Code Blue

Code blue. Sound familiar? No one wants to hear this in the hospital and especially not on his or her own floor or unit! If you don't work in health care or watch medical type shows like grey's anatomy or scrubs you may not be familiar with the term "code blue". This term is "code" for cardiopulmonary arrest which is basically a fancy world for saying a person is no longer breathing, does not have a pulse or both. This situation triggers health care providers or any person in any situation to start CPR (cardiopulmonary resuscitation).

A couple nights ago I was at work going about my shift. At about midnight I was in a patients room hanging fluids when my pager went off for a "staff emergency". I look down at my pager it says, "RM 59 staff EMG". I drop everything I'm doing tell my patient I will be back and run out of there down to room 59. I'm the first one there and I see my coworker leaning over the patient who is half way in bed. He looks like he was sitting at the edge of the bed and had collapsed down sideways to his left side with his back facing me. His legs were still dangling off the bed, as my coworker stood in front of him sternal rubbing him and shouting his name trying to get him to respond. I asked my coworker, "what's going on?!" Because the situation was unclear to me and a lot of times people will use the staff emergency button if a patient is about to fall and need more body power to get the patient safely back in bed. My coworker immediately says, "get the crash cart!!!!” The crash cart is literally what it sounds like. It's a cart that is stocked with everything you need from medications to tools for a patient that has "crashed". Now for those of you who watch medical shows and are not familiar with real hospital situations, not all patients are hooked to monitors already. That's usually only in ICU (intensive care units). I do not work in ICU. So when a person "crashes" on my floor we literally are starting from scratch. We have to hook them up to a monitor that continuously reads this blood pressure, heart rate, heart rhythm, respirations, and oxygen saturation. Luckily the crash cart was located right outside this patients room so I grabbed the crash cart and the monitor by this time we had about 7 people in the room everyone assumed a task so that we could start CPR.

Things that need to be done in a code situation are: first, call a code!!! This means someone go to the phone and call the code line where the operator announces the code overhead in the entire hospital so the code team is notified and comes to the scene while simultaneously someone else is notifing the doctor, respiratory therapy, the rapid response team, and action nurse. While that is happening outside of the room in the room where the patient is the rest of the nurses are getting the bed flat, putting a hard board under the patients back to create a firm surface for chest compressions, starting multiple IVs, drawing labs, putting shock pads on, getting an EKG, checking for a pulse, doing chest compressions, and giving rescue breaths via an ambu bag. I'm sure there is more stuff but those are the ones I can list off the top of my head. Basically it's complete madness. However, the absolute key to a successful code is to KEEP YOUR SH*T TOGETHER! Calm down! There is no need to yell. ONE person takes the lead and delegates so everyone knows what they are doing. Everyone's adrenaline is on full blast. Someone's life is literally in our hands so it’s easy to lose control. I've been a part of several codes this one was REALLY good. I've been is some terrible codes where everyone is just yelling at everyone. Completely unproductive and unnecessary.

My roles in this code was to get the patient hooked up to the monitor then administer rescue breaths. Because I was so wrapped up in the code I didn't even have gloves on when I was placing the pads for the monitor and while ambu bagging the patient but I really didn't care at that point. This guy was not breathing, did not have a pulse, eyes were fixed and dilated. It took the code team 6 minutes to finally get up to my floor. 6 minutes in a code not on an ICU without the code team is a freakin lifetime in a hospital setting!!! 6 minutes is 3 rounds of CPR, 2 rounds of pushing meds, and 2 rounds of shocks. It's a LONG time. By the time the code team arrived we had JUST got a pulse back! PHEW!!! We were stoked. Not only that but, the patient was responsive! So of course what happens the attending physician starts questioning our judgment as nurses for starting chest compressions. She was asking condescending questions implying that we really didn't need to code this patient. We all looked at her like she had 4 eyes. The guy was not breathing and did not have a pulse. Were we supposed to wait SIX minutes till the code team arrived??? He would have been dead!! Needless to say we were completely offended by the attending doctors tone and lack of trust in our clinical judgment to call a code. Why on Gods green earth would we jump on someone's chest and break all his ribs doing chest compressions if he was awake?! Long story short the patient was successfully transferred to ICU to be monitored, as he should be. The next night the SAME attending physician came on to our floor and personally apologized to us for her behavior during the code. She told us that the patient had multiple blood clots in his legs, heart, and lungs. She said if it wasn’t for us starting chest compressions he would have died. BECAUSE we started chest compressions we broke up that clot and the patient survived. I give that attending a lot of credit for one, realizing that she was being extremely condescending and second, that she was wrong and came up and apologized and thanked us for our effort. Not many attending physicians will get off their high horse and do that. It says a lot about her as a person and I respect that.

