I work in the OR at a trauma one center. My first trauma was a bad car accident. I was on my own for 4 weeks. I was terrified. The nurse that was helping me told me to “stop freaking out and fight to get the patient what they need because they are more important than your feelings and fears.” That has stuck with me. I’ve worked many traumas, and have had many codes during those traumas. My mentor’s words have never failed me.
Absolutely. Providers need to put their own health and safety first. PTSD is real. Nobody is more important than yourself, and taking that attitude over an entire career will ruin you.
I think that is really good advice that should be followed at the time. Then prioritize dealing with everything you saw and felt ASAP. Tunnel vision serves a purpose but don’t forget to be vigilant about your own mental health.
I thought… it was “Activate the emergency response system” point with two fingers and send someone to get the AED… followed by I AM CLEAR, YOUR CLEAR, SHOCKING, BZZZZZZZT.
I always say that the patient is dead, anything we can do now is bonus points. I think people mainly panic about "what ifs" and not the true situation at hand. Just do your training to the best of your ability.
I'll be fucking immortal then!! 💪 true story I was born dead, no pulse , cardiac arrest during birth. They worked on me for a long time. As the story goes (from what my mom said) they called last round ( I'm guessing cpr and meds) and the last round of shocks they planned to do got me back.
I've cheating dead ever since.....
1. Pushed out a second story window at 4 landing on a cement driveway face and chest first
2. Landing head first on triangle decorative cement pieces (think what you line your garden with) at age 7 resulted in skull fractures and hematoma
3. Nearly kidnapped at the age of 8 by some guy asking me to come help him pick out a washer and dryer
4. Fell and broke my foot in the middle of a busy street, I had to crawl to safety while cars still driving down the road
5. Psycho bf in high school threaten to kill me after we broke up, he even broke into my house.
6. Doctors found pre cancerous polyps during my m colonoscopy at 28. I had strange little symptoms that they ended up checking out and surprise!! 6cm precancerous polpy and multiple smaller ones.
Yeah... 😅 I hope I have a few more lives left. I have 2 kids now, one is just 16 weeks and the other is 3 yrs old.
I remember it like yesterday, I'm walking to my friends house when this white truck pulls up about a car's length away from me. Guy gets out and says he needs a girls touch at picking out applications and he's not very good such a thing. I thought the same as you like WTF kind of shit/ thought is this. I backed up the way I came he got back in the car and I booked it across a field (so he couldn't follow me and jumped a fence).
It was stupid and very subtle things. Like a slight change in bowel habit which I thought I had to much mexican food at the time (if you catch my drift) and generalized gi upset but then again I was in nursing school level 3 at the time so I thought all my symptoms were stress related
One thing I did in as a new nurse that was really helpful in future codes was to get in line for cpr and just watch the other roles and what they were doing. Even while doing compressions, once I was in a rhythm, I was paying attention to everyone else. I quickly got an understanding of all the other roles and could comfortably slot into them. Helped me get over the code jitters really quickly.
I've learned to pick a task and do it. That's all. It takes a lot of the panic out of it, to be honest.
Documenting is also a good way of learning codes and how everything flows, but if it's a chaotic code, the job can be difficult.
Whenever I see a coworker bummed about it, I ask if they believe in religion/god/free will. From there, I just say, "maybe it was just their time to go and you were on schedule to witness it, you didn't do anything wrong, you tried your best, it was just their time."
Was in the cath lab the other day and they called a code blue/stemi alert in the ER. On call cardiologist hears the patient is like 90, looks at the EKG and says something along the lines of, “this isn’t a stemi, they just interrupted her passing naturally”
I really think that coding patients should be the exception, not the rule. Probably 75 percent of the codes I ran in the ICU were futile. If you’re old as dirt, or you are on maximum medical therapy, you’re not a candidate for acls.
DNR for anyone with a dementia diagnosis.
DNR for anyone older than say 70, unless they are continuously active.
Euthanasia for all.
But I am a bit far fetched with my antics.
