i hate asystole

14 Jan

epi epi epi

It is official, I have decided that I hate asystole or PEA codes.  Since my new nursling days that is almost 3 years ago today (I am still a nursling <3), I have been directly involved in a total of 4  code blues. I am not including respiratory distress with intubation etc because luckily in those situations intervention preceded cardiac arrest.

3 out of the 4 pulseless codes have been aystole or PEA and those 3 patients died. The only 1 that lived was the shockable ventricular fibrillation: so that is the kind of code I liked best, if “liking” a code were possible.

I am still feeling yucky about the last asystole code. The whole thing keeps playing over in my mind and I keep thinking of how it could have been better. I also can not stop thinking about: this code blue seemed different, maybe because it did not happen on my floor where I work. I was going over to a medical floor to pick the patient up to transfer to telemetry. I  had the feeling that something was not right because the nurse called me in a panic, requesting me to hurry and pick up the patient. While I was en-route 3/4 of the way there I heard the code blue announced to the very place I moving towards and I guessed that it was the patient I was supposed to be picking up.

I walked into the room and the medical nurses were doing chest compressions and nothing else. I am not trying to describe anything negative about the medical floor, I am just trying to express that the other code blues that I have been around on the telemetry floor where I work: the nurses just start working as if being moved by some invisible robotic arm. In fact the other codes on the tele floor that I have seen looks more like:  the defibrillator is hooked up, someone is ventilating till the RT gets there, CPR is performed, someone is checking the line, someone is getting the chart, someone is getting the doppler, someone is calling for an IV pump just in case, someone is recording, someone is printing out the morning labs. It helps that I work on a pretty big floor so there are lots of “someones” around to help. <giggle> And all these someones seem to just announce what they are doing without anyone asking or telling them what to do.  The nurse is telling everyone what is going on and then he/she repeats it all again when the doctor and the ICU nurse arrives.

All I can say is that I would rather see v fib on the monitor than asystole any day. This code was just lifeless, and actually I wonder how long the patient was dead before CPR was started. The latter part depresses me too.

So it makes me think about: I like to bitch and complain about the circus arena that I work in on telemetry. But here is an example of: I wished that patient was coding in my own area called telemetry. I am not intending to claim that the outcome would have been different for the patient, that patient was dead. I am just forming an early opinion that there might be a difference in atmosphere. The outcome for my emotions would be different. I bet I would of felt less hopeless afterwards.

And for me, for my sake who is going to lick my wounds and give me some understanding?

I started this blog in the summer of 2007 when my first patient died in a code 2 weeks off of my orientation. I was sad. It helped me to write my experiences and it still serves the purpose. I feel comforted reading medical and nurse blogs because it helps me to feel not so alone in this thing that we love to do: healthcare.


7 Responses to “i hate asystole”

  1. Marco January 14, 2010 at 16:25 #

    It’s a tough situation to be in. However, the things to remember is that the pt. is already dead at that point and you couldn’t really do them anymore harm. You did your best and that’s all that matters. Unfortunately, the only way to become more efficient at codes is practice. I enjoyed your post, it made me think about what I have dealt with many times in the ER.

    • seejanenurse January 16, 2010 at 02:01 #

      Thank you Marco–feel urged to tell me about what you have dealt with.

  2. AnonymousRN January 15, 2010 at 03:59 #

    Nursling… I like it! 🙂

    The codes definitely occur smoother in the ICU than on the floor. Partly due to the fact that the ICU patients are monitored and are 1:1, so any precipitating causes are caught earlier. Also partly because the nurses and doctors in the ICU see codes more often. Compare this to the floor, where the nurses have 4-8 patients to care for, and who may not see codes very often. At the hospital where I work, there is also a rapid response team which is often called to “pre-codes” and has cut down on the number of code blues called drastically.

    This was definitely the case where I worked. I only saw one code in the almost 2 years that I worked on the medical floor before making the jump to ICU. In the year since moving to ICU, I have seen 3 or 4 codes.

    • seejanenurse January 16, 2010 at 01:56 #

      Yes coding in the ICU better than coding anywhere else! I work on telemetry and in less than 3 years have been involved in 4 codes and there were a few more that I was not involved in. Yes rapid responses prevents many full code situations and are useful.

      Love-A-Nursling ❤

  3. my2ndheartbeat January 15, 2010 at 15:09 #

    I saw my first code (up close) since I was the patient being “lit up” over 2.5 years ago. It was a VERY emotional scene for me and the patient I was speaking with a couple of doors away. The Dr’s and nurses worked on the patient a LONG, LONG time …… the sound of the heart paddles charging, charging, again and again is a sound I will NEVER forget. How they can squeeze that many medical people in a room at one time was something. Very fortunately the patient survived and had LVAD surgery a few days later. Thank God for Dr’s and NURSES!!! What a team!

    • seejanenurse January 16, 2010 at 01:52 #

      ❤ I love your hearing about your experiences!

  4. Dede February 24, 2010 at 00:54 #

    This was very thoughtful and humorus in a way because I had to double check the title of this content, then I caught on….but its always great when REAL nurses can share and relate to the same topic.

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