A while ago GruntDoc had a great post about “The End of the Code” wherein he describes his actions as a team leader in the midst of a code. IT shows the true meaning of leadership. Luckily on my floor, the codes are usually quick, the patient well on their way to the Unit before most interventions can occur. One of the charge nurses said basically, “get a rhythm, get an airway and get off my floor.” We neither equipped nor truly capable of handling complex interventions unless completely necessary. No thoracotomies, invasive monitoring lines, transvenous pacing (all of which have been done…) on our floor, the Unit is much more suitable for this kind of heroics. This is not to say that we won’t in the emerging situation, but the reality is that we need them off the floor and down to the Unit quick.
The other night I had my first real code. Not a Rapid Response. A Code. Dude was dead. Wasn’t my patient though. Here’s how it went down:
We were all hanging around the nurse’s station, in that twilight time of 0500, early AM vitals were done, folks were just starting to wake up. The monitor starts the high-pitched binging of a life-threatening alert. Look and see the patient in V-Fib. As we head down the hall, we hear that it’s back in sinus rhythm and the pacer had taken back over. So the nurse heads in, starts checking the patient out. I’m almost back to the station when I hear frantic yelling from the end of the hall and that binging again. “I need the cart!” She hollered. I’m closest to the code cart and run for it. Mind you, our unit is big, it’s nearly and quarter mile round trip from end to end. I’ve never made the trip so fast in my life. Hauling ass down the hallway to the very end (yep, it’s always the room furtherest away) with the code cart. Into the room, the patient is laying in bed, back arched, mouth agape like a recently caught fish, “oh sit” I said to myself. Then my mind went blank. All that time in ACLS, all that time in previous situations. Nothing. It was like those moments in the Matrix where time s l o w e d to a crawl, my mind was trying to remember what to do next. The arrival of the next nurse behind me shocked me back to reality. He jumped in to start CPR, I went looking for the ambu bag to get an airway. But it wasn’t there. I thought, “Isn’t it supposed to hanging from the outside? Wait a sec, I checked the cart myself this evening…was it there?” By that time more people were flowing in the room, breaking open the cart (where the bloody ambu bag was…) and getting things going. At this point I got out of the way. Let the pros take over. They shocked twice, after the second the patient came back yelling and cursing. Which all things considered was a good thing. Not soon after, with a rhythm and a patent airway, they went off the floor to the Unit.
After this though, amny realized that we needed more training. In spite of the nature of the floor, we don’t do many codes. This was the first I had been in since I started back in December. Sure, we’ve had them, but not anywhere near me. So we’re going to get mock codes and a chance to see inside the cart so we(me) don’t freeze trying to figure out where things are. At least I learned one thing: Ambu bags are inside the cart.
Oh yeah, the patient? Was a frequent flyer and this was not the first time they’d coded. Ends up they came back tot eh floor 2 days after the code and went home a week later. Guess it wasn’t their time.