Tried and true, but am I ready for my next code blue?

[Btherese]

April 25, 2015 was the day that changed my life forever. As a junior nursing student I had been living with my parents, who were getting ready to retire down to Florida. I had been gone most of the day and returned around 10pm. I walk in the house and I hear my mom yelling "Bonnie come upstairs!" I yelled back "What is it? I'm about to eat dinner" I had assumed there was something funny on tv she didn't want me to miss- the usual reason she yells for me to come to the family room... But I was so wrong.

She yelled back "something is wrong with your dad!" I sprinted up the stairs and dropped everything onto the floor. Then I looked to see my dad laying in his recliner appearing to be sleeping as he does every night. However, this time he wasn't waking up.

It was like my "nurse mode" was activated. I starting shaking his shoulder yelling his name. No response. I tried a sternal rub and thankfully he opened his eyes. I asked him if he was ok and he said "yeah, I was just sleeping" I said "no you weren't. Are you feeling ok?" At this point he is pale and diaphoretic. "Now that you mention it, I'm really hot" he says. I knew something still wasn't right and told my mom to call 9-1-1.

My mom went to go put on clothes (she was in a night gown) and put the dog in the crate. I stayed with my dad asking him questions so I could figure out what was going on. He was able to answer but kept almost nodding off as I was talking to him. Then he started doing a strange agonal breathing I had never seen before. As I was talking to him I took a quick video because I knew what was happening could be important. He then tensed up, turned purple, and went unconscious.

My heart was racing as I tried to find a pulse on him. I started yelling for my mom to help me find one, praying we would...Nothing... I quickly told her to grab his legs and help me lift him onto the floor. At 5'6" and only 110 lbs I wasn't able to get my 6'2" 240 lb dad over the side of chair with help from my mom. I made sure the chair was reclined back as far as possible and began compressions. I was terrified that I was doing it wrong. I already knew he should be on a hard surface, and since that wasn't an option I knew my compressions might not be as effective. I had never been in a situation where I didn't have an instructor or nurse there to help coach me through. All I could hear is my professor's voice in my head saying "lock your elbows, use your body weight". I asked my mom to go downstairs so she could direct the EMTs to where I was. I needed help, and fast.

After only three rounds of CPR the ambulance arrived. Two EMTs ran up the stairs and took over. I answered questions and gave them information as best as I could. I stayed by my father's head telling him I was there, and begging for him to stay with me, as I kept his airway open. My mother walked in as they were applying the AED pads. I yelled for her to go downstairs because I knew what was about to happen. They defibrillated him...Nothing... Defibrillated again... After 8 defibrillations they prepared to move him to the ambulance. I stood up looked out our bay window to see my whole neighborhood (people who have been like family to us for the over 20 years we have lived there)in my driveway. One neighbor did the 'thumbs up, thumbs down' sign and I responded with a thumbs down.

I helped ambu-bag him as it took all of their hands to get him in the back of the ambulance. My heart was racing and it felt like an eternity before we started off for the hospital. The driver of the ambulance talked to me about school and as we approached the hospital gave me the run down about what was going to happen. They let me give his hand one last squeeze and kiss him on the cheek quickly before they wheeled him in. The second the doors to the ER closed, the adrenaline faded and it hit me all at once. I was a crumpled mess of tears waiting for my family to meet me in the waiting room.

Doctors came in asking me questions, reviewing the short video I took, in awe that he had still been conscious and looking at me. My dad was sedated and they inserted a central line and prepared to put him on a cooling blanket. One doctor came out around 5:00 am and told us it would be a good idea to call any family from out of town. Fifteen minutes later a different doctor came out to the waiting room as asked "who was the person that started CPR?" In that moment I was convinced I had done something wrong. I knew he should've been on the floor when I started CPR. I must have not compressed deep enough. Maybe my breaths weren't effective... I raised my hand and the doctor comes over and shakes it "that's amazing. Because of you, your dad is doing well. He woke up right before we were about to put him on the cooling blanket. Scared the crap out of the nurse when she turned around and he was looking right at her"

The next day he was removed from the ventilator and things were looking up. That night I stayed with him in ICU. He went into cardiac arrest again at 2:00am. This time all I could do was stand and watch as people ran into the room and began fighting to save him. One nurse told me I could leave but I refused, standing in the corner of the room watching. She helped talk me through what was going on as they defibrillated him. It killed me that I couldn't do anything to help this time. As I stood there I was amazed by how organized all of the responders were. Everyone was calm, had a job, and was ready to jump in as needed. After 4 defibrillations they were able to stablize him.

He was rushed to the cath lab where they found 4 blockages. He received quadruple bypass surgery that Wednesday. Amazingly, his recovery went smoothly and the doctor has reported there is minimal to no damage to his heart.

While I am beyond grateful my dad had such an incredible outcome, it makes me nervous how I will handle my next code. I know that my dad is not the typical patient. Many of them don't come back. I also know that when I reacted I was confident that whatever I did it would be ok because it was my own family member and I was just doing the best I knew how. Did I stay calm because I was the only person to help so there was no other option? I'm hoping that I just have this magical natural ability to stay calm in crazy situations, but I know that's probably not true. Does it get easier every time or are all nurses still nervous about their next code blue?

I'm planning on working towards a career in the ICU when I graduate this spring. People tell me I should be confident that I can do it because I've already been through this aweful situation and been able to put my training into effect. I feel like I just got really REALLY lucky. I know if EMS hadn't responded as rapidly there would have been a much different end result, so it wasn't just me singly handedly saving his life. Because of this situation I want to learn how to be even better and I know I still have so much to learn. Working in a hospital setting during rapid response is COMPLETELY different. I'm just nervous that the bar as been set high for me and I won't be able to rise to the occasion.

[cmj806]

Wow! Thank you for sharing. How is your dad doing now?

[akulahawkRN, ADN, RN, EMT-P]

That's an awesome outcome! You got things going early on, when it's most important. EMS arrived on scene reasonably quickly and started the ACLS stuff too. Since nobody neglected the importance of CPR during that whole time, he had as good a chance as anyone gets and he did pull through.

As to keeping things together, that happens once you've been trained as to what to do. Most of the time, I'm pretty laid-back. When the time comes, I tend to get very serious... it's like flipping a switch and few people have seen me go instantly from laid-back to dead serious. I have lots of training to fall back on. As you get more training and experience, you'll find that in times of crisis, you'll likely fall back on your training and just "do it" until you don't need to any longer.

I give you two thumbs up for being clear-headed when it mattered. Good job!

[Btherese]

He's doing great! His retirement started earlier than expected (go figure) but he's enjoying time to do some more fishing and exploring. Thank you for asking!

[Btherese]

That makes sense. I haven't had training yet on responding in a hospital setting (I'm going into my complex adult med-surg rotation this spring). I'm SO glad to hear you've been able to fall back on training and just do it. It seems like that what happened with the CPR in this case. It was almost like an automatic response because everything happened so quickly. I'm hoping I'll feel more confident once I've been through that training, but I'm sure until that moment comes to act on it I'll still be nervous about it. I'm just glad to hear that your training has helped you be able to switch into that mode. There's still hope for me I guess!