So we have a Code coming in....

sunnycalifRN · Nov 26, 2009

Congratulations on a job well done. It's unfortunate that the patient didn't make it. Eventually, you'll be involved in a successful resuscitation!

86toronado, BSN, RN · Nov 26, 2009

Good for you! I've been in on several codes, but have never gotten to do compressions. Sadly, many codes do not have desirable outcomes, but it's usually a rush regardless!

PostOpPrincess, BSN, RN · Nov 26, 2009

Good for you keeping yourself "under control" with your first code/death.

I find that those who have no experience can go either way--handle it well or have a meltdown. I don't like the latter and prefer not to deal with it.

scootertrash nurse · Nov 26, 2009

excellent !!!!!!!!!! nuff said :yelclap:

BluegrassRN · Nov 26, 2009

Great job!

And good for that nurse, getting students into the code. I hope it serves as a reminder to all of the nurses here--if you have less experienced nurses or students on your floor and there is a code, have them do the compressions. If you are the less experienced nurse/student, volunteer for them. It's the perfect position! Compressions aren't difficult to do typically, and after the first couple you get the feel for them. You can see *everything* that is going on--you really get a good view of the code. Actively watch--what the team leader does, what role the different members play, etc.

What a great experience for you as a student.

CandyGyrl1985 · Nov 26, 2009

I know what you mean about sounding morbid... I worry about what other people think when I get excited about medically gross things...

It is sad that the patient did not make it.

It is also exciting that you were able to get your first code under your belt!!!

~Just Living the Dream~ :redbeathe

Dinith88 · Nov 26, 2009

Ahh...such sweet eloquence from the mouth of babes.

That memory will will stick with you for the rest of your life.

Welcome aboard, rook.

:)

MissERN · Nov 26, 2009

And just a side note...according to ACLS protocol, once an advanced airway (ET tube/LMA) is placed, you no longer have to stop for breaths after 30 compressions. After the pt is intubated you can do continuous compressions while someone is giving 8-10 breaths/min. BUT you must do the 30:2 until the pt is intubated.

I'm sorry that the pt outcome was not good, but I'm glad that you were able to have the experience, because it will help you next time you find yourself in a code. Good luck to you!

Crash_Cart · Nov 27, 2009

I have quite literally done chest compressions on 100's if not 1000's of people in the past over a 10 year span working in ER. YES! I have had sore wrists, sore arms, sore neck, sore calves, and yes I am pretty sure you can even crack your own ribs doing CPR! :) It's simply hard and grueling work! I remember some docs wouldn't "call the code" sometimes for over an hour!

Just so you are aware and unlike TV drama, in real life it has been my personal experience that the majority of them don't actually make it when they arrive at the ER. A very small number of them actually do. When you do have a successful code, it seems many of them will often become unstable at a later time and code again. Sometimes this happens the next day on another shift when they have been transferred from the ER to ICU/CCU etc..

The fact these patients don't make it, does not in any way somehow reflect on your skills or ability to perform CPR in any way, but rather it's just that in the majority of these cases,it's really more to do with the patients pre existing prognosis.

On many occasions brain death has occurred long before anyone had any opportunity to start CPR at the 911 scene. When some patients would roll into the ER on the ambulance stretcher, we would sometimes refer to our effort as taking "heroic measures" because we know in the majority of these situations, its quite apparent the patient aspirated, had that certain light grayish blue color around their ears, neck, their nail beds etc. It's often quite obvious they were without O2 for quite some time.

I'm not trying to freak you out or anything but when you gain a little more experience, you will find out what a certain look of "death" actually looks like when looking into their eyes. There is a certain distant gaze about it. It's usually at this point you will start knowing if your efforts are going to be heroic or not.