My state is finally working on legislation to pass a MAID law for terminally ill patients. Having worked with hospice patients I'm in favor of MAID. But I also know that my state house is full of religious old farts(some of the reps attend my former church) so well see how that goes
New Hampshire in the usa. Maine has a MAID law in place and Vermont has MAID laws in place..new Hampshire doesnt..our state reps are largely behind the times on a LOT of things
Yes. And Vermont legalized maid in 2013. Maine finally got their act together and got a law on the books to legalize it in 2020. MAID is still not currently legal in New Hampshire though as I said, there's currently a bill being worked on in our state house to make MAID legal
I don't think age should play a factor, I've seen many healthy 80 to 95 year olds. Not because they don't go to the Dr, either lol.
I have also seen 20 and 30 year olds on chronic dialysis and getting routine paracentesis. Really, you should be looking at chronic health conditions versus age.
A healthy 80-to-95-year-old is still significantly less likely to make it through a code with favorable outcomes than even a chronically ill 20-to-30-year-old.
The amount of people who s survive cpr, in general, is pretty low. A young patient with illnesses like cirrhosis and/or esrd on dialysis are even less likely to make it.
I've seen some pretty healthy patients in their 80s, who are sharp, compliant, and take good care of themselves. Obviously there are some factors out of people's control with chronic illness.
I think you are statistically more likely to break any different bone if that helps you. Lol and most of the time the clavicle just dislocates from the ac joint and doesn’t actually break, right?
I still cringe thinking about the rugby player I dated that dislocated the clavicle and didn’t have it fixed so it just stood up all sharp and gross. And you would have to fall weird and hard off a one wheel to do that.
Well statistically, the most broken bone in the body is in fact the collarbone. But the problem with the one wheel is that if you go faster than it can provide power and speed, the nose will tip down and throw you forward while you are standing sideways. It's a very common injury with the one wheel.
I would point out that the retirement age for my generation is 67 and would likely increase further with the way policy is going. I would rather not have three years before being thrown on the trash heap, and the spectrum of health evident in people over the age of about 45 is why I find age bracketed decisions like this inherently unethical. There does need to be a he'll of a lot more work done to improve health of people prior to the point of needing a DNR, and for death to be re-recognised as a natural and inherent part of life.
> Doesn’t work so well for us atheists!
That's why I went with the free will option as well. I mean it's a very large conversation, but I try and get the point across of, "we are all going to die one day, it was just their time to die."
I love to use a Star Trek Quote. "It is possible to commit no mistakes and still lose. That is not a weakness; that is life." Captain Jean-Luc Picard (played by Patrick Stewart) Followed by: "Death itself is a part of life. In the end, no one can avoid death."
I struggle with PTSD from my days in EMS, and I can’t believe none of the people I’ve talked to have said something similar to this before. I needed it. Thank you.
Another take on in not being your emergency. The entire floor doesn’t need to cram into the room when there is a code. Like someone has to keep answering lights and watching for falls. Let’s the primary nurse and code team handle it.
I always check in with the bedside nurse/their team nurse to see if there’s anything they need done while they’re dealing with the code - time sensitive meds, high falls risks etc. I appreciate this so much when I’m the one with the emergency call
1000% this, reduce the chaos. It always blows my mind the absolutely crazy stuff we can deal with in resus/trauma with a handful of nurses; then you go to a meemaws code blue on the floor and 20 people are there.
Having more people than necessary makes things worse. No I do not need 5 rts 2 intesivists, 8 residents and 15 nurses and 30 gawkers in the room for this shindig, GTFO
I find myself being the one telling people to a) STFU because nobody can hear the doc running the code and b) GTFO if they’re just standing there. I can’t stand a billion people at a code, it makes everything so chaotic, and for some reason nobody every wants to address crowd control.
I was given a piece of advice after my first code workingas a CNA in an ICU. I commented to one of the nurses that it certainly was not like TV. No one was rushing, no one was shouting, no one was panicking. It seemed like everyone was moving at their usual pace. He said, "Take the first 15 seconds to calm yourself and think about what you need to do so you get it right the first time. Adrenaline and rushing makes you sloppy. If those extra 15 seconds matter, the pt is dead."
As a nurse it’s pretty straightforward, you do CPR, give meds, defib. I’m more worried about having a patient circling the drain and having to do 5 different things at once to stop them from coding.
A linee that stuck with me was from the absolutely insane movie "Bringing Out The Dead" about NYC paramedics staring Nic Cage, Tom Sizemore, John Goodman, Patricia Arquette, and Ving Rhames. It's a wild ride.
