Coding Mr. S

I've been in a couple of codes during my short nursing career but this week was the first time I coded my own patient. It was incredible to see the amount of teamwork that went into trying to revive him. Doctors and nurses work really hard to get your loved ones back.

Sadly, after nearly 45 minutes of CPR, defibrillation, fluid boluses, and meds, Mr. S didn't make it. He was still breathing when the doctor running the code asked everyone in the room if there were any objections to ending the code and providing the patient with comfort care until he passed. This can be "disturbing" to the family someone in the room noted, "when the code is ended and the patient is still breathing. Respiration is the last thing to go." But Mr. S had no blood pressure, no pulse. His body hadn't been profusing for nearly an hour ...And so there were no objections and the code was ended. Mr. S stopped breathing. We washed his body and "bagged" him, tying a tag to his toe with his name and time of death on it. I had only known him for a couple of hours.

Oh S*@$!!!

I had to give my first sternal rub today when I found my patient unresponsive in bed. Seemed she was sleeping so peacefully but, alas... no. A sternal rub is a type of painful stimulus one can apply when trying to wake an unresponsive patient (see green glove below). Try it on yourself and you'll agree it hurts (I just did). Others include pressing down on the nail bed with your fingernail, pinching/twisting the skin below the collar bone, and pressing on the (closed!) eyeball.

This was the first time I've ever gotten close to a code with my own patient and it was pretty intense. I think I heard someone call it a "soft code" which made me think of soft core porn but in life saving terms rather than sex movie ones.

Xmas on Ice (Chips)

 

It's Christmas on Trauma and what does Santy have for you? One size large 3rd degree burn from a scalding pot of grease, one malodorous nasty wound infection, one holiday stabbing at the mall, and a paaaartridge in a pear treeeee...!

It's sad when patients are NPO and can't have anything to eat or drink and they literally beg you for ice chips. "I'm sorry", "I wish I could..." (the worst is when you forget and ask them if they've ordered breakfast yet. Ouch. Sorry!)

Even sadder is being a patient hospitalized on Christmas who holds the holidays in very high regard and is alone with no family or friends in the area to visit them. But possibly saddest of all is dying on Christmas at 7:00am. Good morning and good night, and Merry Christmas.

Expired

I saw my first code the other day. Codes are called over the hospital intercom system so that people from different areas of the hospital can respond, and a nurse on my floor was one of the people who responded that day. As she was running out the door my preceptor yelled for her to take me with her.

When we got to the other unit the patient was on the floor. I couldn't see much because the room filled up with about 40 people in a matter of seconds. During a code there are different "jobs" that people do: there is the person who runs the code (normally a physician or NP, I believe, because they give the orders for administering drugs), a nurse who prepares/administers the drugs from the crash cart, a recorder who writes down everything that's being done and the effect (if any) the actions have on the patient, people taking turns performing chest compressions and administering breaths to the patient, and probably a bunch of other people who do other things I'm forgetting about. Oh and there are about 20 other people in the room who just want to see what's going on but who are not actually doing anything at all (and they eventually get yelled at to leave the room).
The code went on for 15 minutes -which seemed like an eternity to me- and I mostly hid outside the room trying to stay out of the way. The patient was in PEA and nothing they did was having any effect. Towards the end, the nurse who brought me with her motioned for me to come into the room. She had been working as the "recorder". Shortly after I went in, the attending physician entered the room and gave a signal for everyone to stop. The time of death was announced and the nurse from my floor put a check in the box next to the word "expired" in the "outcome of code" section on the sheet used for recording.