Yes, I have cracked a few ribs too. Sometimes you can actually feel it happening while performing the compressions. Usually it starts out with the compressions feeling like the chest is feeling a little "stiff" and then suddenly you start noticing CPR seems somewhat easier, more like you are pushing down on a bag of loose jelly. Other times you feel a "pop" (feels and sounds like knuckles cracking) and sometimes you don't. Cracked ribs does happen, usually through no fault of your own. It's usually because everyone has various bone density characteristics and it's almost impossible to predict in advance if you are using too much force or not in every instance. However, I do find cracked ribs typically occurs more frequently with the frail population. For example cracked ribs rarely seems to occur with obese patients for some reason.

A cardiac monitor is a good way to tell if your chest compressions are good or not. When I do CPR compressions during a code, I try to watch the monitor for a nice, even and consistent rise and fall on the monitor. Don't "spike" the monitor too sharply, /\ you wan't to achieve smooth and "round" compressions like alternating inverted "U"'s. The idea here is to allow for the heart to fully exert and allow the flow of blood "out" Then you must allow enough time for the heart to "fill" up again - fully, before doing the next downward compression. Think about this in terms of "inhaling and exhaling" instead of thinking of it as doing "CPR". (This is why I feel "counting" while doing CPR is not particularly effective.)

Good work... You did really good. :)

My Best.

PageRespiratory! · Nov 27, 2009

I have quite literally done chest compressions on 100's if not 1000's of people in the past over a 10 year span working in ER. YES! I have had sore wrists, sore arms, sore neck, sore calves, and yes I am pretty sure you can even crack your own ribs doing CPR! :) It's simply hard and grueling work! I remember some docs wouldn't "call the code" sometimes for over an hour!
Just so you are aware and unlike TV drama, in real life it has been my personal experience that the majority of them don't actually make it when they arrive at the ER. A very small number of them actually do. When you do have a successful code, it seems many of them will often become unstable at a later time and code again. Sometimes this happens the next day on another shift when they have been transferred from the ER to ICU/CCU etc..
The fact these patients don't make it, does not in any way somehow reflect on your skills or ability to perform CPR in any way, but rather it's just that in the majority of these cases,it's really more to do with the patients pre existing prognosis.
On many occasions brain death has occurred long before anyone had any opportunity to start CPR at the 911 scene. When some patients would roll into the ER on the ambulance stretcher, we would sometimes refer to our effort as taking "heroic measures" because we know in the majority of these situations, its quite apparent the patient aspirated, had that certain light grayish blue color around their ears, neck, their nail beds etc. It's often quite obvious they were without O2 for quite some time.
I'm not trying to freak you out or anything but when you gain a little more experience, you will find out what a certain look of "death" actually looks like when looking into their eyes. There is a certain distant gaze about it. It's usually at this point you will start knowing if your efforts are going to be heroic or not.
Yes, I have cracked a few ribs too. Sometimes you can actually feel it happening while performing the compressions. Usually it starts out with the compressions feeling like the chest is feeling a little "stiff" and then suddenly you start noticing CPR seems somewhat easier, more like you are pushing down on a bag of loose jelly. Other times you feel a "pop" (feels and sounds like knuckles cracking) and sometimes you don't. Cracked ribs does happen, usually through no fault of your own. It's usually because everyone has various bone density characteristics and it's almost impossible to predict in advance if you are using too much force or not in every instance. However, I do find cracked ribs typically occurs more frequently with the frail population. For example cracked ribs rarely seems to occur with obese patients for some reason.
A cardiac monitor is a good way to tell if your chest compressions are good or not. When I do CPR compressions during a code, I try to watch the monitor for a nice, even and consistent rise and fall on the monitor. Don't "spike" the monitor too sharply, /\ you wan't to achieve smooth and "round" compressions like alternating inverted "U"'s. The idea here is to allow for the heart to fully exert and allow the flow of blood "out" Then you must allow enough time for the heart to "fill" up again - fully, before doing the next downward compression. Think about this in terms of "inhaling and exhaling" instead of thinking of it as doing "CPR". (This is why I feel "counting" while doing CPR is not particularly effective.)
Good work... You did really good. :)
My Best.