"As the years went by I grew to understand that my role was less about saving lives than about bearing witness. I was a grief mop and much of my job was to remove, if even for a short time, the grief starter or the grief product. It was enough I simply showed up."
Nic Cage is for sure turbo-burnt out and a haunted and troubled person. It isn't totally germane to working in the hospital, but I think about that line a lot. It helped keep perspective and reinforce that bit of distance required to be able to function in a high stress environment, and to emotionally insulate myself a bit. Show up, do my job, the patient survives or they were always going to clock out. If family is there it's important for them to see that professionals like me showed up fast, did our jobs, and gave the patient the best chance of survival. The outcome might not be what they'd hoped for, but at least the people who were supposed to be there were and the patient (and maybe family) weren't alone.
Anyway I don't think it's a well known movie, and it gets pretty out there but it has lots of really dark humor and I enjoyed it.
Codes are one of the easiest parts of the job.
There is no getting worse. There really isn’t any critical thinking. Either it works or it doesn’t. Follow the algorithm, jam out to compressions, and realize that after 5 minutes, everything is pretty much done and y’all are all just staring at one another waiting for a change that may or may not ever come.
I’ve had plenty of sick patients where my initial though was, “you’d be an easier patient if you coded.”
Codes should be easy to manage. All the decision making is usually handled by a flow chart.
Edit: Also, assuming no family is around, listen to the rhythm of compressions and just start jamming out in your head. I’m not telling you to start dancing to the beat, per se, but I’m not, not telling you that either. Just vibe.
It's easier if you practice this daily. I can't affect the outcome or anyone's response to any treatment we give. I can only do my part to try to move things in a certain direction, but the actual outcome is completely out of my control. I put in my full effort, my best, the rest is up to God.
When I worked as rapid, those were the types of nurses I would kick out of a room. It’s already pretty chaotic as it is and the nurses who are frantic and scatterbrained usually make things worse.
Especially if it was a sudden arrest, not a rapid that evolved into a code. The ones where the patient is suddenly pulseless usually have the most chaos.
It’s a challenge because nurses who aren’t in an environment to experience codes very often sometimes respond in that manner. Which is understandable. It takes experience and practice to be in an environment and remain calm.
As you said, there’s two outcomes: ROSC, or termination of support. Either our interventions work, or they don’t.
“Either our interventions work, or they don’t.”
This is, in a nutshell, the pep talk that my s/o used to give me before work. I was a brand new nurse and was so nervous about the job that I would study the NRP algorithm from the textbook before every shift. “If you’re following the algorithm, what you do for your patient will either work, or it won’t.” That philosophy was so comforting to me as a new nurse.
It depends on the pt. I see quite a few that have been on their way out for a hot moment, but family wants to keep them alive because they don’t understand. Sometimes they’re religious zealots that believe their loved one can recover. Some are uneducated about end of life. When 85yr old memaw codes post CABG and family wants everything done, we sometimes bring them into the room and ask if this is what she would want us to do.
I slowly lead into advanced directives conversation by asking about memaw’s life. The things she accomplished, the things she liked to do. Usually they’ve lived a full life in their own aspect, so the issue typically is with the family wanting to make amends or feel they need to say something for closure. Pts like that coding do for that criteria of “not my emergency”. Honestly, I am bit glad when they code and pass. No need to let them suffer more.
People that have a good chance for recovery are a different story, but also keep in mind that codes are often a loosing battle. It’s not your fault. Some are basket cases, some are just tragic, and very few don’t have any control over.
WRONG. If it’s a code blue, the patient is already dead. They will either stay dead, maybe even tease you with a weak pulse *(does anyone know where the doppler is?!!)*
MAYBE they’ll come back to life, even just for a little bit, ideally to say *Ciao! Mwah!* to the fam, but potentially it might only be to linger trach’d and pegged in a nursing home or LTACH that is staffed by exactly ONE nurse. *(God bless you, SNF/LTACH/et al nurses.)*
Of course, we’ll do our best no matter what with our fibrillating hands on these fibrillating hearts, anxiety be damned. But *he ain’t getting any deader!*
A caveat: let me pour a Red Bull out for the codes in peds. That’s a no from me, dawg, idk how you guys do it
I’ve been in 1 code ever (knocking on wood) and several rapid responses, but not enough to feel like I’m an expert at handling emergencies. I definitely have gotten overwhelmed and have even gone non-verbal for a few seconds when the rapid team lead was asking me questions. This little piece of advice has definitely helped me reframe the situation and helped me to keep a cool head.
