Your first Code Blue

helper T cell · Mar 28, 2008

There was a code blue called on my floor the second week I was on my preceptorship. I am just BLS at this pt. but went to room anyway. There were already 2-5 people in there and one had started compressions so I was just looking in (yes frozen) MD came running in and askes me what happened? Could I respond? Sputter sputter blank blank!!

Luckily I didn't remain totally useless. All the nurses were at the code or busy so I manned the front desk and covered a few pts. until there reg nurse was free.

So after this I went over what to do in a code. What my role would be. CPR, recorder or just what I did cover holes on the unit . Also my manager said I could come in on a day I wasn't scheduled and go throug the crash cart. This was SO beneficial for me. Try to get RT to go through the airway stuff with you. Anyway now at least the crash cart doesn't look like something from a different planet to me. So far there hasn't been anymore code blues on my unit.

Sounds like you have an awesome preceptor.

:rolleyes:

sjaubert · Mar 29, 2008

Hey, don't sweat it. The team showed up and the code was enacted that's the main thing. In fact the first priority in any code is to get a code called and going. If it takes a few seconds longer despite what everyone says i say stop and think for a second or two and if in doubt based on the assessment call it. I think a lot of young nurses are afraid of being laughed at if they make a bad call and that's too bad. Also i think most new nurses let their feelings take over and forget to remain as calm as possible. You have to be deliberate about it. Running around letting you emotions take over is not necessarily more productive and it takes some effort. It doesn't mean you don't care and you actually become more efficient. Try to remember your basics and go from there and remember a code is 'supposed' to be a team effort meaning there will be help hopefully with more experienced nurses who know the routine better. Don't let the egos intimidate you. That's not what its about. I always try to help someone along but you should keep that attitude also. Nothing worst than a second or third year hot dogger who tries to be top gun. I mean that crap is good in the movies but in reality its about good human interaction if everyone is to benefit. I know i sound very ideal about it all but anyway i hope i helped and i'll just say this i've seen very few codes go perfect. I put some of the blame on hospitals. For example i liked it when we did the code cart check of drawers though i hospital now doesn't allow the cart to be opened until a code. I also liked it when we mixed more of our drugs and now i understand its against regulations. That all seems to work against reinforcement of acls training. I can tell you it gets better with practice and more codes and also i refresh myself occasionally with those acls cards you look at occasionally at work. You need someone around like me to encourage you and i hope you can find them at your hospital. Unfortunately i see a lot of 'less than adequate' charges to give such help which i also see as a hospital problem when they can't retain and value such experience for a variety of reasons. I do not believe as some that letting the family in the room at this time is good. It tends to make me self conscious rather than acting naturally. Good luck. Steve

JRD2002 · Mar 29, 2008

I have been to many codes. I have only been nursing for a little while but I worked for the hospital laboratory for over 5 years and we were required to go to codes anywhere in the hospital. Everyone handles it differently. I have seen many people freak out and have to leave the room. These same people a few months later are usually fine and do a good job of working the code. Death is never easy to get used to but after a while your body learns to cope with the stress/adrenaline rush and you get through it. Don't judge yourself to harshly...it sounds like you did a great job for your first code.

Good idea to go through the crash cart and the different roles. Codes usually aren't talked about much and teaching isn't usually conducive while a code is going being worked.

Joni's Mom · Mar 29, 2008

Hi,

Hope this isn't a silly question, but I have never been to a code and was wondering what are the steps to a code? What do you do first, second, third, and so on? I do know that you call for help, then assess, then 2 breaths, then 30 compressions, but what other steps are included.

Thanks in advance.

MajorDomo · Mar 30, 2008

When was your first code blue?

As a nurse, about a month after I was off orientation. (I was a firefighter/EMT prior to becoming a nurse, so I worked a couple before that)

Was it your pt?

Yes

Did you lead the code?

No

How did you react?

I think I said "Can I have some help in here" then pulled the code cord. Did a sternal rub (no response), checked for a pulse (no pulse), cursed.

How did you feel while you were working on the pt?

He was a chemical code only and was in asystole, so it was over in less than a minute.

How did you feel afterward?

Had to call his wife, she stayed everynight since his admission three days prior, this was the first night she left his bedside. So I felt like crud.

With either people I precept or people I know are new to nursing, during their first code I have them stand back and watch how it runs, usually there are an abundance of people working the code so having them observe tends to be the best thing for them to do. A debrief afterwards seems to helpas does doing post mortem care (Giving the final care).

loricatus · Mar 30, 2008

Hi,
Hope this isn't a silly question, but I have never been to a code and was wondering what are the steps to a code? What do you do first, second, third, and so on? I do know that you call for help, then assess, then 2 breaths, then 30 compressions, but what other steps are included.
Thanks in advance.