>

The only way to really asses the efficacy of chest compressions is to feel for the carotid pulse while administering compressions.

PageRespiratory! · Nov 27, 2009

So I was just finishing up my last day of clinicals for my first term of nursing school this past week. As we were sitting in the break room of the hospital talking with our instructor about the day's events this guy walks in and announces they have a code coming in and invited the students to come along. I thought cool - we will get to watch what happens on a code! Another student and I say we'll go and off we walk to the emergency dept.
As we are walking this guy (can't even remember what his title is) starts quizing us on our CPR knowledge and it becomes apparent that we have just volunteered to do the chest compressions! Suddenly I find my anxiety level has gone through the roof and I am thinking oh my gosh what I have just agreed to? Can I really do this? What if I do it wrong? What if I see the patient and can't do it!
BREATHE I tell myself....remain calm...BREATHE...you can do this!
We get to the emergency room, get quick instructions on where to stand, then we gown up. After a few tense minutes the patient arrives and my anxiety level seems to dissipate a little and is replaced by excitement. The moment has arrived. It is a controlled chaos as everyone takes their places around the patient. When the pt first arrived she had a chest compressor on - which is a device that does the compression's for you. For a brief moment I feel disappointment, perhaps we won't get to participate after all. But, the device apparently runs on batteries and quits working! So..before I know it my co-student is being told to start compressions. She jumps up on the stool and begins. Soon I hear her ask me if I am ready....ok here I go!
We change positions and I begin. With guidance from they guy who first came to tell us there was a code....my CPR training comes back to me and I get into a groove. WOW...I am tired....this is alot more work than I ever expected! But I keep going - and unlike what they teach in CPR class - we are not counting the compressions to breaths. I am told don't stop - just keep going while the person at the head of the bed manages to count my compressions and breathe for the patient. Once I get into a groove I glimpse down at the patient's face....mistake! I quickly looked away so emotions would not take over. "SWITCH"
After switching off several times between the two of us (students that is), I start to realize that doing CPR is nothing like it is in the class room. I am exhausted, out of breath and the plastic gown and gloves are sticking to me...yuk! They had us put on face shields as well - but we quickly took those off as our quick breathing had fogged the shield up anyway - making it impossible to see had we kept them on.
In the end, after working on the patient for what seemed only minutes (but was actually about 30 minutes) the Doctor called it. I knew from the beginning that the chances of this turning out good were slim, but I had hope anyway. I even prayed a few times as I was over the patient doing compressions "Please God let this turn out good, let us bring the patient back. Let me end clinicals on a good note."
Reflecting back on my first time doing CPR ~ I did crack a rib. I heard it pop but didn't feel anything. At first I thought what did I do wrong to make it pop? But it happens and I knew I couldn't pick myself apart over it. The whole time we were in the ER our instructor was standing behind us, giving us confidence and guiding us. The guy that grabbed us in the first place was also there guiding and instructing us as we were giving compressions.
As we took off our gowns and gloves we realized that we were covered in sweat - yew! Plastic doesn't breathe very well! The adrenaline rush lasted for about 2 hours afterwards and for the rest of the day I couldn't get the patient's face out of my mind. I wondered if my emotions were going to take over and I would break down but I never did...okay well maybe I cried just a little!
All in all - I did it. My first time doing CPR...wow....I did it! What a rush! I felt compassion for the patient and family - but I was also excited that I got to do CPR...and I almost feel like that excitement is just a little bit morbid! But then again.....don't all nursing students have that feeling when they get to do something new for their patients?
Oh and the next day I was so sore! My arms and upper back - heck even my wrists all hurt!
Thanks for listening! I knew this was a safe place to share my experience!!

>

That means you're doing it correctly. Did you notice how violent the thumper seemed to be? Quality CPR is ugly.