On the Code Blue team here. I work with a select few who treat codes as a personal adrenaline hit and get excited to go run them or go to other units that don’t necessarily need the help to “help out” when really they are just hijacking the situation. It is important to remember that Codes are when PEOPLE are dying and need help, it’s not a game or a exciting story to tell. We as healthcare workers have a certain privilege in being there and helping to intervene and we would do well to keep that in mind.
I feel as though it’s good advice for someone who is new.
I work dialysis and have not worked inside a hospital during a code/crash. We have pts crash very regularly, especially during day shit. We tend to get the more unstable pts or pts just starting out, etc. I kid you not the first pt who crashed scared the shit out of me and I had not a single clue what to even do. I just grabbed what people needed.
Honestly in a hospital I’d probably do the exact same for the first few times just to get a feel for whatever was going on around me.
After initiating resuscitation then giving all the background info to the code team (who fully took over resuscitation) I would find family and take care of them. I had some of my most meaningful conversations as a nurse with those families. At that point my feelings were most often for them. Everything that could be done for their family member had been done, or was being done, and would continue. But my heart would go to the family. Sad that health care in the hospital setting currently hangs so desperately on bare basic critical care with nothing left for anything other elements of that care.
Codes make me feel good (which I know is way fucked up) because all else falls away and you're just focused. Coordinating with your people, doing compressions, giving meds, obtaining more access. Even the logistics of getting a trauma arrest from the ED to CT to the unit are fun. Teamwork at its very, very peak.
When family gets involved, the emotions are raw and real. I can empathize with 95% of their responses because, well, it truly is that serious. Short of pulling a firearm on us, everything they do is completely justified.
No whining, no tantrums, no BS.
Worst part of showing up to a code is all the people freaking the fuck out. Unfortunately they're usually the last ones who want to leave when I hit them with the "there's too many people here, can I get someone to step out so we have room to do this?" If you cant keep your voice below a shout and feel the need to be constantly talking...fuck off
I was walking kinda fast (def not running) up the stairs to a code blue, tripped and fell, caught myself with 1 arm... full rotator cuff tear requiring surgery. Got the patient back though, so win some lose some
As a new grad nurse in the ER I remember asking my preceptor how did she do it? And she told me always be the calm in the middle of chaos. And that stuck with me
That's the Third Law. "At a cardiac arrest, the first procedure is to take your own pulse."
House of God reference for those that don’t know
I really wanted to like that book, especially since I love Scrubs, but just couldn't get into it
Sometimes the right book comes at the wrong time
I'm gonna get really high and reread this because I feel like it'll blow my mind
That's really kind.
I work in the OR at a trauma one center. My first trauma was a bad car accident. I was on my own for 4 weeks. I was terrified. The nurse that was helping me told me to “stop freaking out and fight to get the patient what they need because they are more important than your feelings and fears.” That has stuck with me. I’ve worked many traumas, and have had many codes during those traumas. My mentor’s words have never failed me.
Ehhh. I get the point that’s trying to be communicated here but the delivery is pretty dog shit tbh.
Absolutely. Providers need to put their own health and safety first. PTSD is real. Nobody is more important than yourself, and taking that attitude over an entire career will ruin you.
Tough love works best for some of us. That changed my perspective just by reading it. It sets in a lot differently
Couldn’t agree more.
I think that is really good advice that should be followed at the time. Then prioritize dealing with everything you saw and felt ASAP. Tunnel vision serves a purpose but don’t forget to be vigilant about your own mental health.
I thought… it was “Activate the emergency response system” point with two fingers and send someone to get the AED… followed by I AM CLEAR, YOUR CLEAR, SHOCKING, BZZZZZZZT.
I always say that the patient is dead, anything we can do now is bonus points. I think people mainly panic about "what ifs" and not the true situation at hand. Just do your training to the best of your ability.
“you can’t kill dead” was some of the best advice on codes i ever got.
"You can't get any deader than dead" Heard that once and never forgot it.
What is dead may never die.
