Anatomy of a Code

Very well written!!!!!!

Yup sounds about right !!!!

Perfectly said! I had this happen as I was leaving I had given report but the next shift didn't know them so I stayed. When I did leave I cried from the let down I think cause how intense it always is. Thanks for sharing

Well written. Sounds like last night minus a few changes to the source of the asystole. A well run code can be beautiful and seemless.

It's why mock codes are so important. The room doesn't need to be full, the room should be clear of extra people. It's more help to the team, especially when (as the author noted) the other patients on the unit, especially the roommate of the patient coding are comforted and taken care of by extra staff and there is less noise than there needs to be.

Thank you for this. I had a patient code not too long ago, but unfortunately she didn't survive. It was my first full-blown code, and while I was assured that everything was done as it should have been, I felt like I was almost in a dream state for most of the code. I think it's helpful to read it from an observer's perspective because even though I *know* all of the tasks are being carried out by *someone*, it's hard to see when I'm actually in the situation. I can also relate to the adrenaline rush - unfortunately I still had 8 hours of shift to get through. I don't think I stopped moving until it was time to punch out, and then all of a sudden when I could stop moving, the tears started and didn't stop until I got home. I know this is all a bit rambling, but reading your article made me think about that day again, and I couldn't help but respond.

I work as a subacute nurse. So we get less codes. But when we get one it is so different. We do not have a doc in the facility 24/7. So codes are run completely by the nurses. We have no pharmacy and no IV meds, no respiratory, no anestheologist. We have usually just one RN and two LPNs on the floor for up to 40 patients. We do not get many codes, but it makes them so much scarier when we do.

With staffing changes, it scares the heck out of me that we really don't usually have enough staff for someone to answer lights on the floor. Yet another minus for tight staffing

Just another day at the office!

I supervise a LTC and rehab facility. I would love to have the support I had when I worked acutes. We don't have a doctor, respiratory, lab, a pharmacist, or an anesthesiologist. Our crash cart is more like an advanced first aid kit. It has oxygen, BVM, a Gomco kind of suction machine, one bag of NS, an IV start kit, some airways, and some other odds and ends. No AED. No drugs. I have my nurses move blood and O2 until the paramedics get there. About the most advanced thing I can do is do the IV start so the paramedics can push drugs if they need to. If anyone has any suggestions, I am open to them.I found it to be important to assign roles to each member of my team, both back in my med-surg days and now. If one is the charge nurse or supervisor you have to assume leadership until somebody with more letters after their name than you gets there. Assignments help your staff not have that "I don't know what to do!" panicky feeling. Assign compressions, Ambu, recording, someone should get the chart(no EMR at my place!), and whatever else you need. Get unnecessary staff back to their work areas, politely. Especially the rubberneckers. Never raise your voice, it just betrays your own anxiety and makes peoples hands shake more. When the doctor, the code team, or the paramedics get there, back your team out of the way, as appropriate, and continue your leadership. Give report, and make sure recording continues.I remember during one code in med-surg the doctor looked at the patient's nurse and shouted, "You, I need two lines started now!" That particular nurse was a good nurse, but the worst IV starter on the floor. I pointed to my best IV nurse and told her to do it. I said to the doctor, "Sir, tell me what you need, I'll make it happen." The doctor is running the code, and you may be the one managing your nurses.Most of the codes we do in LTC do not survive. We do our best with what we have, but if a 94 year old heart stops, it is not likely to recover. If you happen to have a loved one in LTC, please consider a DNR, Do Not Hospitalize, or hospice care, if appropriate. Often families put this off, and it forces me to go all out, thinking, "What a shame" while I do it.

It is an indescribable feeling to be a part of a well-run code. Great article!

Very well written. Those darn codes are just frustrating. So often the ending is not a good one. I can say in the 20 or so codes I have seen only 5 survivals. 2 with excellent outcomes, 2 with ok-ish outcomes, and 1 that was in a semi-vegatative state after.