The first time your pt crashed


I'm a new ER nurse (but have worked in the ER for 2 years) and the other day my pt that had been pretty stable for like 4 or 5 hours crashed out of nowhere. My preceptor was nowhere to be found and I wasn't really able to think clearly. I knew exactly what to do, it just didn't come to me (the patient survived- I had already found another more experienced nurse who ended up taking over the situation). So, do you guys remember the first time a patient crashed on you and how you handled it? I assume it can only get better next time, but I was still disappointed in myself.


49 Posts

Specializes in Er/ICU/Med-Surg/Home health.

Yes, with time, it will become second nature to you. When I first started, i really just wanted to run away from codes all together. Now, many years later, I want to be a part of every one that comes along. The more you are involved with, the more skilled you will become. Also, look into getting ACLS certified. This will help you become more confident. Thats the great thing about the Er though...your patients may look fine one minute and be crashing the next.


9 Posts

I had ACLS but it all went out the window the first time my patient coded. I was a deer in headlights and so freaked out, I didn't even know how to call for help. Thankfully, we brought him back him back quickly. I don't care who you are or how much you know, the first time you experience that, it is a shock. I failed miserably, but have never had a issue since!!! To this day, when I have pt who has the potential to code, I am always more aware of who is working near me and what I need to do be on top of the worst. I am a far better nurse today for being a failure in the past.


199 Posts

It was awful. My pt while in nursing school clinicals vasovagaled on the toilet. I got a funny feeling and caught her right at the last second. I had to wedge my not so little body between the sink and her head and fall to the floor with her while her eyes rolled up in her head and she puked on me. I screamed help and a rapid response was called. She was fine before the response team even made it there. I just trusted my gut and I think I saved her from cracking her head open. That was my closest call so far, thank goodness for rapid response and my nice soft body to act as a cushion!


1 Article; 2,188 Posts

Specializes in Home Care.

My first code was a terrible experience. I work in medical rehab where our patients are stable so I never expected to have a patient code.

There was no saving her, she went quickly.

I don't like thinking about that experience. I was a wreck. Thank goodness my unit manager, clinical nurse, team leader and co-workers were all there and supportive of me that day.

I'm a better nurse for that experience.

Has 8 years experience.

Oh yes! It was awful. Weird I did the assesment without even realizing it. No response, no respirations, no pulse. After that? I was a wreck. I pulled the code button and everything happened so fast that I don't remember how and when the RRT and my supervisior got there! Sadly, the patient was already gone. I've seen plenty of codes in the ER, but it's different when you're now the nurse but I think it's something you and I will become more confident in with time. And since I'm in the process of taking my ACLS (day 2 of torture tomorrow) I think if it happens again, I'll be more helpful.


22 Posts

Specializes in Medical Surgical.