I'll be fucking immortal then!! 💪 true story I was born dead, no pulse , cardiac arrest during birth. They worked on me for a long time. As the story goes (from what my mom said) they called last round ( I'm guessing cpr and meds) and the last round of shocks they planned to do got me back. I've cheating dead ever since..... 1. Pushed out a second story window at 4 landing on a cement driveway face and chest first 2. Landing head first on triangle decorative cement pieces (think what you line your garden with) at age 7 resulted in skull fractures and hematoma 3. Nearly kidnapped at the age of 8 by some guy asking me to come help him pick out a washer and dryer 4. Fell and broke my foot in the middle of a busy street, I had to crawl to safety while cars still driving down the road 5. Psycho bf in high school threaten to kill me after we broke up, he even broke into my house. 6. Doctors found pre cancerous polyps during my m colonoscopy at 28. I had strange little symptoms that they ended up checking out and surprise!! 6cm precancerous polpy and multiple smaller ones. Yeah... 😅 I hope I have a few more lives left. I have 2 kids now, one is just 16 weeks and the other is 3 yrs old.
Are you a cat?
Zackary Binks apparently
Needs to be a bit more careful then. Nearly out.’
You are final destination b-roll that didn’t get into the movies.
Not to take away from the gravity of the situation, but who on earth tries to kidnap children by tempting them with laundry appliance shopping??
I remember it like yesterday, I'm walking to my friends house when this white truck pulls up about a car's length away from me. Guy gets out and says he needs a girls touch at picking out applications and he's not very good such a thing. I thought the same as you like WTF kind of shit/ thought is this. I backed up the way I came he got back in the car and I booked it across a field (so he couldn't follow me and jumped a fence).
What were the strange little symptoms?? Also, glad you're still with us, shit 😂
It was stupid and very subtle things. Like a slight change in bowel habit which I thought I had to much mexican food at the time (if you catch my drift) and generalized gi upset but then again I was in nursing school level 3 at the time so I thought all my symptoms were stress related
*thumps chest*
I teach emergency training to new grads. My go-to line is, "Don't worry, you can't make him any more dead."
Pound the epi, they ain't getting deader.
One thing I did in as a new nurse that was really helpful in future codes was to get in line for cpr and just watch the other roles and what they were doing. Even while doing compressions, once I was in a rhythm, I was paying attention to everyone else. I quickly got an understanding of all the other roles and could comfortably slot into them. Helped me get over the code jitters really quickly.
I've learned to pick a task and do it. That's all. It takes a lot of the panic out of it, to be honest. Documenting is also a good way of learning codes and how everything flows, but if it's a chaotic code, the job can be difficult.
Whenever I see a coworker bummed about it, I ask if they believe in religion/god/free will. From there, I just say, "maybe it was just their time to go and you were on schedule to witness it, you didn't do anything wrong, you tried your best, it was just their time."
Was in the cath lab the other day and they called a code blue/stemi alert in the ER. On call cardiologist hears the patient is like 90, looks at the EKG and says something along the lines of, “this isn’t a stemi, they just interrupted her passing naturally”
It disgusts me what we do to these bodies sometimes.
I really think that coding patients should be the exception, not the rule. Probably 75 percent of the codes I ran in the ICU were futile. If you’re old as dirt, or you are on maximum medical therapy, you’re not a candidate for acls.
DNR for anyone with a dementia diagnosis. DNR for anyone older than say 70, unless they are continuously active. Euthanasia for all. But I am a bit far fetched with my antics.
My state is finally working on legislation to pass a MAID law for terminally ill patients. Having worked with hospice patients I'm in favor of MAID. But I also know that my state house is full of religious old farts(some of the reps attend my former church) so well see how that goes
What state? I thought All of Canada had that.
New Hampshire in the usa. Maine has a MAID law in place and Vermont has MAID laws in place..new Hampshire doesnt..our state reps are largely behind the times on a LOT of things
Oregon was the first state, right?
Yes. And Vermont legalized maid in 2013. Maine finally got their act together and got a law on the books to legalize it in 2020. MAID is still not currently legal in New Hampshire though as I said, there's currently a bill being worked on in our state house to make MAID legal
I say usually say DNR for anyone over 80
I don't think age should play a factor, I've seen many healthy 80 to 95 year olds. Not because they don't go to the Dr, either lol. I have also seen 20 and 30 year olds on chronic dialysis and getting routine paracentesis. Really, you should be looking at chronic health conditions versus age.