Situations that require CPR are always scary no matter how many times you have been involved in a code. This is someone’s life, someone’s mom/dad, sister/brother, wife/husband, someone’s child, bottom line it’s SOMEONES loved one. You don’t want to be the person making that phone call telling that family they have lost their loved one. Furthermore, for those of you not involved in health care who have never taken a CPR class the most important thing to know if any person goes down and you witness it or you stumble upon them call for help (911) and start chest compressions until help arrives. Don’t waste your time giving rescue breaths. Research has shown it is crucial to do chest compressions as early as possible after the collapse of a person to pump and circulate whatever oxygenated blood is still in their system to their brain and most of the time people giving rescue breaths were taking too much time and where not adequately give breaths of any significance. IF you are in an airport, mall, gym, any type of shopping center usually they all have an AED somewhere. If you remember ask for an AED. This is a portable defibrillator (the machine that delivers shocks). It is super easy to use just turn it on and it will prompt to on what to do exactly step by step. If a person does not have a pulse and is unresponsive administering a shock ASAP is the most effective way to get them back into a normal heart rhythm. Usually adults go down due to cardiac (heart) issues. Children are usually respiratory issues. Things like the child has drowned, choked on something, or had an asthma attack. Children usually have a pulse! Don’t start doing compressions on a child that has a pulse! The American heart association (AHA) wants you to call for help FIRST then start CPR on and adult that goes down. On a child the AHA want you to do one round of CPR THEN call for help. This is of course if you are by yourself. If there are multiple people then of course someone is calling for help while you do CPR in both situations.

Best way to avoid these situations is be safe with children. Don’t leave them unattended especially around bodies of water. Make sure they take their meds and have their albuterol especially during the cold days of the year and when playing sports. Adults, take charge of your life. Eat healthy, exercise, don’t smoke and take your medications regularly especially if you have high blood pressure or are a diabetic.

You don’t want to be the next code blue. Here is a link on how to handle a code blue situation.  Research has shown that people who have viewed a CPR instructional video are SIGNIFICANTLY more likely to attempt life saving resuscitation. PLEASE watch!!! You could save someone’s life!

http://www.heart.org/HEARTORG/CPRAndECC/HandsOnlyCPR/DemosandVideos/Demos-and-Videos_UCM_440561_Article.jsp

Until Next Time.

- Norah

Do you want to be right OR do you want to be happy?

We all have heard the phrase, "do you want to be right or do you want to be happy". Mostly in relationship context. However, this phrase can apply to anything really especially at work. At any job you can be the best worker and usually if you are one of the "best" workers you are also that one that catches all the flaws in the system. However, who likes a person who ALWAYS points out your flaws? This could be the reason why you never get promoted. This could be the reason why the guy or girl that is not as good of a worker as you are got the promotion and you didn't. Managers tend to have a lot on their plate. Now, I'm not saying this is the RIGHT way of doing things but it is the way it is. So you can choose which path you want to go down.