No, it is not a silly question. Most codes should be run following ACLS guidelines (which initiates using BLS). Check out this link for more information that can answer your question:

http://www.acls.net/

shellsgogreen · Mar 31, 2008

original poster; of course you're not a failure!!!

if anything, it serves as a great learning experience watching how a code is run, so each time you're in one, you are gaining knowledge on what to do.

my first code freaked me out too - pt lost his pulse, all of a sudden 85 people were in the room - i was the recorder (actually, the charge nurse talked me through it, so i got to learn about that.

i felt odd afterward - sad mostly, as the family wasn't there with him in his final hour. :crying2:

Pediatric Critical Care Columnist · Mar 31, 2008

Being the recorder (my favorite role!) can be a really good opportunity to learn the flow of a code: who does what, when and how, the language used, the doses of the different drugs used, and a myriad of other useful information. Then afterwards, you can go over the documentation and ask questions to help clarify things in your mind. But having said that, being the recorder is a difficult job in a chaotic situation. You have to be able to concentrate on what's being said (often two or three people are shouting out orders and responses), listen and write at the same time and not be distracted by people coming and going. Accuracy, legibility and completeness are all really important... for legal and social reasons. It's a lot easier to explain to the family what was done, how long they worked on the patient and how it was decided to stop, and if the chart ever ends up in court, the lawyers will pick holes in everything that isn't crystal clear. On TV, we never see anyone recording what's happening and you have to wonder if they ever chart!

Sl455 · Oct 8, 2011

I know how you feel:) I am a RN student and I just got a job as an ER tech. Someone took me through the run so here's how I remember how it goes in the ER for the tech anyway:

1) Pt on Hard surface (pt on bed board or there will be an emergency button on bed to make bed hard for CPR) start compressions and call for help.

2) Crash Cart with defibrillator

3) Ambu bag with 15L o2

4) Pads to pt (over upper right chest and lower left rib) and machine on (you will have help by now and as the RN you will probably be doing the Ambu bag while someone else does compressions continuously..ignore the 30:2 because you have more than one person so just keep giving them o2 and watching the monitor. Give air about once every 10th compression but also depends on spo2 reading so look at monitor. If needed place their pillow/blanket/rolled towel under their neck to lift their chin for better airway passage. Watch for chest rise, not stomach to ensure air is in lung. If you need to shock, get your stethoscope away from ANY metal attached to pt. Check femoral pulse after shock to be positive about heart).

5) If its in the ER tech will do this or someone else in the team: Intubation kit opened for MD. (Its in the bottom drawer of the crash cart probably).

6) Tech will do this: Take out the laryngoscope, the tube, put the guide wire in the tube, blow up the balloon with the 20 cc syringe of air to check it, lube the tip and put is in its bag aside for later and get the suction ready. Put in oral airway. Hyperventilate pt before MD intubates pt.

Other stuff to know: Make sure large bore IV access is on pt and there will probably be an emergency standing order for 1 mg epinephrine. If MI or extremely rapid heart beat crisis situation where pt is at risk for shock The Dr. may order lidocaine and amioderone drip for extreme arrhythmia. Get pads ready but no code yet.

Just remember that you can't do it all and you need to work as a team, so if you grab that ambu bag first, THAT is your job right then. You will probably switch out with compressions. Remember CAB (compressions, airway, breathing)

I think this is about it....as far as I can remember now. Nurses, feel free to correct me if anything is wrong or if you have a more efficient way because I am only a student and new tech.

Here's a good video:

xtxrn, ASN, RN · Oct 8, 2011

My first witnessed code was as a student. So I was useless, until it came time to take the body to the morgue. I'd been a CNA, so dead people didn't bother me. What did bother me was the paper sheet over her floating as I walked by to turn the lights off :eek: I was out of that morgue VERY fast.....got laughed at for weeks

First code on my patient -- before DNRs were really 'hardcore'- a lot was left up to the discretion of the staff taking care of the patient. She as ok when I'd checked on her and hung a IVPB....RT came out and asked who had that patient- I said I did, and he said "she's dead"....I freaked- called the code (she was blue with dependent lividity :uhoh3: ) and started doing compressions- VERY annoyed that nobody was doing anything. Another RT had showed up, and they both got under my arms and hauled me out. I was going to pump her back from somewhere....

Both died from AAAs so nothing to do at that point.

I wondered what I'd missed with my patient but when a AAA blows, and someone isn't REALLY close to an OR with a waiting crew, it's a moot point.

Editorial Team / Moderator · Oct 11, 2011

Now, I know it sounds silly to ask that question because NO ONE'S baseline HR should be that low, but I have seen that low on this floor.

Actually, I've seen perfectly healthy (usually uber-healthy!) people with HRs in the 40s-50s. Usually marathon runners. It still freaks me out, though. LOL.

First code I witnessed was when I was a paramedic (which I still am, but before I was an RN), we were called to a guy's house -- he was having chest pain. OMG, he looked awful -- gray, sweaty, terrified. Everything about him screamed "inferior wall MI!!" which is what it was -- they just get this look, you'll know it when you see it after you've seen it once! Anyway, we loaded him up in the medic unit and hit the road with a quickness, doing all the stuff we needed to do -- monitor, IV, O2, ASA, etc. -- when the patient said, "I feel dizzyyyyyyyyyy..." I looked at the monitor and ruh-roh, it's v-fib. My partner rips the patient's t-shirt down the middle, I slap on some gel pads (this was back in the days of a LifePak 10 and paddles), and we get ready to shock. We're pulling up in to the ambulance bay at the ER, and our driver comes around back and opens the doors. There stands the patient's family, there I am with paddles charging. Yikes! I said something nonsensical to the patient's family like, "We'll be right with you!" and I turned back to the patient. Pulled him out of v-fib and into a perfusing rhythm with one shock. Love it! Early defibrillation rocks. Good outcome. I think he was in his mid-40s.