I am so glad that someone posted on here. I work on a general medical floor as well. I took ACLS hoping to become a critical care nurse, but working on the general medicine floor has made me forget certain aspects of emergency care. I had a young patient the other night crash out of no where. All night she was stable, at MN her vitals were stable. Only symptom present is that she was lethargic at night time but arousable (which is not unusual)When I rounded on her again at 2 she was sleeping. No problems were identified. The patient was drinking fluids, but not eating well and the only problems she had during the shift was she complained of abd pain from having gallbladder issues. At 3 am I was going to change IV fluids and the patient was moaning. I went in an immediately reacted. Obtained vitals, all WNL, BS really low. Gave and amp D50 after obtaining orders and informing the physician and bs up and stable. Patient would open her eyes, respond slightly but still not appropriate. Called the physician to inform him of what was going on. Continued to monitor patient VS, temperature was slowly dropping but ranging around 96.0, patient refused to stay in warm blankets, and I told the doctor that she needs to be transferred something just wasn't right. It was day 3 of admission for this patient and she had a known alcohol and suicide abuse in the past (suicide was not mentioned upon this admission). Upon further examination I searched through her purse and found pill bottles. We were unsure if she took anything extra or not but I informed the doctor and house supervisor and the charge that these pills were found in her purse (that should have been confescated by the admitting nurse on day 1). To make a long story short, patient continued to decline and had a known history of hepatic disease, patient was extubated the next night in ICU and passed shortly after that. I did everything in my power working on a unit without specialty resources while still caring for 5 other patients. Patient hadn't had any diagnostic blood work such as cbc, cmp, pt/inr anything like that since admission and her abg's and wbc, k, PT/inr/ptt and abgs were all off. I did everything in my power to get the patient to a location that can safely care for her only to be looked down upon by ICU nurses, who forget that on our floor we are not use to seeing many codes or in this case rapid declines as our patients are sick, but usual stable. We have5-6 lives we are responsible for and we cannot monitor as closely as they can. Even though in all honesty I monitor patients quite frequently. In this case I knew what to do, but felt helpless because I had to wait for orders and did not have access to potentially life saving measures. In this case I know based on the rapid decline in condition and what the diagnostics showed, there was no hope and I know it is not my fault, but does it ever get any easier? I felt like because the patient arrived in poor condition, I was being judged on my competency when I could only do what I could do in my power with the resources I had. I know exactly how you are feeling and calling for someone to help you is nothing to be ashamed or embarrassed by, you advocated for that patient to ensure they were taken care of.

Specializes in ED/ICU/TELEMETRY/LTC. Has 20 years experience.

Mine was a nurse at a doctor's office. This doctor frequently came to our telemetry floor. All of a sudden, this woman who had had no complaints and had not even rung her bell, called me in a panic. I ran down there and she suddenly died.

Called the code, and this smart aleck ER doc comes up there, impatiently stating, "I've got a man in the ER having chest pain." I just looked at her and said "Is he alive?" She said yes, so I told her to "Run this code."


6 Posts

I am a new nurse, and during assessment my pt was unresponsive after many attempts to arouse her, for a split second I thought she was crashing. Fortunately she was okay. I was so nervous and scared, I am not sure if I will be able to handle a real code after seeing how nervous I was with that lady.


914 Posts

Specializes in Cardiac/Telemetry.

I've been a nurse for about three years and I have yet to become completely confident in a code. It's a high stress situation, and unless you've been involved in a lot of codes, it takes a while to get used to them. My first code was a pt who was stable and actually laughing and talking with me a few minutes before I left the room. I go up to the nurses' station to look for something when the monitor tech tells me that the pt had become tachycardic. As I was leaving to check, the patient presses the call light and the secretary answers it. She tells me that, "I don't understand what's being said. I just hear noises." I practically run to this pt's room, ask if everything was okay, don't get a response; I see eyes roll backward, agonal breathing...the whole nine yards. I freaked out, started screaming to call a rapid response, nurses come flying in the room, and the pt codes. It all happened so fast, I still don't have any idea what exactly happened. The pt went into PEA and it was a while before we got a pulse. I will never forget this one because everything played like a movie. I was so unbelievably scared!


210 Posts

Has 2 years experience.

I have ACLS and have been in codes before (all of which were brought in by ambulance, none of them have coded on me- but I KNOW to do CPR!!!), but this person was bleeding out and went into hypovolemic shock. I'm glad to hear that I'm not the only one that froze the first time though! One of the other new nurses working with me seemed so calm and collected!


36 Posts

Specializes in ICU, Public Health. Has 5 years experience.

I remember the first time I shocked a patient. I said "all clear" and went to shock. Luckily, my preceptor was there and noticed that my scrub jacket was leaning on the patient. It was full of things like clamps, scissors, pens...If she hadn't grabbed it for me, who knows what would have happened. That'll NEVER happen again.

Code situations get easier. For me, I am more comfortable being on the code team of someone elses patient. If it is my patient, I am more stressed.