Scared of "Code" situation...how to prepare?

hoolahan, ASN, RN · Oct 6, 2004

Wow, consider yourself lucky!! But I can relate. I didn't really have code nightmares until I transferred to ICU, then I literally dreamed several times about putting the defib paddles on without gel. I was pertrified I would shock someone else, myself, or burn the pt.

I do have a few suggestions.

Of course you have BLS, and I would suggest ACLS, but, if you don't read strips on a regular basis, I think you may lose the skills that you learn.

If you want to learn about rhytms, try a book by Dale Dubin. I can only remember the 12 lead ekg book, but I believe he wrote one of rhythm strip interp too. Avoid Marriot's book, it's deep for beginners. Conover also has a good book that covers all the basics.

Look around at other hospitals. Sometimes they will let you take their courses. Find out where the ER nurses go to learn strip interp, or the ICU nurses

Speaking of ER and ICU, the best way to get over your fear is to observe. How many codes have you seen? Ask your sup if you could respond to a few codes for observational purposes. If you must participate, choose the documenter role to start. Most hospitals have one person who is assigned to document.

Also, offer to check the code cart for expiration dates. This will give you the opportunity to open up and explore the equipment used for codes. Ask how the equip is used. You may wish to stay over one day and have an ICU/ER/CCU/ or PACU nurse, explain the use of the airway equipment.

In every ICU I have worked in, we have to check the code cart q shift, including testing the defib paddles.

Just getting the ACLS book would be a big help in explaining a lot of the things you need to know in a code situation.

There are also dummies in ACLS classes with metal buttons that you can actually practice paddle placement and defibrillation on.

If the mountain won't come to Mohammad, he must go to the mountain.

Discuss this as a goal for your next eval with your manager. It will show you set a goal, made a plan for achieving it, and when you have your next eval, it will look great that you were motivated and took the initiative to continue your own learning.

talaxandra · Oct 6, 2004

I'm hospital trained - during my training I had eighteen codes in seventeen months (no, I don't have Munchausen's by proxy!), so the spooked factor went pretty quickly. After fifteen years in I've probably been involved in a couple of hundred real codes, and it's only recently that my hands have stopped shaking; I still get nauseated after the adrenaline rush dies down, though.

Take the time to check out the crash cart, but don't expect that you'll remember where everything is. Organise a mock crash on your own - maybe on a quiet weekend. Reading ECG's is skill that you have only as long as you use it regularly - it takes no time at all to forget what all those little bumps and dips mean :) I imagine ACLS is much the same - if you haven't had any codes yet, odds are you'll forget most of it before you need it.

Now that my hospital has a MET code policy, where we can summon ICU assistance way before patients actually arrest, real codes are something of a rarity, and a lot of my colleagues are a bit freaked by the idea of what to do in a code.

So I'll tell you what I tell them - help arrives really quickly; there's always someone who knows more than you; the most important thing is to keep your head together (it's not you that's coding, so take a breath; you have time, so take a breath (breathing's important for staff as well as patients :)); what you've learned will come to you when you need it; if you're jangly avoid drawing up drugs - your hands will shake; hurrying is bad - be calm and methdical, even if others around you are freaking out; panic is contagious and unnecessary.

Good luck :)

meownsmile, BSN, RN · Oct 8, 2004

My facility makes code cart inspection part of the recert for CPR for employees. We have one open that has all the supplies in their places and we have a checksheet the CPR instructor and health ed rep goes over with us after we finish our demos for CPR. Thats a major help. Usually we have a code team that comes to the unit when a code is called, and the RN on the unit team takes the documentor role as soon as the code team arrives and takes over.

RN-PA, RN · Oct 8, 2004

I definitely feel for you, RGrif. Codes also scare me and like you, I've had patients go south quickly and called Respiratory Therapy or the House Physician STAT, possibly transferred them to ICU, but have never had my own patient code in my 10 years on med-surg. (**knock*on*wood** :chair: ) Over the past year, our unit requires that we participate in at least 2 mock codes/year-- many opportunities are given to participate-- and it's helped me a lot. I don't know what it's like at your hospital, but at ours, once you call the code, people come out of the woodwork to help. An ICU nurse is always assigned to codes and is designated to draw up all the meds, and often the house nursing supervisor documents (I work 3-11). The nurse assigned to the patient has the chart and relates pertinent information to the doctor(s) assisting at the code.

