New nurse, first code

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Specializes in LTC.

I was minding my business at the nurse's station when my supervisor came breezing past. "Come with me, we have a code" was all I was able to make out. We hurried along to the unit, where we were met by very distraught looking unit nurses. We were pointed to the room and upon entering, was met by a very gray, very not breathing elderly woman. Her eyes were open, her lips were blue, and there were no signs of life. My supervisor started with the mouth to mouth (we had asked for a Ambu-bag as we were passing the nurse's station, but they had failed to produce one at this time), and I started on chest compressions. So, here I am, pumping away, and all the while ribs are popping under my palm. I wanted to quit SO BAD, but have been trained otherwise, so I kept on. This poor woman had BUBBLES coming out of her mouth and nose, and the blood started soon after. Finally, another nurse came in and took over compressions so I went to hunt down that blasted Ambu-bag. Imagine my surprise when I rounded the corner to the nurse's station and both of that units' nurses were just standing there! I yelled at them to get an Ambu-bag NOW, and a suction machine as well. NEITHER KNEW WHERE TO LOCATE THESE THINGS. One miraculously found a bag, and I ran it to the room and hooked it up to the O2. I could do no more other than watch as the nurses continued the code, hearing that poor womans' ribs break, and watching as more and more blood and fluid ran from her mouth and nose. Finally, the fire dept. and paramedics arrived and took over. After another 20 minutes, they called her. To make matters worse, this lady had just arrived last night and was the mother of one of our employees. I am sitting here wondering what we could have done differently, or it if would have mattered at all. I will never, EVER forget what it feels like to have ribs break under your hands, nor will I ever forget the brutality that is a code. I'll never forget that lady's face with the fluids running out as they were. The worst part is I don't even know her name. But I know she was somebody's Mom, and that hurts worst of all.

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{{{{HUGS}}}}

I have never actually performed CPR, so I have no experience to share with you. But.. know you tried. It sounds like you and your team did their best- and that is all you can do. You did not mention her age....But there really is nothing else you could have done- it was her time. God Bless.

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Specializes in Telemetry/Med Surg.

Hugs.....probably nothing anyone could have done differently to affect the outcome. Sounds to me like an embolism. You did everything right and all that you could do to help this patient. It's true though, you never forget your first code, first chest compressions of ribs fracturing. But doesn't your facility have a crash cart with the Ambu-bag?

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Specializes in Utilization Management.

How awful! I'm so sorry that the patient didn't make it. I agree, it was her time to go.

However, some good might come out of this. First, everyone needs to know when a Code is called. Second, there needs to be a universal, coordinated response of all staff members to any Code. Third, there needs to be visible, accessible, stocked Crash Cart with a charged defibrillator and supplies available.

If there is no policy for your facility or if policy is not being followed, staff members need to be accountable.

I know that your participation in this Code will only help you to organize the next one better.

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Specializes in Case mgmt., rehab, (CRRN), LTC & psych.
there needs to be visible, accessible, stocked Crash Cart with a charged defibrillator and supplies available.
Unfortunately, no nursing home where I've ever been employed has ever had a defibrillator in the building. Apparently, these LTCFs do not want to budget for one to be included in the crash cart.

In addition, our crash carts contain the bare minimum: Ambu-bag, suction machine, oxygen mask, nasal cannula, full oxygen tank, and backboard. Nothing more, nothing less. We are fortunate if the crash cart is even stocked properly!

Unfortunately, this is the sorry state of LTCF codes. If I am lucky enough to ever reach retirement age, I'll make sure to be DNR status.

