Alrighty... I dont know how many of you newbies have seen a code yet... or have one happen to your patient... If anyone has i would appreciate your input... it happened last night i am still freaked out...:imbar
I work 3-11.. I had three patients last night and i decided to assess this one first... right at 1500..This guy was a 59 year old... he had had a CABG x4 on the 14th so he was pod #7 he was a 1 pack a day smoker and a drinker.. he had been on ativan protocol and had been halluciating.... but all that had ended the day before.. he was awake and alert and oriented but a little vague.. no hallucinations... He had also been in UCAF 2-3 days ago and they had him on po amiodarone... so he has been NSR for a few days.. nothing else significant except he had been started on dopamine for renal issues.. 3 mcg/kg.. so he had dopamine and 1/2 ns running through a h/L . He was on 6 liter NC.. and sat 91, 92% lungs were junkie of course.. insp ans exp wheezes and scattered rhonchi T/O... anyways so i did his assessment and I put him back to bed... vitals were stabel.. NSR, 70's bp 150's....afebrile.....
I went to see my other 2 patients... at 4 i checked wiht our moniter tech to see what he was doing... still NSR in the 70s.... about 4:45 i went into his room to give him his coumadin... he was sitting up eating dinner.. he was acting a little vague... it took me 5 min to get him to swallow his pill.... he was trying to chew soup without his dentures in... anyways i took his pressure again just cuz i hate dopmamine it freaks me out... i always am neurotic about chekcing bp and hr when pts are on it... anyways he was 100/30... (lower of course than earlier but earlier he had just been started on dopamine... so i expected his pressure to rise a little ealier) hr was 76... i walked out to the nurses station and our moniter tech tells me that .. he had a 2 sec pause and is bradying down the the 30 and 40s but comes right back up... my former preceptor was sitting right there... and i asked her if dopamine can cause pauses... we both walked right into his room and he was slumped over in his chair.... face blue gray.... i freaked.... of course we called a code.. and 30 people showed up.. there was a RT already on the floor as well as 2 docs so there were there immediately... he never went asystole... i guess he had a faint femoral pulse... i didnt really do anything.. i havent taken ACLS yet..... and he didnt have to be vented ... they gave him 1 mg of atropine... and put him on a 100% nrb and he came back.... (although he was still confused when we got him to the ICU) he was stable enough to be transfered to the ICU...
Anyways i was shaking i was so freaked.. i cant get his face out of my head...... he was so blue/gray... i couldn't sleep last night and I am still thinking about it...
anyone else had their patient code?? i have never even seen one before nevermind happen to my patient.... of course i work on a cardiac surgical floor so it happens ... anyways... i need some feedback... Sorry this is soooo long!!!!! :imbar
Re: Dopamine. Our pts. must be in ICU or IMC unit for dop. drips
Re: Your reaction. Normal. Each code is an adrenaline rush and imprints all sorts of images into your mind. Turn them into "positive" situations by learning from them. You will get more skilled with time, but I hope you never get over the desire to do the best for your patient. I think you reacted appropriately. I once allowed my new grads to observe a code in ER. Nice, sunny Texas morning. Probably a MVA or nursing home resident, right? Nope. It was an 18 mo old who choked on a goldfish cracker and died. My grads were traumatized and had to be sent home. Learned my lesson: check with ER first to get info on patient.
And don't beat yourself up over "I should have dones". There were plenty of people there and he received good care.
Regarding the post about not taking ACLS in a monitered unit, I have been working in the ER since August, and the nurse manager there did not want us new grads to take the course for a few months. At first I was like what the heck is this? But who am I to question the nurse manager, and I was not about to pay the money out of my pocket just to take it if I could wait and have the hospital pay for it. Her reasoning? She said that if we took it right away we wouldnt really understand it, but if we worked the unit for a while and saw what was going on and then took the course it would "sink in more" so to speak. I just took it 3 weeks ago, and in a way it made more sense since I have seen a few codes before, but I think we would have been fine also taking it when we first started. It didnt really matter whether or not we had it during that time because during a code there are plenty of people there, and I was able to do something else, like bag or document what was going on. I would imagine that it would be the same in the ICU until the new employee took the course. One of the nurses on the floor said that a lot of hospitals dont offer it to the new employees right away because some people will take it and leave.
speaking respectfully, your nurse manager marches to a different drummer. This is the only time I have heard of this, and feel you were not oriented properly. If you don't understand, and can't assist, you are just another body in the way. What ever you would learn in the class is 100% more than the lack of knowledge you held at that time.
In Florida, you can't even float to a speciality unit unless you have passed BLS and ACLS. Would you like your parent to go to a unit where people are not prepared?
Specializes in CCU (Coronary Care); Clinical Research.
I took ACLS when I was a student...I was also doing an emmerison program(working 40/hrs a week with a preceptor as a student) in the CCU during this time...I read that book cover to cover so I could be on top of it when I took the class...the class was ok and I feel like it was very helpful to have before I entered the unit, with each code, everything made more sense and came together...that being said, the hospital that I work in requires BLS upon hiring in any unit. ACLS must be obtained within 6 months from date of hire if working in critical care or ER, though it is highly encouraged as soon as possible. I am pretty sure that if you are not ACLS certified you can do anything BLS related but can't push meds... Because it is a requirement upon hiring, the hospital does not pay for that first certification, but recertifications are paid for.