We floor nurses are told to focus on the basics until help arrives: "The ABC's"- Airway, Breathing, Circulation. By the time a code is called, a nurse has run for the code cart, another has gotten a backboard under the patient while another sets up the ambu and O2 and a suction cannister. During our mock codes, we all take turns with the various responsibilities until it's more comfortable. We also go through all the drawers of the code cart to become more familiar with it all.

I would strongly advise that you speak with your nurse manager and assistant about your concerns, and about your feelings/observations about your burned-out nurse educator. You and your co-workers deserve much better education than what you're getting, and so do your patients.

mattsmom81 · Oct 9, 2004

If you're not comfortable within the education system you're in, take ACLS outside your facility...many nurses do this for reasons you describe , I did too when I was a young nurse. You need to develop a confidence level in your abilty to manage a code situation. You can do this...don't let your unresponsive education dept. form your comfort level.

pricklypear · Oct 9, 2004

I think you have gotten some really great advice! If it is any comfort, my experience has been that the anticipation is worse than the actual event. I think you will be surprised at yourself and the skills that you posess beneath the surface. There have been some situations where my brain has come up with the most astonisingly brilliant things (no idea where it came from) and my hands have done the smartest things without any input from me. Afterwards I'm like, "what the heck just happened???" "how did I know to do that?" I think some of the other posters said that even after several codes they still get jittery and nervous. I don't think that ever goes away, especially if it is your patient. About EKGs, does you hospital have a telemetry floor or rhythm central where patients are monitored? It might be worthwhile to schedule some time there to learn rhythms from people who see them everyday.

Good luck!!! You'll do better than you think!!!

ERRN1028 · Oct 9, 2004

If it is a REAL CODE! (If you happen to be 1st to see patient)

1: O2- Face mask Ambu patient(you are their ventilator)

2: Pulse? & Monitor (get them on the EKG monitor)

3: Yes take ACLS

As a person who goes to codes a lot, I understand you are nervous. BUT.. those are really the most imp things you can do to get started till the CODE TEAM comes !

Thought that may help !

General E. Speaking, RN, RN · Oct 26, 2004

My facility makes code cart inspection part of the recert for CPR for employees. We have one open that has all the supplies in their places and we have a checksheet the CPR instructor and health ed rep goes over with us after we finish our demos for CPR. Thats a major help. Usually we have a code team that comes to the unit when a code is called, and the RN on the unit team takes the documentor role as soon as the code team arrives and takes over.

I remember in the "old days" having to check the crash cart every shift ( or day?). I mean actually breaking the seal and looking at each drug for expiration dates...very helpful! I knew exactly where everything was on that cart. Nowadays, the defib and outside compartments are checked but the seal where the meds are isn't cracked. Granted the drawers are labeled, but in an emergency where adrenaline is flowing...

We do get to explore the cart once a year during an equipment lab but this is definately not as helpful as doing it daily.

EmeraldNYL, BSN, RN · Oct 30, 2004

That's so funny, because I'm a total code junkie. I love being on the code team and the adrenaline rush that I get from it. I too was really, really nervous when I first started but the nervousness wears off in an emergency and you just do what you were trained to do! I agree with the others about taking ACLS, I definitely think it would relieve some of your anxiety.

imnmk_rn · Oct 30, 2004

No matter where you are - med-surg, tele, ICU/CCU, ER, your first reaction in a code is the same... adrenaline rush and ABC's. Your hospital's code team will probably "take over" as soon as they get there for things like rhythm interp, meds, etc - the things that might freak you out the most. Here's the deal - the only way to get past that anxiety is to be involved in codes. I agree with what someone else said - ask if you can go to codes to observe. And taking ACLS wouldn't be a bad idea. Maybe before you do that, take an EKG interpretation class. Whatever you can do to learn, do it. But be reassured that in a code situation, you don't have to be the one who knows everything. There will be others who have had lots of ACLS practice.

bellehill, RN · Oct 30, 2004

Once a code is called make sure you hook the ambu bag up to oxygen, attach the defibrillator and hook-up suction. Before you finish these steps the code team will have taken over. Make sure the patient's nurse is in the room and able to give a run down of the patient, why they are in the hospital and their medical history. The actual event isn't nearly as bad as you are imagining it is, just stay calm and do what you know.