Code Blue Experiences

Comments

  1. Laura says

    Thank you group for sharing. Did a code today, witnessed fall and vfib arrest. 83 year old HTN CABG AS, HLD. Admitted to hospital for chf workup. Got a ton of po anti htn meds, came off Tele to go for test, when he returned passed out in bathroom and code team came running.
    Code itself went well, shocked him out of the rhythm asap, then PeA. 2 rounds Epi. Got him back, intubated him, came back with me to ICU.

    But where did my doc go? Need orders. Bp down .Fluids started. I mentioned ,hey we need central line. Doc said stop sedation and see. Pt woke up pissed,now he is too awake for lines and procedures etc. Played with that for awhile (not fun), finally got a bit POd. Docs went back and forth, he needs this he needs that. Let’s try 5 times for an aline but he can’t have central til later (?) Started peripheral pressors which worked well. Finally got a line. Preparing for transfer too other facility. Drop the patient off, see old friends l,mosey on home.

  2. Jeff with admin. says

    Wow Ellen,
    That’s a bummer that your experiences haven’t turned out better. Don’t get discouraged though. They’re are sometimes when all of your efforts will be in vain, but there will be some times when your efforts will make the difference between life and death.

    I have been involved in many codes and some of them were very gruesome and disturbing, but quite a few of them were exhilarating when the patient was revived and the outcome was quite good.

    I hope that you don’t let two bad experiences keep you from being involved. You could make the difference and be the person needed on a team to help save lives.

    Thanks for sharing your story! Kind regards, Jeff

  3. Ellen says

    As a nurse I’ve participated in several codes, non with good results, unfortunately. The last code left me quite shell shocked and I hope I never have to be part of one again. The patient was not mine, but I was one of the first in the room, another nurse started compressions while I placed the back board and pads, I then pulled the bed out from the wall, hooked the O2 to bag and started bagging. Soon respiratory came in and took over, intubating the patient. To my chagrin I realized I was trapped in the end of the room by the bed and dresser, as I wanted to leave; every code I’ve been in ends bad. It took them 7 minutes to get the epi in, the patient did momentarily start having respirations on his own, then stopped. The aid next to me ended up getting tired from doing compressions, so I had to take over at the end. During the last set of compressions thick blood started coming up the tube down his throat and a foul odor hit my nose. It was grisly and left me with PTSD symptoms for a week, and questioning if he could have survived if the epi has gone in when it should have.

  4. Josie says

    Wow! 15 minutes of compressions. I can’t imagine how exhausted you were. Maybe he died because he weighed 550 lbs. He dug his own grave. I do not believe it is the fault of the anesthesiologist, nurses, respiratory therapists or anyone else who assisted taking care of this patient. What a sad situation.

    Great web site. Love the quizzes. It helps me to see where my weaknesses are. Thank you!

  5. Jeff with admin. says

    This story of sudden cardiac arrest with a successful resuscitation is amazing. Refractory ventricular fibrillation. CPR for nearly 2 hours with 12 shocks. He survived and was completely intact.


  6. Bonnie says

    When I was first on my own in the ICU I had a patient who was in the ICU as step-down overflow for hypotension following surgery for amputating his toes. He was alert and oriented and talking with me about the contents of his fridge having been there for years. He told me his milk was probably spoiled, and his house was full of old takeout containers. He was obese and very deconditioned, and I couldn’t imagine how he’d made it alone at home for so long. At about 6:45 before shift change he put his call button on. I was washing my hands and after I dried them I went into his room to see what he needed. He was unresponsive, turning grey and was in pulseless vtach. It wasn’t one minute after he put his call button on! Needless to say, he did not make it. It was the most exciting code for me, probably just because it was my first. Adrenaline was pumping! It was very surprising, also, since he was going to be transferred out of the unit soon.

    • DR ZAHEER ABBAS says

      DEAR BONNIE IF U DIAGNOSED UR PATIENT WITH PULSELESS VT ,HAVE U STARTED WITH CPR UNTILL DEFEB .MACHINE ARRIVED. IN THIS CASE U SHOULD START FOLLOWING CARDIAC ARREST ALGORYTHM.

  7. Sheikh Abdul Khadar says

    I was in my third year MD anesthesia programme doing on call duty. Code blue was announced at about 2 o cloack night in intensive care unit(that was the practice in our institution that time 1996) . When I reached the sight ,active CPR was going on .I took over the bag valve mask ventilation. I found the patient was being ventilated through the mouth. But to my surprise the patient was having tracheostomy.so the mistake was realised and the patient was ventilated through the tracheotomy tube. Patient recovered and discharged home after a week.

  8. Bernadette Santiago says

    Thank you Jeff for this site. I just passed my ACLS test with a 98! And I did well and was comfortable with the mega code skills. For three weeks I spent 1 to 2 hours a day with the practice test and the mega code simulators. It really prepared me well. Will be coming back in two years for my recertification.
    Thanks again!

  9. kimberley says

    one particular code blue stands out in my mind, I was helping a fellow nurse accept a patient to the med/tele floor, waiting in the room , patient is brought to the room and as we transferred the patient to the bed I noticed they weren’t breathing, ” the patients not breathing ” check for a pulse , of course no pulse , CALL A CODE
    not a great way to admit a patient .