As said before your first code will stay with you. Don't beat yourself up over what could have happened. I am going into my 9th yr of EMS and still remember my first. Walk/Run into the house to find a former member of the service doing CPR on his wife. Can't count how many I've worked since, but have learned something from each and every one.
In regards to not having taken ACLS.. let me explain..
I am going to take ACLS... i have a year from date of hire to take it... my place is similiar to whoever else wrote and said they were told to wait a few months and they would understand it better... That is also what i was told... its not that we arent prepared with knowledge... i was in a 12 week new grad intership class.. 8 hrs a week of everything u need to know about cardiac and respiratory and icu stuff.... it was awesome course... learned tons.. but all that informtion that was sort of confusing and definately overwhelming is now starting to make sense now that i have been a floor nurse for about 5 months... i guess the same can be said for ACLS..... the more experience u have the better it will make sense... also... its good to have a break between 4years of nursing school ,start to a new job and 12 weeks of more classes... its exhausting and frightening to be a new grad and have so much info and responsibilty thrown at u... u already feel inferior enough...
anyways what i am trying to say is that i think i will understand ACLS more now that i have been on the unit for a while and there is some space in my brain for some new information..
In regards to not having taken ACLS.. let me explain..
I am going to take ACLS... i have a year from date of hire to take it... my place is similiar to whoever else wrote and said they were told to wait a few months and they would understand it better... That is also what i was told... its not that we arent prepared with knowledge... i was in a 12 week new grad intership class.. 8 hrs a week of everything u need to know about cardiac and respiratory and icu stuff.... it was awesome course... learned tons.. but all that informtion that was sort of confusing and definately overwhelming is now starting to make sense now that i have been a floor nurse for about 5 months... i guess the same can be said for ACLS..... the more experience u have the better it will make sense... also... its good to have a break between 4years of nursing school ,start to a new job and 12 weeks of more classes... its exhausting and frightening to be a new grad and have so much info and responsibilty thrown at u... u already feel inferior enough...
anyways what i am trying to say is that i think i will understand ACLS more now that i have been on the unit for a while and there is some space in my brain for some new information..
I'm with everyone who says ACLS made more sense when they took it a few months into their training on a new unit. I work on a very acute cardiothoracic surgical unit, and I happened to have had ACLS before I started there. Ask me how useful I was for my first code? Not at all. LOL Just going to the class and getting a card does NOT make you a code queen, I just stood back, played gopher and let the experienced nurses do what they knew how to do. And with each code I stepped in a bit more. No one ever said that I was 'just another body in the way', nor was I ever made to feel like that. Just my two cents here. Hope every one has a Merry Christmas!!
I must confess an age problem. I have been a nurse longer than not being a nurse. It seems like my day one, I participated in codes.
Visions of jumping up on the bed and wearing traditional uniforms and support white stockings, dresses only, never a pants uniform. And a prayer that no one saw much. I don't think they had ACLS in 1975. And lets not forget having to wear a cap!
I attended ACLS efery other year since what feels like birth and I was not one to volunteer. What a vision in white polyester, wearing my "clinics" shoes, and lining up for nail inspection. Polished nails or dirty shoes, you were out the door. It is a good thing I was a child prodigy and became a nurse at the age of three. (that makes me 31, right?)
I should not judge when someone needs ACLS, I just don't remember not participating in a code.
Visions of jumping up on the bed and wearing traditional uniforms and support white stockings, dresses only, never a pants uniform.
:roll
That's great! I actually love scrub dresses, but this is exactly what I'm afraid of!! :roll
ACLS is GREAT to have, but nothing beats experience! Does one ever get to the point that they're COMFORTABLE in a code situation? I've been doing this nursing thing for only four years, and I certainly don't feel comfortable, I'm still always afraid I'll walk into a code situation and just freeze, forget what to do. Do nurses who've been nurses for decades still feel like this?
Ive been in so many codes in my life, Working ER and before that ICU. They were and still are common occurrence. And yes I remember back to the old days when only doctors could do compressions and we didnt even have ambu bags back then. And before that most often we would put them in a corner somewhere so their family could be with them as they peacefully passed away. That wasnt all that long ago.
The first form of resuscitation I learned was the old back pressure arm lift technique. Things do change. And yes I still remember how to do it.
:roll 
purplemania, BSN, RN
2,617 Posts
Re: Dopamine. Our pts. must be in ICU or IMC unit for dop. drips
Re: Your reaction. Normal. Each code is an adrenaline rush and imprints all sorts of images into your mind. Turn them into "positive" situations by learning from them. You will get more skilled with time, but I hope you never get over the desire to do the best for your patient. I think you reacted appropriately. I once allowed my new grads to observe a code in ER. Nice, sunny Texas morning. Probably a MVA or nursing home resident, right? Nope. It was an 18 mo old who choked on a goldfish cracker and died. My grads were traumatized and had to be sent home. Learned my lesson: check with ER first to get info on patient.
And don't beat yourself up over "I should have dones". There were plenty of people there and he received good care.