my undergrad program was called "values clarification". It was intended to make each of us reflect on and clarify our own personal value system and underlying beliefs. As part of that experience, although I am not a religious person I realized that I really did believe in a 'higher power'. This helped me come to terms with the fact that there are many circumstances that are just waaaay beyond the scope or authority of anything we can do. And that is the way it is supposed to be. The universe is unfloding as it should.

My clinical practice has been in critical care - where codes and hand-to-hand combat with the Grim Reaper are a daily occurrence. It's always sad when a life ends, even when it means the end of suffering. But it's much easier to accept when you can see it as the inevitable end of a continuum and realize that it's not about you.

There is an inescapable burden of cumulative emotional trauma that is associated with patient care. Failure to recognize and cope with it can lead to a lot of negative outcomes, including self-medication and burnout. I am fortunate to work in a faith-based organization, where we have processes in place to recognize and support the emotional needs of clinicians. Our chaplains help staff to cope with potentially traumatic events such as codes. Is this a potential resource for you?

Don't let anyone put you down for your natural & entirely appropriate emotional reactions. With time and experience, you will gain a bigger perspective that will strengthen your coping skills ... but never lose or distance yourself from your own human empathy.

[turnforthenurse, MSN, NP]

I think you did everything right - please do not beat yourself up over this! Your very first code is always very scary. Hang in there