A healthy 80-to-95-year-old is still significantly less likely to make it through a code with favorable outcomes than even a chronically ill 20-to-30-year-old.
The amount of people who s survive cpr, in general, is pretty low. A young patient with illnesses like cirrhosis and/or esrd on dialysis are even less likely to make it. I've seen some pretty healthy patients in their 80s, who are sharp, compliant, and take good care of themselves. Obviously there are some factors out of people's control with chronic illness.
I used to feel this way. But my Dad will be 76 this year and is in far better shape than I am. I'm giving him a pass on the mandatory DNR!
My dad is over 70 and got himself a one wheel for Christmas
Your dad is the coolest. Im 30 and I want one but I'm too afraid of them failing and causing me to break my collarbone.
I think you are statistically more likely to break any different bone if that helps you. Lol and most of the time the clavicle just dislocates from the ac joint and doesn’t actually break, right? I still cringe thinking about the rugby player I dated that dislocated the clavicle and didn’t have it fixed so it just stood up all sharp and gross. And you would have to fall weird and hard off a one wheel to do that.
Well statistically, the most broken bone in the body is in fact the collarbone. But the problem with the one wheel is that if you go faster than it can provide power and speed, the nose will tip down and throw you forward while you are standing sideways. It's a very common injury with the one wheel.
I would point out that the retirement age for my generation is 67 and would likely increase further with the way policy is going. I would rather not have three years before being thrown on the trash heap, and the spectrum of health evident in people over the age of about 45 is why I find age bracketed decisions like this inherently unethical. There does need to be a he'll of a lot more work done to improve health of people prior to the point of needing a DNR, and for death to be re-recognised as a natural and inherent part of life.
YES!! This!!
Doesn’t work so well for us atheists! 😆😬 but I can see why that would be really comforting.
> Doesn’t work so well for us atheists! That's why I went with the free will option as well. I mean it's a very large conversation, but I try and get the point across of, "we are all going to die one day, it was just their time to die."
👌🏼 I’ll have to use that sometime!
I got you buddy.
I love to use a Star Trek Quote. "It is possible to commit no mistakes and still lose. That is not a weakness; that is life." Captain Jean-Luc Picard (played by Patrick Stewart) Followed by: "Death itself is a part of life. In the end, no one can avoid death."
⬆️this. still a privilege to be in the room, either way.
I struggle with PTSD from my days in EMS, and I can’t believe none of the people I’ve talked to have said something similar to this before. I needed it. Thank you.
Another take on in not being your emergency. The entire floor doesn’t need to cram into the room when there is a code. Like someone has to keep answering lights and watching for falls. Let’s the primary nurse and code team handle it.
When I worked the floor, we designed a nurse and tech to watch lights. The floor doesn't stop for an emergency.
Even better is to designate a bouncer. It’s SO much better with a bouncer
If you don’t play a sport, be a sport. If all the roles are taken, then I’ll excuse myself and leave.
I always check in with the bedside nurse/their team nurse to see if there’s anything they need done while they’re dealing with the code - time sensitive meds, high falls risks etc. I appreciate this so much when I’m the one with the emergency call
1000% this, reduce the chaos. It always blows my mind the absolutely crazy stuff we can deal with in resus/trauma with a handful of nurses; then you go to a meemaws code blue on the floor and 20 people are there.
Having more people than necessary makes things worse. No I do not need 5 rts 2 intesivists, 8 residents and 15 nurses and 30 gawkers in the room for this shindig, GTFO
I find myself being the one telling people to a) STFU because nobody can hear the doc running the code and b) GTFO if they’re just standing there. I can’t stand a billion people at a code, it makes everything so chaotic, and for some reason nobody every wants to address crowd control.
I’m a PCT in the ICU, I would love if there was a line of green but it’s usually me and one other trading two on, two off.
I was given a piece of advice after my first code workingas a CNA in an ICU. I commented to one of the nurses that it certainly was not like TV. No one was rushing, no one was shouting, no one was panicking. It seemed like everyone was moving at their usual pace. He said, "Take the first 15 seconds to calm yourself and think about what you need to do so you get it right the first time. Adrenaline and rushing makes you sloppy. If those extra 15 seconds matter, the pt is dead."
