First code- sort of a vent..

Not 20 minutes before I had checked on pt. She was taking to me, no s/s distress, no change in condition, o2 was on 3L via N/C through a concentrator.

The next thing I knew the aide was calling to me for help, pt was not responsive. Went into room to eval. pt, she was indeed unconcious and did not appear to be breathing, absent of pulses and apical was just a few random beats, possibly just residual electrical impulses causing contractions at the end of death. Anyways, started CPR with ambu and compressions until the rest of help came as she was a full code. The first few compressions cracked ribs- pretty ghastly but overall the whole process wasn't as freaky as I'd imagined it. Ultimately she didn't make it- but literally, I had JUST spoken with this person not a half hour before! The aide said her nasal canula was on the floor next to her, but the pt. has taken it off before as she is confused, with no trauma to her. Could it have been that? It seems unlikely as she was only on 3L via N/C. She had to have been out for quite a bit, to get a line in her for atropine and epi, they had to go into bone.

I really don't know what happened. I had not given any meds so no allergy. I'm not overly anxious about it, pt was old and quite sick but GEEZ, that was fast! Has anyone ever had a patient ultimately be their own undoing, similarly by taking themselves off O2 in their confusion or ..? I just feel kind of helpless if these confused patients are going to be so unpredictable.. please just leave the O2 on your face alone! I'm sure it's highly unlikely that it was why she died but still. It doesn't help! I guess it's just what happens when you get old. You do things which end up killing you.. Last edit by Cat_LPN on Jul 6, '10
you have just described my worst nightmare - walking in and finding a patient not breathing. I have been a nurse for about 8 months now and have never had a patient code. I have only been a part of one code - and all I did was stand there and hand over meds when called for. I am TERRIFIED of my first code. I wish it would just happen so it would be over with. I guess it was just that person's time.

What "terrifies" you? Is it a lack of understanding of what may take place, what your role might be? The idea of losing a patient? I have found over my career that when something terrifies me, in my case it's usually due to a lack of information regarding something. I have found if I can educate myself, the terrors go away. What can we do to help you with your fear????

It's unlikely that less than 20 minutes of removing 3L of O2 led directly to her demise. Now that you've gotten through your first code you can think about what you've learned. Kudos to you for demonstrating the right response - initiating CPR, etc.It does get easier, though some codes/patients will stay in your mind forever.And psst... not an "a line" (that would be an arterial line) but an intraosseous (IO) line was established in your patient for IV (intravenous) access. They are quite useful for quick access in a patient with poor peripheral vasculature.

Quote from AltraIt's unlikely that less than 20 minutes of removing 3L of O2 led directly to her demise. Now that you've gotten through your first code you can think about what you've learned. Kudos to you for demonstrating the right response - initiating CPR, etc.It does get easier, though some codes/patients will stay in your mind forever.And psst... not an "a line" (that would be an arterial line) but an intraosseous (IO) line was established in your patient for IV (intravenous) access. They are quite useful for quick access in a patient with poor peripheral vasculature.

Sometimes people just die - even in the middle of a conversation. Totally without any prior indication. If they are lucky, in their sleep.This is no reflection on you at all.

Yeah, sometimes people just die. It's time. It's also possible that she went into flash pulmonary edema, which can happen as fast as it sounds, and someone can be talking one minute and frothing at the mouth the next. You didn't mention any pink froth, so it was probably just time to go.

Quote from JulieCVICURNYeah, sometimes people just die. It's time. It's also possible that she went into flash pulmonary edema, which can happen as fast as it sounds, and someone can be talking one minute and frothing at the mouth the next. You didn't mention any pink froth, so it was probably just time to go.

Kudos to you for calling a code and starting CPR.One night we had a new nurse fresh off orientation do an assessment at midnight and find a person (not a DNR) had expired. She did not call a code, she noted in the chart the person was dead and went about her rounds before informing the charge nurse roughly 2 hours later.... (I left at midnight and thus missed the rest of this saga in person but believe me we all heart about it ad nauseam as we had to redo competencies and have inservices out the wazoo)I was glad not to be charge that night.You will lose patients in your career and sometimes it will happen in the blink of an eye. I know it is hard to absorb and not second guess maybe what could have prevented the occurrence but please don't worry yourself about it. It sounds like it was just the lady's time to go.

Quote from highlandlass1592What "terrifies" you? Is it a lack of understanding of what may take place, what your role might be? The idea of losing a patient? I have found over my career that when something terrifies me, in my case it's usually due to a lack of information regarding something. I have found if I can educate myself, the terrors go away. What can we do to help you with your fear????

Quote from highlandlass1592What "terrifies" you? Is it a lack of understanding of what may take place, what your role might be? The idea of losing a patient? I have found over my career that when something terrifies me, in my case it's usually due to a lack of information regarding something. I have found if I can educate myself, the terrors go away. What can we do to help you with your fear????

Quote from Tina, RNI have to be honest, too. I am terrified of being involved in a code! When I graduated nursing school, I worked in med/surg for about 3 years. I never had to code a patient of my own. I went to a couple of codes, but there were always so many people in the room that I wasn't able to get close enough to actually be involved. After my hospital experience, I ended up doing case management for an insurance company for a few years. So, obviously no codes there, either. Now, I'm getting ready to return to bedside nursing in a couple of weeks as a per diem med surg RN. Since I haven't done bedside nursing in years, there are many things that I am anxious about, and codes are right up there on my list! For me, it's definitely a fear of the unknown. I mean for crying out loud, I've never even done CPR on an actual person, just on the mannikins in class! I think that doing the meds during a code would be so nerve wracking. Documenting everything, too. I'd be so scared that I would forget a tiny detail and get in trouble... I wonder if maybe there is a YouTube video or something that shows a simulation of a code??

You did all the right things. Death can happen very quickly where elderly people are concerned. I walked a patient to the bathroom, walked him back to his bed, then watched as he actively started the dying process. Hospice had been called in earlier that day. The RN hadn't even opened his case yet. Then I called the hospice RN to come and do it quickly as he was actively dying. All of this happened within 15-20 minutes. The family didn't believe me when I told them he was actively dying. Not until the RN came and told them did they believe it. His process was completed in about 90 minutes.