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!
Until Next Time.
- Norah
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