Alive after the code

1 Dec

I am being a lazy nurse blogger again. What can I say for myself? I have no legitimate excuses, I miss my blog so here I am with not much to say. I was going to write about my latest experience in a code blue situation, I was going to give everyone the step by step run down of ACLS initiated at the bedside on a telemetry floor and the awesome outcome, but I lost my drive as each day passed by after the event, till it seemed like routine. It was pretty darn amazing though: the teamwork, Fave Cardio, the RT, the nurses, the whine of the defibrillator charging.

Here is the scene without a minute by minute detail: I was just back from lunch, and the patient was being diaylized, I am walking down the hall and I hear the dialysis RN yelling we need help in here. She was talking to the patient when all of a sudden: nothing, no pulse, no response. At the same time at the monitor station the tech was saying: Ventricular Fibrillation in room # 13. By the time I get into the room I see the dialysis nurse un-hooking the permacath from her machine, there is water all over the floor, 2 nurses are already at the bedside, 1 calling for the backboard and 1 lowering the head of the bed and raising the bed at the same time.  It seemed like it took forever to hear the “code blue room telemetry room # 13”, in fact by the time I heard the announcement the patient was already being ventilated via ambu, the backboard was under and the patient was being compressed and had already been defibrillated with 200 joules and the first epinephrine was already prepared waiting to go in. Ten minutes in the patient was intubated, the House MD was there and one Fave Cardio showed up to collaborate with the House MD. Fave Cardio did a superb job demanding full charge on the defibrillator and he seemed to like to press the charge and shock button, he made everyone nervous charging that machine but kept saying every time, “Do not worry keep compressing, it is just charging.”  I took the position as recorder which I am comfortable doing and helped to keep everyone organized and aware of: how many shocks have been delivered, how much time has passed, reminding everyone to stop after the shock to check the rhythm and for pulse (it seems that it is natural and easy for everyone to get back on the chest quickly, forgetting to check pulse/rhythm) how many epinephrine have gone in, how many amiodarones have gone in, how many bicarbs have gone in etc. It was kinda amazing and long: over one hour this patient was being resuscitated related to the fact that the patient did get a pulse, rhythm, response several times but then kept losing it and we would start all over, and kept going till after about an hour and fifteen minutes the patient maintained pulse and rhythm to the point of moving the lower extremities, by the time we rolled the patient up to the unit the patient was trying to pull out the ET tube! It was neat to see not only ACLS but the differential being worked up at the same time to try and reverse the causation of the problem. ABG revealed severe acidosis and that being said it did seem that after dumping in amp after amp of HCO3 and running in the amiodarone gtt the whole intervention started to turn for the better, with maintenance of pulse and rhythm for longer periods. It was strange to watch the patient get defibrillated, hear the pulse via doppler, see a sinus rhythm on the monitor and then watch it go back to v fib again and then the scenario repeat time and again. The bottom line: the patient lived, early defibrillation improves the outcomes, and it does not always end badly. This was a patient on the younger side and we did not give up. Not to say that we would give up on the elderly patient though, it is just that in my 2 years and 10 months of being a registered nurse witnessing several code blues in the hospital setting, this is the only one that I actually witnessed a living outcome. All the rest died.

On a another note I have experienced many more rapid responses that prevent code situations before they develop, so I encourage the use of the rapid response system even if you are not sure what is going on with the patient, the point is to get help for the patient.

Other news: I am still spinning on telemetry. I am in a perpetual debate with myself over where I want to be in my career, so I just keep turning the telemetry packs. I kind of like tele nursing, the turnover rate is fast, the patient acuity has a huge range but at the same time I feel like I am doing the same thing everyday. Hmm, still thinking about  it.  The contest is between emerg vs critical care, we will see who the winner will be one day. ❤

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One Response to “Alive after the code”

  1. keepbreathing December 20, 2009 at 04:03 #

    Interesting story! 9/10 of the Dialysis codes I respond to in the hospital are duds: the patients falls asleep or passes out and someone calls a code. Also good to hear of a survival; the vast majority of post-CPR patients seem to die, even with things like post-code cooling and rapid sepsis screening and whatnot.

    As for Emerg vs. Critical Care: it’s hard to pick. Both have bursts of tremendous excitement followed by long lulls and plentiful manure. The major difference is that Critical Care gives you more continuity of care, and emerg care is more crash/burn. You’ll do well wherever you go!

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