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Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
I was minding my business at the nurse's station when my supervisor came breezing past. "Come with me, we have a code" was all I was able to make out. We hurried along to the unit, where we were met by very distraught looking unit nurses. We were pointed to the room and upon entering, was met by a very gray, very not breathing elderly woman. Her eyes were open, her lips were blue, and there were no signs of life. My supervisor started with the mouth to mouth (we had asked for a Ambu-bag as we were passing the nurse's station, but they had failed to produce one at this time), and I started on chest compressions. So, here I am, pumping away, and all the while ribs are popping under my palm. I wanted to quit SO BAD, but have been trained otherwise, so I kept on. This poor woman had BUBBLES coming out of her mouth and nose, and the blood started soon after. Finally, another nurse came in and took over compressions so I went to hunt down that blasted Ambu-bag. Imagine my surprise when I rounded the corner to the nurse's station and both of that units' nurses were just standing there! I yelled at them to get an Ambu-bag NOW, and a suction machine as well. NEITHER KNEW WHERE TO LOCATE THESE THINGS. One miraculously found a bag, and I ran it to the room and hooked it up to the O2. I could do no more other than watch as the nurses continued the code, hearing that poor womans' ribs break, and watching as more and more blood and fluid ran from her mouth and nose. Finally, the fire dept. and paramedics arrived and took over. After another 20 minutes, they called her. To make matters worse, this lady had just arrived last night and was the mother of one of our employees. I am sitting here wondering what we could have done differently, or it if would have mattered at all. I will never, EVER forget what it feels like to have ribs break under your hands, nor will I ever forget the brutality that is a code. I'll never forget that lady's face with the fluids running out as they were. The worst part is I don't even know her name. But I know she was somebody's Mom, and that hurts worst of all.

*** As an ICU nurse in a large hospital I am on the code team. I go to codes 2-10 times a month. I do all the rolls in the code, including running them. I have broke more ribs than a rodeo bull. I am glad you got to experience this code so early in your career. From your description it sounds like a very mild code. Wait until you add intubation, defib and central line placement. I hope it will make you, as it has made me, a strong patient advocate when the DNR question comes up. So often, when the DNR status of a patient is being discussed the doctors fail to relate what it means to code mom or dad. I think this is mostly because the docs don't have any idea. Unless they are an ER doc or trauma surgeon they have likely never run a code and maybe never even seen one. I use my experience to educate the family and patient just how brutal and inhuman it is to code a person. My detailed descriptions have led many patients and families to change their minds and in more DNR orders. I have angered many doctors doing this, especially surgeons, they seem to think that if they operate then the person needs to live no matter what. They have complained to my manager several times. I don't give a darn. My role is not to please doctors, it's to advocate for my patients.

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Specializes in LTC.
How awful! I'm so sorry that the patient didn't make it. I agree, it was her time to go.

However, some good might come out of this. First, everyone needs to know when a Code is called. Second, there needs to be a universal, coordinated response of all staff members to any Code. Third, there needs to be visible, accessible, stocked Crash Cart with a charged defibrillator and supplies available.

If there is no policy for your facility or if policy is not being followed, staff members need to be accountable.

I know that your participation in this Code will only help you to organize the next one better.

That's the problem with this facility. When I started there, I asked where the crash cart was, and they laughed at me. There is not a code team, and unbelivably, we are not required to be CPR certified to work there. In fact, I remember being told that if there is a code, that we are only required to "bag 'em", but not to do chest compressions. (?!!). I'm sorry but I couldn't live with myself knowing I didn't do all I could for a resident. But, if management broaches the subject, I plan to plead ignorance. I already have an arguement in place for having necessary supplies in a central location for such an occasion. We have "oxygen supply" closets on all units. What a fabulous place for code supplies! We also only have the bare minimum: Bags, O2, backboard. I guess it's better than nothing. The lady was elderly, and there d/t COPD and dehydration from what I understand. I'll find out more about her tonight. I really want to know her name. Thank you all for responding. It helps SO MUCH hearing from others who have either been there, or can truly sympathize with me over the situation. You have no idea how much you have helped.

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Sheesh! No defibrillator in the entire building?

I thought the place I worked at was bad because we only have one but at least we have one.

I don't think that is the kind of place I would want to work at.

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