Okay, I am a new RN working on a hectic med/surg floor. I have never seen a code in school or since I've been working. I've seen tapes in school about the process and the mayhem that goes on. I am terrified (having nightmares actually) that I will walk in the room, my full code pt. is not breathing, and I don't have a clue what to do.
(As you can tell, my orientation left a little for the imagination)
If my understanding is correct- (please correct me)
First I would yell at or try to arouse the pt, maybe shaking them
If no response, (check for breathing and pulse)I would yell for help while lying bed flat and getting pt positioned for CPR
Then initiate CPR
By this time, someone has called the code since I yelled for help a few steps before-
When the code team comes in, do I just keep on doing CPR, or does someone move me out of the way and intubate?
What is my role after that?
What if I just came on shift and only know a small amount about the pt?
As you can tell, I want to save this person- I don't want to mess up. Can you tell I'm panicked?
Pulses Vtach needs to be shocked asynchronously just like Vfib and follows the same algo as Vfib, and yes you shock first before any meds are given. I teach ACLS and this has been phased out but when I was first a nurse, this was the mantra and it helped me out....
Shock Shock Shock, Everybody Shock, Little Shock, Big Shock, Mama Shock, Papa Shock, Everybody Shock...though with the advent of Amiodarone that's been lost since ACLS is now geared to be more basic...I guess we could have put "Auntie Shock" j/k
Oh an Siri I have a question for you since you also teach ACLS...How extensive do you have them do Megacode...Do you make them go through each antiarrhythmic in that particular algorhythm, or do you let them choose one, or do you choose one for them, I've seen some who makes people go through all of the antiarrhythmics making a megacode station last for about 15 minutes a piece and with a class of about 20 or 30 and 3 or 4 stations it takes awhile to get some through....Appreciate your input.
Great advice so far. IF anything, get a basic dysrhythmia class. Luckily, you should have a code team that can run quick! I too fear my first code. I actually fear the time going into the code, where you're trying to get them NOT to code. I can handle a code (I hope).
In nursing school we learned
"Please shock shock shock, Everyone Can Shock, And Let's Make Patients Better"
(Thump, 3 shocks, epi cpr shock, amio, lido, mag, ... bicarb- I've blanked on what the P stands for).
But you're trained for the basics. If not or you spaz, by the time you call for help, someone will be in there telling you what to do! That's my thought that gets me past my fear- If my patient codes, I know the simple stuff to do. I know to breathe for them, thump their chest, and I know how to chart. My ACLS Rn will be there in a matter of seconds and we can shock and drug them up. -andrea
Specializes in Education, FP, LNC, Forensics, ED, OB.
Oh an Siri I have a question for you since you also teach ACLS...How extensive do you have them do Megacode...Do you make them go through each antiarrhythmic in that particular algorhythm, or do you let them choose one, or do you choose one for them, I've seen some who makes people go through all of the antiarrhythmics making a megacode station last for about 15 minutes a piece and with a class of about 20 or 30 and 3 or 4 stations it takes awhile to get some through....Appreciate your input.
Hello, hrtprncss :balloons:
I do not make the student go all the way through. Usually you know if they know their stuff beforehand. I let them have the choice of antiarrhythmics when applicable. Now, if I think they don't know or are unsure about some of the others in the same algorithm, I will say something like, "We ran out.....pick another". I make good and sure all know how to defib, sync, pace......utilize the electrical therapies.
You are correct. You can make for a LOOOOOOONG megacode if you make them do ALL of it. And, we usually have 35 in our classes.........
Wow! This is all interesting stuff! Eighteen years as a nurse, and I've NEVER had to participate in a code other than fetch fluids, charts, watch the code in progess if the room isn't too overcrowded, comfort the family, and standby in case they need me for something else. I have BLS/ACLS, but have never had to use either one in all these years. I get the "good patients"...the ones that are a true DNR........and just go in peace. :chuckle
I hope I will remember enough to do what needs to be done when and if I ever have to activate a code, etc. Come to think of it, my card is up for renewal this November....:uhoh21:
Great advice so far. IF anything, get a basic dysrhythmia class. Luckily, you should have a code team that can run quick! I too fear my first code. I actually fear the time going into the code, where you're trying to get them NOT to code. I can handle a code (I hope).
In nursing school we learned
"Please shock shock shock, Everyone Can Shock, And Let's Make Patients Better"
(Thump, 3 shocks, epi cpr shock, amio, lido, mag, ... bicarb- I've blanked on what the P stands for).
But you're trained for the basics. If not or you spaz, by the time you call for help, someone will be in there telling you what to do! That's my thought that gets me past my fear- If my patient codes, I know the simple stuff to do. I know to breathe for them, thump their chest, and I know how to chart. My ACLS Rn will be there in a matter of seconds and we can shock and drug them up. -andrea
about the thumping, did I read somewhere that it could convert a rhythm to asystole, and then you would not have Vfib or Vt to shock? I am in way over my head here, so bear with me....
Specializes in Education, FP, LNC, Forensics, ED, OB.
about the thumping, did I read somewhere that it could convert a rhythm to asystole, and then you would not have Vfib or Vt to shock? I am in way over my head here, so bear with me....
Good question, chadash.
Well, much controversy. The American Heart Association does not support the precordial thump as a first line treatment in an arrest because of just what you said.
But.....and a BIG BUT.......if you SEEVTach on the monitor and the patient is pulseless (witnessed arrest), and a defibrillator is not "readily" aviailable, you can deliver a thump. If it is Vfib.....all the thumpin in the world will not help.
I haven't been here since I posted the origional thread,(don't ask-haha) but I wanted to thank everyone for the replies!
No pts. coding yet, but I do feel a little better after reading all of this. I just hope I can stay calm and instinct will kick in and I'll just KNOW what needs done.
hrtprncss
421 Posts
Oh an Siri I have a question for you since you also teach ACLS...How extensive do you have them do Megacode...Do you make them go through each antiarrhythmic in that particular algorhythm, or do you let them choose one, or do you choose one for them, I've seen some who makes people go through all of the antiarrhythmics making a megacode station last for about 15 minutes a piece and with a class of about 20 or 30 and 3 or 4 stations it takes awhile to get some through....Appreciate your input.