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Old 11-02-2007, 10:17 PM
MyOwnWoman
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Default My First Code

I was just at floatfloorrn.blogspot.com reading about her first code. It brought me back to the day that I vividly remember my first code. Those who worked with me that day vividly remember it as well. We still laugh about it. Yes...we laugh. Let me explain.

I was out of nursing school for one year. I had worked on a general medical floor for the first year and decided it was time to go for the gusto and jump into CCU. A local hospital was hiring, I applied and got the job. In the first year of nursing, I had never had a patient code on me, never have a patient die on my shift, so all was good with the world.

On this particular day, I was fresh out of CCU orientation. I had taken my CPR class and my ACLS class the preceeding week so I was of course perfectly capable of anything that should arise in the CCU. I was working with the person who had precepted me that day so all was good.

I went into my patient's room (the only patient I had that day) and did an assessment on her, talked to her for a bit and she said she felt fine. In fact, her actual quote was, "I feel like I could run a marathon today." Breakfast trays arrive and I set her up for breakfast. I bring in her tray, open up all her packages and ask her if there is anything else I can get for her. She smiled brightly and said "No thank you."

I went back to the nurses station (not 10 feet from her room) and started to chart her morning assessment. I hadn't been sitting for more than 2 minutes when I hear this "gurgling sound" coming from her room. I get up quickly thinking she is choking on something and when I enter I see by her face and the monitor that she is in full cardiac arrest.

I immediately press the arrest button and lay the bed back down to more of a flat position. I push the tray away from her and get down the ambu bag. I check a pulse and make sure her airway is clear. Slowly, all my fellow workers arrive in the room. As each nurse arrived in the room, I stepped back just a little farther until I was out of the room completely CLEANING the nurses station.

Finally, the person who had precepted me must of looked around and didn't see me. (Of course, how could she, I was dusting and cleaning the nurses station.) She finally called out.... "Where is MyOwnWoman?" I answered immediately.... "Right here." Her eyes narrowed as she peeked around the corner and I knew that I had done something wrong. I must not have dusted the phone, that had to have been it.

"Get in here." (She said get your ass in here, but I'm going to leave that part out.) She pushed me to the front of the code and trapped me in there so I couldn't get out and I had to perform.

Yes, the lady survived and didn't remember much of what happened. I, on the other hand, am not quite sure I ever recovered the embarassment, but I remember every vivid detail.
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Old 11-04-2007, 01:51 AM
neuronurse
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I think I will always remember my first code. It was on an 18-monther. We had extubated and she wasn't doing well, so we needed to reintubate, but her cords were so swollen we couldn't get anything in. I remeber grabbing gowns (she was in isolation) and passing them out, I was helping push drugs, hand things between clean/contaminated, it was crazy. But the whole time I just kept looking at her and realized that this little girl wasn't fighting anymore. The little girl who was sedated earlier and still fighting the restraints and trying to pull out IVs wasn't fighting the biggest fight of her life. You have this sudden realization that she's gone, no matter what the monitors say.

It's amazing how calm you can be in a code. Before I ever had experienced codes I knew that I would either be calm or a crazed person (those are really your only options), but I wouldn't know until that first code. What I didn't know was that neither of those choices were exclusive. When it came down to it inside all I wanted to do was run, to press myself up against the wall to be away from it. But on the outside I was calm, I was there, and I hated myself for not being able to do more (I was a student at the time). It's amazing how your at war within yourself during the code. I remember hearing this screaming in my head and wondering how anyone could hear anything over that noise. But everything slows down and you manage to be completely calm despite the storm going on within.

Since then I have been in several codes, I am no where near an expert, but you get comfortable with that war. The tug and pull of the human need to feel alive and run from death, and the nurse inside, needing to be with her patient.
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  #3  
Old 11-04-2007, 03:01 AM
jojodow
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I, fortunately have never had anyone code on me. I've witnessed co-workers during a code but always came up on them after plenty of people were in the room.

I'm not sure I can say I would have done differently MOW. It's always scary.
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  #4  
Old 11-26-2007, 05:17 AM
Elocin22
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(So I've been on hiatus...went to Calfornia, been working a lot. I'm back, so I'll try to log on more!)

I am not writing about the first patient I saw code, but the first patient that was mine and coded. I was, of course (as in, "Go freaking figure!"), floated to a med-surg unit out of CCU that night.