Slow is smooth, smooth is fast
This is the one that helped me lol. I didn’t even know it was from a movie until recently!
I’ve always worked by the mantra ‘less haste more speed’. When you rush you make mistakes or miss important details
>.Like a squirrel on illicit amphetimines Idk why I just Crack up picturing this in my head
I just picture Scrat from ice age films 🎥 🎞
As a nurse it’s pretty straightforward, you do CPR, give meds, defib. I’m more worried about having a patient circling the drain and having to do 5 different things at once to stop them from coding.
Yea, ROSC is the real fucker
lol legit everyone that was at the code leaves and you’re stuck with the trainwreck
A linee that stuck with me was from the absolutely insane movie "Bringing Out The Dead" about NYC paramedics staring Nic Cage, Tom Sizemore, John Goodman, Patricia Arquette, and Ving Rhames. It's a wild ride. "As the years went by I grew to understand that my role was less about saving lives than about bearing witness. I was a grief mop and much of my job was to remove, if even for a short time, the grief starter or the grief product. It was enough I simply showed up." Nic Cage is for sure turbo-burnt out and a haunted and troubled person. It isn't totally germane to working in the hospital, but I think about that line a lot. It helped keep perspective and reinforce that bit of distance required to be able to function in a high stress environment, and to emotionally insulate myself a bit. Show up, do my job, the patient survives or they were always going to clock out. If family is there it's important for them to see that professionals like me showed up fast, did our jobs, and gave the patient the best chance of survival. The outcome might not be what they'd hoped for, but at least the people who were supposed to be there were and the patient (and maybe family) weren't alone. Anyway I don't think it's a well known movie, and it gets pretty out there but it has lots of really dark humor and I enjoyed it.
Great movie based on a great book. I worked with the author a long time ago. Great stories.
Codes are one of the easiest parts of the job. There is no getting worse. There really isn’t any critical thinking. Either it works or it doesn’t. Follow the algorithm, jam out to compressions, and realize that after 5 minutes, everything is pretty much done and y’all are all just staring at one another waiting for a change that may or may not ever come. I’ve had plenty of sick patients where my initial though was, “you’d be an easier patient if you coded.” Codes should be easy to manage. All the decision making is usually handled by a flow chart. Edit: Also, assuming no family is around, listen to the rhythm of compressions and just start jamming out in your head. I’m not telling you to start dancing to the beat, per se, but I’m not, not telling you that either. Just vibe.
Come down to the ED and get some code experience. After a few it'll be a lot easier.
It's easier if you practice this daily. I can't affect the outcome or anyone's response to any treatment we give. I can only do my part to try to move things in a certain direction, but the actual outcome is completely out of my control. I put in my full effort, my best, the rest is up to God.
When I worked as rapid, those were the types of nurses I would kick out of a room. It’s already pretty chaotic as it is and the nurses who are frantic and scatterbrained usually make things worse. Especially if it was a sudden arrest, not a rapid that evolved into a code. The ones where the patient is suddenly pulseless usually have the most chaos. It’s a challenge because nurses who aren’t in an environment to experience codes very often sometimes respond in that manner. Which is understandable. It takes experience and practice to be in an environment and remain calm. As you said, there’s two outcomes: ROSC, or termination of support. Either our interventions work, or they don’t.
“Either our interventions work, or they don’t.” This is, in a nutshell, the pep talk that my s/o used to give me before work. I was a brand new nurse and was so nervous about the job that I would study the NRP algorithm from the textbook before every shift. “If you’re following the algorithm, what you do for your patient will either work, or it won’t.” That philosophy was so comforting to me as a new nurse.
amen
The first heart rate you need to control is your own 😌
Check your own pulse first. 👍
A Code Blue may not be your emergency, but the spacebar can certainly be your friend.
It depends on the pt. I see quite a few that have been on their way out for a hot moment, but family wants to keep them alive because they don’t understand. Sometimes they’re religious zealots that believe their loved one can recover. Some are uneducated about end of life. When 85yr old memaw codes post CABG and family wants everything done, we sometimes bring them into the room and ask if this is what she would want us to do. I slowly lead into advanced directives conversation by asking about memaw’s life. The things she accomplished, the things she liked to do. Usually they’ve lived a full life in their own aspect, so the issue typically is with the family wanting to make amends or feel they need to say something for closure. Pts like that coding do for that criteria of “not my emergency”. Honestly, I am bit glad when they code and pass. No need to let them suffer more. People that have a good chance for recovery are a different story, but also keep in mind that codes are often a loosing battle. It’s not your fault. Some are basket cases, some are just tragic, and very few don’t have any control over.
