"Code blue" = deer in the headlights!
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I am a former poster to this site but I've gone so long between posts that I've had to change my user name a couple of times! (formerly known as Waggy).
I love this site but don't get to spend much time here but today, I have to post!
I've been an RN for seven years. To accomodate my young family, I've mostly worked part-time/PRN in rehab and urgent care. A year ago, I decided to try an acute Med/Surg floor to regain my rapidly disappearing skills! I have three small children so I work two 12hr shifts a week. My mind hasn't stopped spinning since starting my job!
My last two shifts, I took care of an elderly lady being treated for a UTI w/syncopal episode x1 at home. Hx of CABG, stents , on tele, SR, occ SB in high 50's, asymptomatic, etc. PO abx and IVF . No problems the first shift. The next day, I thought something's going to happen with her today. !!!!!
Midmorning, she converted to a bundle branch block. No change in her condition. BTW, she's full code! The doc orders an EKG. Shortly afterward, tele asked me to check her leads since they seemed to see "asystole". I booked it to her room. She's fine, leads in place, her monitor shows SR w/ BBB.
Tele comes up with a strip showing two nine-second runs of non-conducted P waves. Yikes! Just as I'm paging the doc, my PCT comes running saying she was in asystole. (deer alert!)
I find her glassy-eyed and "0" heart rate on her tele. I immediately pulled the code button and basically freaked! I didn't manually check for a pulse or see if she was breathing! I just noted her changed appearance and the monitor. Just as everyone came in the room, she came out of it and her rate went up to the 60's. I basically couldn't remember my name at that point but I was able to give some hx on her. Plus, the house docs taking care of her were there.
Yet I felt so stupid! Was calling a code necessary? At first it seemed indicated, but she came out of it so fast. I didn't think about oxygen-she'd been RA but, of course she would need 02! Another nurse kindly put it on for me.
She seemed OK at that point but we got her ready to transfer to CCU. The doc asked us to place pacer/defib pads on while waiting for an available bed. I finally got my wits about me, implemented the other orders while the charge put the pads on her. I was hanging her LR and the charge was explaining the pads and her heart stopped again!
Amazingly, this time I was very calm! The charge pulled the button and the whole team came in again. Within ten seconds, she came back without intervention! We immediately put her on the transport monitor and got her to the CCU where, by last report, she was stable with pending cardio involvement!
After the first event, I berated myself for what I thought might be overreacting and panicking. Although I consider myself a pretty good nurse, this level of acuity is new to me and I feel like a new grad again without the benefit of the recent education!
Yet now that it's happened, I think I'll be more confident and focused now that I have a frame of reference to this particular situation.
What are your experiences/suggestions?
Thanks for listening!