As an aside: For those of you who are tele-RNs or ICU RN's, is it just me, or do you also have that feeling of anxiety when you can't monitor your patients' hearts closely?

Anyway, some brilliant person decided this 85-ish year old woman needed to have a Go-Lytely prep because her Hgb had been SLOWLY decreasing and they thought she might have something going on in her belly. This poor little lady had been bedridden for some period of time and was now being forced to drink the world's nastiest concoction to get her cleaned out. *Grumble* So, I go back to check on her and tell her what a great job she's doing with it and she tells me she's nauseated. "Okay, let me get you some medicine for that." I go get some Zofran and head back to the room. As I'm pushing it, I notice that her IV is leaking. So I tell her I'm going to go the supplies to start a new IV. She said something along the lines of, "Okay honey. I'll be right here." I was gone less than a MINUTE and when I walk back in the room I know immediately something is very wrong. Her head is to the side, her eyes are open, and there is very little ventilatory effort. So then I go to call the code and there's no stinking code blue button. So I yell down the hall, "How do I call a code? And someone get me the code cart." They bring the code cart in and LEAVE!!!!!!!!! (Not even joking! They left me! Alone! I am not a one man army! I cannot bag and do chest compressions and push meds-especially when my stinking line is bad!) Just then the supervisor for the night, an ICU colleague, comes running in and we run the code. PEA. I pulled the sheet down, at the beginning of the code, her legs were blue. My vote is that she threw a clot. Anyway, she didn't make it.

I always thought my first patient code would be on the unit, not on a night when I floated. Go figure.

*Please don't ever leave your colleagues alone in these situations. Yes, they are scary as hell. But each of those nurses who have been trained in BLS were perfectly capable of doing something, even if it was just getting IV supplies or hooking up O2.
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  #5  
Old 01-08-2008, 01:42 AM
LesleyJoy
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Oh, dear... my first code. OK, I'll tell you about it, but laugh with me, will you?

I was a brand new EMT. I was so new, in fact, that the shine had not yet worn off. I had not yet learned that providing care sometimes involves frights, slights, sorrow - and belly laughs.

Let me set the scene. My unit responded to a chest pain call. We found an inebriated middleaged man lying in an unmade bed in a house so old and cluttered that it could not remember its better days. My preceptor and his partner assessed the patient while I watched all wide-eyed and eager from the sideline. Eventually the two of them decided there was nothing wrong with the patient and left the room to get the refusal of care form they had talked the patient into signing. Both of them left. Both.

I looked at the patient. He looked at me. Then his eyes rolled back in his head. He quit breathing. He had no carotid pulse. I look at the monitor. V-tach. What was I supposed to do? I did not know how to use the defibrillator. I hollered for help. No help arrived in the three seconds that lasted for at least a 100 years. So what did I do? I hit the patient. Yep. I leaned right over and struck him midsternum as hard as I could. Apparently my preceptor and his partner arrived in time to see me attack the poor fellow because just as my fist was landing I heard a loud "Whoa!"

I ignored them. I checked for a carotid pulse while looking at the monitor. The patient had a faint pulse and the monitor showed a sinus rhythm with plenty of PVCs. He remained unconscious. Then I stood up, frowned at the two miscreants, and said, "V-tach - AND YOU LEFT ME HERE!" The men fell all over themselves to provide the care the patient needed. In due time the patient was delivered to the hospital still unconscious, but intubated and perfusing.

I waited for the men to comment on what had happened. But they did not talk. Neither did they look at me. We left the ER when the paper work was complete and walked to where the ambulance was parked. I trailed behind them. Then I lost my temper. I scrambled around them and, once clear, I spun around, put on my hands on my hips, and glared at the paramedics. They looked at me. They looked at each other. Then, like a river flowing around a big rock, they passed me on either side. Suddenly one of them punched me on the arm. The other one said, "Aw, you just hit that guy because he made you mad!" Then they laughed. And so did I.

Joy
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  #6  
Old 01-08-2008, 03:39 AM
Apeman
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Default My first code

My first code was also on ambulances. My crew mate and I responded to an MVC pedestrian. When we arrived on scene the patient was conscious and covered with a blanket from one of the local factories. Coming out from under this blanket is a river of blood. On investigation we find bi-lateral partial amputations of both legs just below the knees.

At this stage both my crew mate and I (both BLS), both fairly new to ambulance work decided we needed more help from a paramedic (called CCA in South Africa). We get on the radio and ask for assistance but are told that both the CCA's are busy at a bus accident 50km away. We asked for ILS support but also all busy.