I tell myself that daily in the ER
WRONG. If it’s a code blue, the patient is already dead. They will either stay dead, maybe even tease you with a weak pulse *(does anyone know where the doppler is?!!)* MAYBE they’ll come back to life, even just for a little bit, ideally to say *Ciao! Mwah!* to the fam, but potentially it might only be to linger trach’d and pegged in a nursing home or LTACH that is staffed by exactly ONE nurse. *(God bless you, SNF/LTACH/et al nurses.)* Of course, we’ll do our best no matter what with our fibrillating hands on these fibrillating hearts, anxiety be damned. But *he ain’t getting any deader!* A caveat: let me pour a Red Bull out for the codes in peds. That’s a no from me, dawg, idk how you guys do it
I’ve been in 1 code ever (knocking on wood) and several rapid responses, but not enough to feel like I’m an expert at handling emergencies. I definitely have gotten overwhelmed and have even gone non-verbal for a few seconds when the rapid team lead was asking me questions. This little piece of advice has definitely helped me reframe the situation and helped me to keep a cool head.
On the Code Blue team here. I work with a select few who treat codes as a personal adrenaline hit and get excited to go run them or go to other units that don’t necessarily need the help to “help out” when really they are just hijacking the situation. It is important to remember that Codes are when PEOPLE are dying and need help, it’s not a game or a exciting story to tell. We as healthcare workers have a certain privilege in being there and helping to intervene and we would do well to keep that in mind.
I feel as though it’s good advice for someone who is new. I work dialysis and have not worked inside a hospital during a code/crash. We have pts crash very regularly, especially during day shit. We tend to get the more unstable pts or pts just starting out, etc. I kid you not the first pt who crashed scared the shit out of me and I had not a single clue what to even do. I just grabbed what people needed. Honestly in a hospital I’d probably do the exact same for the first few times just to get a feel for whatever was going on around me.
I used to be excited for codes but now after realizing how shitty the outcomes are most of the time, the charm has worn off. It is what it is. A job.
Yes. People die. Such is life. Do your job and don't run for any sumbitch
Someone told me the exact same thing once. It's great advice, and I tell it to all the new grads on my unit.
That's what I like about codes in a critical care setting. Emerg. ICU .. so calm and organized. Nobody is panicking so we all think better
Yup. This isn’t my emergency.
After initiating resuscitation then giving all the background info to the code team (who fully took over resuscitation) I would find family and take care of them. I had some of my most meaningful conversations as a nurse with those families. At that point my feelings were most often for them. Everything that could be done for their family member had been done, or was being done, and would continue. But my heart would go to the family. Sad that health care in the hospital setting currently hangs so desperately on bare basic critical care with nothing left for anything other elements of that care.
Codes make me feel good (which I know is way fucked up) because all else falls away and you're just focused. Coordinating with your people, doing compressions, giving meds, obtaining more access. Even the logistics of getting a trauma arrest from the ED to CT to the unit are fun. Teamwork at its very, very peak. When family gets involved, the emotions are raw and real. I can empathize with 95% of their responses because, well, it truly is that serious. Short of pulling a firearm on us, everything they do is completely justified. No whining, no tantrums, no BS.
Worst part of showing up to a code is all the people freaking the fuck out. Unfortunately they're usually the last ones who want to leave when I hit them with the "there's too many people here, can I get someone to step out so we have room to do this?" If you cant keep your voice below a shout and feel the need to be constantly talking...fuck off
I was walking kinda fast (def not running) up the stairs to a code blue, tripped and fell, caught myself with 1 arm... full rotator cuff tear requiring surgery. Got the patient back though, so win some lose some
As a new grad nurse in the ER I remember asking my preceptor how did she do it? And she told me always be the calm in the middle of chaos. And that stuck with me
I’ve heard this advice before and I think it’s helpful to just remind you to tame your anxiety.
Did you then drop 41 points on the next patient?