Reoccurring code nightmare

This has happened to me before in PICU. I was doing compressions on an 18 month old girl who was not intubated yet at this point in the code. She had severe pulmonary hypertension and significant cardiac problems.

She was being bag/mask ventilated and her eyes were closed. Just prior to getting intubated, while still as blue as blue can be, her eyes flew WIDE open, her mouth formed an "o" shape and her arms shot out and she went as stiff as a board. She looked alive for a hot second. It looked like she was looking right at me. We did a femoral and brachial pulse check at this point and looked at the monitor...nothing. No pulse. Still asystole. She presented in PEA, so asystole was definitely a move in the wrong direction.

They quickly intubated at that point and her arms relaxed, and her eyes eventually closed. She was pronounced about 30 minutes later.

It was an unsettling way to watch a child die. She was my first patient who ever did this...but she wasn't my last. It's happened maybe a handful of times during my career.

It is traumatizing to see. But it does happen. You were right not to stop compressions until an independent pulse could be confirmed...or not. It does happen and I can only say that it just takes time to get over.

Talking to a chaplain seems like a good place to start. Your employer's EAP is another good resource. You usually get three to six free counseling sessions there.

Warm wishes and you aren't alone!

PixieRN1, thank you so much for sharing your experience. Coding anyone and watching them die is gut wrenching but a child is a whole other experience that I can't even fathom going through. I will reach out to the EAP also.

I've had this happen to me a couple times. It's seriously spooky. And you were clearly right to continue compressions. Patients in comas, if you open their eyes, will sometimes follow your finger with their eyes if you move it side to side right above them. This does not mean they are 'looking' at your finger, or making sense of the task at hand. They aren't engaging with the part of their brain that assigns meaning or understanding. Simply reflex. This is similar to what happens to people who look at you in a code. When this has happened to me in the past, even those that did have a pulse back and survived had no memory if the event. Know that the last thing your patient saw was not you doing compressions.

You did the right thing. This patient did not survive, but you gave him the best chance.

I hope you have a peaceful nights sleep soon