We were informed by the control to load the patient and to go like hell for the nearest hospital. We tried our best to put pressure dressings onto these ehattered limbs but because of the massive injuries this proved very difficult. We managed to get this lady onto the trauma board and loaded her into the ambulance. We mobilized towards the closest hospital 30km away with the request to control to please mobilise help as soon as someone became available.

10km down the road my crew mate called for me to stop as he didn't like the look of the patient. I got into the back as she arrested. We started CPR and again contacted our control to let them know that the patient had arrested. 2 CCA's and 3 ILS arrived at our position within 5 minutes. Multiple lines were then inserted and a full resus attempted but to no avail.

To this day I still feel that if we could have got lines up and possibly the MAST suit on before moving her we could maybe have saved her.

I will never forget it.
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Old 01-08-2008, 12:41 PM
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My first code did not happen until well into my nursing career. I'd been to other ones responding as an ICU nurse, but they were never *my* patient.

The first one that was my patient didn't end well. I was running the CVVH and the patient had at least 3 pressors, and we'd just added a fourth. The family always held a bedside vigil. He was in such bad shape due to an elective procedure and we were all a little shocked at what had happened.

He was tach'ing along at 110-120 or so, and things were actually stabilizing somewhat. I was relieved because although I knew he would die (was certain of it), I didn't want him to die on ME. I had gotten to know his family well and the delusional part of me was really pulling for him.

Anyway, I was literally looking up at the monitor to see what the blood pressure was so that I could write it down... and he went from a heart rate of 115 to NOTHING. There was a perfectly normal QRS, and after that... a completely totally flat line. Like a lead had fallen off. He'd been a little sweaty, so I looked around at all the leads... and they were all sticking perfectly fine.

So we coded him, although I can't for the life of me think of what drug we gave him that he didn't already have infusing and he came back quickly enough.

Only to code again 10 minutes later. His family didn't want to stop, not even then.

He didn't code again until after I'd left at the end of my shift and I believe he coded one more time after that and nothing we did could revive him.

I printed out that EKG strip and saved it, though. I had never seen a heart rate of 115 go to NOTHING without any warning. No idiopathic or ectopic beats at all. I have never seen it since, either.
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Old 01-08-2008, 12:50 PM
MyOwnWoman
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Geena.. I don't think I've ever seen that to this day. I've seen the heart rate go from 120 down to nothing quickly, but never immediately. Definitely not a good sign!

Apeman... I don't think anyone ever forgets their first arrest and there will always be ...could have beens and should have beens... the important thing is you did what you could with what you had....and that deserves a kudos!
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Old 01-09-2008, 10:52 PM
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I've seen a few sinus-to-asystole arrests in my time (I worked my first 8 years in coronary care).

But my first code was on my first day as an RN.

Old Veteran's hospital, WWII vet, bilateral BKAs waiting for a nice place to open up at the Veterans home in northern CA. He was rolling around the floor in his w/c, laughing and joking with the nurses and then got back into bed between breakfast and lunch. I went to take his lunch to him and he wouldn't wake up.

He didn't look dead!

I go to the LVN who was precepting me that day and ask, "Is Joe always hard to wake up?" She said, "No...." and went in to look at him. She calmly said "He's gone." and told me to go call for the code cart.

The code cart was, literally, half a block down the hall! No code buttons!

I remembered what my nursing instructor had said about codes - we might not know what to do but we can always grab the clipboard and be the scribe.

So that is what I did.

I've seen many deceased since then and I still swear the guy looked like he was napping!
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Old 01-11-2008, 01:26 PM
runningnurse
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My first code didn't happen till my 2nd year in...
It was a gentleman who was in for an elective joint replacement (his 2nd and he had coded the first time too....)Anyways, we were finishing his last hourly check for the night and he was grey...give a good couple of hard sternal rubs, yell in his ear no response. Call a code of course, once the RT got him intubated he started breathing easier. Gave him some Narcan and within a minute, he has this crazy amount of projectile vomit all over himself and the area...he survived but he wasn't all too happy that we made him throw up. His words were along the lines of "I can't f**king believe you guys made me throw up" LOL
Anyways, glad he survived-but it still irks me that the doc's knew he was a HIGH risk (especially cause he had already arrested the first time he was there for the same procedure on the other leg) and still gave him Morphine for his pain control and EpiMorph prior to the surgery....BAH!
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