  10. Sue, RT says

    After 35 yrs in the field, my 1st code blue was a long time ago. The 1st job I had, an experienced nursing supervisor told me there will be codes where everything will go like it was written in a textbook and the pt will die. Then, there will be codes where everything possible will go wrong and the pt will live and there will be all the scenarios in between. If you believe in a higher power, remember He has the last word. Do your best and remember the outcome is not riding on your expertise or lack of.

  11. Inessa says

    My first code blue was a few years ago on med-surg floor. Night shift.
    I had a confused old patient with a sitter. At the beginning of the shift I noticed that the patient was restless and tachypneic, but his VS were OK. I decided that he is stable enough and I still have time to review his condition later after I will be done with my other four patients. Two hours later I was on my break, reading his chart. The question was to give him another dose of Zyprexa or there was something else going on. Walking pass the door, I noticed that my very restless patient was sitting very still in his bed. “Something is wrong.”
    I called his name, shook his leg, arm– no answer. The patient was Full code. Palpated pulse…
    “Call the code!”
    So much for my break…
    Placed the head of the bed down. Yelled that I need a board. And started chest compressions, thinking, Fast, Hard, and Deep; Fast, Hard, and Deep. ( by the way, Jeff, just a few months ago I took ACLS and your course, so I felt empowered)
    Rapid Response Team came very fast. Someone took my place, so I could answer the questions:
    “Full code. Was restless and tachypneic. Has a sitter because of confusion after a recent surgery. ”
    The patient was intubated and sent to ICU.
    I visited him in a few days. Noticed a chest tube. Was told that during CPR a few ribs were broken. But the patient survived.

    • Jeff with admin. says

      Wow! That is a great story. Thanks for sharing. You really had to put your skill into practice. Great job!

      It is great that you got to visit the patient and see that the outcome was good. It pays to be ready.

      Kind regards,
      Jeff

  12. cminew says

    I have recommended this site to three other colleagues. I am again using this site for my own recertification.

    Thanks, Jeff!

  13. Jeff with admin. says

    Well, I guess since I started this page I will write the first code blue experience. The outcome of this code blue experience was not so good, but it was a pretty crazy experience, so I will share.

    This code blue happened around 2004 or 2005. We had been taking care of a man that weighed approximately 550 pounds for two or three weeks. He was admitted for respiratory failure, pneumonia, and he had multiple comorbidities.

    He was placed in our ICU because the rooms on the medical surgical floor could not accommodate his considerable size, and he required a large specialized bed because of his size and weight.

    The first week that he was in the hospital, I was amazed at the massive quantities of food that his family brought to him. He used to eat an entire bucket of KFC chicken 25 pieces, and he would, for a snack eat, a #10 can size of pudding.

    After the first week of care, his respiratory status declined significantly, and he was placed on BiPAP. Over the next week, his respiratory status continued to decline to the point that noninvasive respiratory measures were not adequate to keep him out of respiratory distress. The handwriting was on the wall. This guy was progressing quickly to full-blown respiratory failure, and none of our interventions were reversing the trend.

    At this point, it was determined by the attending physician that he needed to be intubated and the risks of intubation were discussed with the patient.

    This guy had no neck, and the anesthesiologist was concerned that we would not be able to successfully intubate the patient. However, there didn’t seem to be any other choice in light of the patient’s condition.

    Everything was prepared for the intubation, and about ten people were in the room to give assistance.

    The patient was sedated with Versed, and the anesthesiologist attempted the intubation. Three attempts were made without success, and the patient was oxygenated in between each attempt. The patient’s respiratory status continue to worsen for the next 30 minutes while multiple intubations were attempted. Two physicians and one respiratory therapist tried and failed. To make things worse, during one of the later attempts, the patient vomited.

    At some point around the 30-minute mark, the patient developed bradycardia which rapidly degraded into PEA.

    I’m not sure if I can verbalize exactly how we attempted CPR on this 500+ pound man. We began chest compressions with the person providing chest compressions on the side of the bed, but, due to the size of the patient, the compressions were insufficient to produce any significant cardiac output. No one could get high enough on the guy’s chest to perform proper chest compressions.

    At this point, I proceeded to climb onto the man, straddle his upper torso with my legs as if I were on a horse, and began chest compression. No one else felt comfortable enough nor wanted to perform chest compressions in this manner, and so for approximately 15 minutes, I provided continuous chest compressions. I was completely exhausted when I was finally relieved by another young guy that came to assist later into the code. He and I alternated chest compressions for another 15 minutes before everyone on the code team decided that further attempts at resuscitation we’re going to be futile.

    This was one of the longest codes that I have ever participated in. I think that the main reason why the code lasted for such a long time was the fact that we were partially to blame for the arrest because of our failure to successfully intubate the patient. In retrospect, it would have been a good thing if we would have had access to something like a Bougie, Combitube or a King airway device, but none were available at our small facility.

    This patient would have most likely ended up in this situation whether or not we would have attempted intubation. Nonetheless, it was a difficult decision on the part of the entire team to give up and call the code.

    I look forward to your comments, and I hope that others will share their code stories.

    Kind regards, Jeff

    • Stacey Praschunus says

      Sorry to hear that the pt lost the battle. Can only say “Wow”. Im suprised no one else climed on the bed – being ‘only’ 5’6″ – I have to get up on the bed to do compressions.
      I am not short – it just makes it easier to keep the right rate/depth going. After all – we learn CPR on our knees right.

    • