need some help and opinions

Allison P · Sep 29, 2002

I know exactly how you feel. On my second night on the job in ICU(I'm a new grad-5/02) my pt went into resp. arrest and coded while I was at the bedside. Everyone told me that I caught it quickly- I had resp. in the room before she went into full resp. arrest, but I still second guessed everything I did. She was a neuro pt and it turns out she herniated, so there wasn't anything we could have done. She did stay on the vent several days before her family decided to take her off. She was very young(only 27), and she had been responsive (and combative) right up until she went into resp. arrest.

I've worked on quite a few codes since then, and it does get better. Everyone told me I was lucky to get my first one over with so quickly. I didn't believe them at the time, but now I think maybe they were right.

Good luck. Hope you feel better.

Allison:)

KeniRN · Sep 29, 2002

((((RENA)))) What you're feeling is normal. Its a mix of emotions. I remember my first code. It was a 7 week old infant and I was a nursing assistant on the cardiac stepdown unit in a peds hospital. Everything went smoothly,but afterwards I was not sure of what I was feeling. I think its scarey anytime a code happens, but worse when the person seems fine one minute and crashing the next. What I mean by this is when the pt is otherwise stable and not already critical. Am I making any sense? The baby I was caring for was fine,relatively speaking. I was holding him, he was smiling and doing the things a 7 weeker does and then with the snap of your fingers he was extremely irritable and then his heart rate plummeted (sp?) and he went limp in my hands. Thank god his room was right next to the nurses station and the doc was standing at the counter doing his charting. This was about 2:30am. Everthing happened so quickly as I ran for the cart. The last I saw of him he was being wheeled down the hall to the cicu and later someone mentioned he was placed on ecmo.I don't know if he survived.

I had such strange feelings, sometimes like butterflies in my stomach, for the next week. It helped me to talk about it with my co-workers. the pt's RN was pretty upset, it was her first time that it was her pt that coded. Our NM had those of us involved who felt they needed it meet with a staff MH CNS.

bagladyrn, RN · Sep 29, 2002

It's perfectly normal to keep turning this over in your mind - especially the first time. Did you get a chance to review the code with your co-workers afterward? Not to see if anything went wrong - more just to vent and decompress from the stress reaction. Coming here and talking about it helps too, so keep talking if you need to.

micro, RN · Sep 29, 2002

that "feeling" I don't think ever goes away, but after punching out it does get easier......

but then somedays it still will crop its head........and make you go ?????????

you and your team did all that you can do.......

that is why they say medicine is an art and a science..........

and the human body is not immortal.........

sometimes it "hurts" on the front lines of "caring"

micro

be well

BadBird, BSN, RN · Sep 29, 2002

I think every nurse goes over in her head the steps before and during the code, it is amazing how fast a seemingly stable patient can crash. I think we work so hard to get the patients healthy that when they code we sometimes look upon it as a personal defeat, it makes you wonder if you did something wrong or did not pick up on something fast enough. We are not perfect and the best care can not change the outcome in all cases.

Trauma Columnist · Sep 29, 2002

I'm an experienced ER RN and it never gets "easier" - however, you become confident that you are doing the best you can do and sometimes the end result is out of our hands. I have seen perfectly healthy young people die from prolonged Q-T syndrome, infants from SIDS, people in their 30's from an acute MI. Then, I've also seen the little old lady, contracted, with G-tube and trach survive CPR and go on existing. It is unnerving at first, but like all the others have said - you do get to the place where you feel that you did everything in your power to help.

midwestRN · Sep 29, 2002

Hang in there. You'll never forget her, but the memory will get less painful over time. After something unexpected happens, I still can't shake it for a while, but I talk to my co-workers that were involved in their care. Just remember that she needed you and you were there for her. Tomorrow, someone else will need you, and you'll be there for them, too.

live4today, RN · Sep 29, 2002

Ditto to what midwest RN said. :kiss

Rena RN 2003, RN · Sep 30, 2002

thank you all ever so much. i think you have stated what i have been feeling much better than i could have.

the super, nurses, and i all went over the situation for the rest of the shift (2 hours) and that did help.

things like this is the reason i have no desire to work LTC as a nurse. i get "too attached" to those CLOP (cute little old people). this lady and i were just this morning discussing the wonderful evening she had with her husband, children, grandchildren and a couple of great grand children. i work in sub-acute so this lady was fully expected to go home. her family took her to dinner for the evening then brought her back before bedtime.

i met her husband who has a wonderful sense of humor. i met 2 of her daughters (one of them has a cold at the moment and the other doesn't like apple pie). i met her grandaughter and her husband (they have a daughter who is teething and is miserable).

this lady doesn't like milk, uses a glaze in her hair, goes to the beauty shop every thursday at 10 a.m., prefers apple to orange juice, and likes cinnamon mints.

i don't want to get attached to CLOP. cause now i don't know how to feel. i'm empty sorta. i'm sad. i wanted to go to the hospital after work but didn't know if my facility would appreciate or support that since i knew the family would propaby question me about what had happend. i didn't want to get into that with them.

well, i just don't know. i think talking with you guys/gals has really helped. thank you very much.

Rena

bagladyrn, RN · Sep 30, 2002

Just a thought, sort of my view on things. If this lady does not survive, what better memory for her family to have than of that last "wonderful evening" and a lady who was able to enjoy all those things you listed right to the last. Would be my preference.

CATHYW · Sep 30, 2002

I'm sorry you all had a code today, and that it had to be your first. Since you recount the steps of it clearly, it sounds as though you know your CPR well. Sometimes a code team can do everything known to man to help a patient, and if it is there time to leave us, they will. The only consolation I was ever able to achieve with codes (personally) was that I did the best I could do to help the patient. There were a couple of codes that did not go well because of the MD that was there, but the patient likely would not have made it, anyway.

You sound like a caring person. It is difficult to go from talking with someone to coding them, but it happens. Just do the best you can for your patients, and do not beat yourself up for something you can't help. It is okay to be sad. Unfortunately, you will get a little more used to this as time goes on, but that doesn't mean you are an unfeeling, uncaring person.