Managers tend to like things running on autopilot. When they finally get to this stage they are happy, comfortable, and most importantly don't want to be bothered. Therefore, if you are the great worker that you are and you see and find flaws everywhere and feel the need to always be the one to bring them up to management or get into confrontations frequently with colleagues about not doing their job right and it gets back to the manager through the grapevine then guess what? YOU have now interrupted their happy, comfortable, and don't want to be bothered autopilot state. YOU have created more work that they frankly just don't care or want to deal with. So now even if you are always on time, never call in sick, always go above and beyond your job title you still will never move up. WHY? Because of management's preception of you. Why would a manager want to promote someone that points out all their flaws? Someone that will always create more work? Someone that always creates drama? Now, you could be RIGHT. But it doesn't matter! This is when you ask yourself, "do I want to be right or happy"? Clearly you want to be happy and you think but reporting with is RIGHT you will be happy but instead it backfires.

As a staff member you need to learn to to pick and choose your battles, especially if you want to climb the ladder. You want your manager to feel like you always have his/her back. That you will not cause drama. That you will keep their office, company, unit ect. running on autopilot just they way they like it. They really don't give a damn that Suzie came in 2 minutes late or that Johnny never does his sign out reports. JUST DEAL WITH IT.

Coming from someone that is pretty opinionated and see's flaws all the time where I work and in my profession I have learned how to "play the game". Why? Because I want to be an executive one day. And if I'm perceived as that one nurse that is ALWAYS complaining, always creating drama, and ultimately creating more work for my manager and ruining her utopia then I will never move up the ladder. Learn to deal with issues independently. If the issue is something that needs to be addressed approach your colleague on your own and deal with it in a professional manner. Realize that people have different personalities. You cannot and will not change peoples personalities. To be successful you need to be adaptable. LEARN TO ADAPT. You will be golden if you do.

It is just like a relationship. Who wants to date someone that always points out your flaws. That doesn't have your back. That always creates drama. That doesn't get along with people and can't adapt. That doesn't help you grow as person. Would you want to be with a person like that? Would you want them to be a part of your life? No! I certainly wouldn't. Neither would your manager. So the next time you come on shift and your colleague leaves you in shambles to start your shift. Take a deep breath. Calm down, and get your work done. Don't run to your manager or jump on the computer and shoot an pissed off email. Be an adult and handle it yourself. Usually once you let some time pass you are not so upset. You get time to think about it and realize it really wasn't THAT serious. IF it was THAT serious. Then the next day or the next time you see that colleague tell them, NICELY. You have A LOT more clarity when you are NOT in the heat of the moment. It's always better to "cool off" before trying to approach someone about something when you have had some time to think it over and "cool off".

Lastly, when you leave a job that has poor management and you really disliked it there. This is NOT the time to write a lengthy letter to the manager of the things you think they need to work on and just didn't want to say while you were an employee there. NEVER ruin your connections. Believe me your letter will not change ANYTHING except your relationship with that manager and anyone connected to her/him. You never know when you will need that person in the future. If you know you might have "rocked the boat" a few times during your employment say something to your colleagues and manager like, "Thank you for believing in me. This has been such a great opportunity I have learned and grown so much from all of you. Most importantly thank you for putting up with my mistakes I know I'm not perfect! But if I could come back with all the knowledge have today after working here I know I would be a better colleague to you all than I was when I started and I thank you guys for that....blah blah blah" this way you make everyone feel appreciated and you leave with people having good thoughts and FEELINGS of you. You have heard of the saying, "they may not remember what you said but they will never forget how you made them FEEL". This is what you want. You want to make your manager and your coworkers feel special. THAT is how you build lasting relationships. That is how you start to climb that ladder. So the next time you THINK you are being a "good" employee by reporting what is "right" REMEMBER, do you want to be right or do you want to be happy?

No system follows the rules to a T. It's almost pointless to always point out the flaws. Observe and stay silent. To get to the top you don't have to follow all the rules. You just have to have enough followers.

Until Next Time.

-Norah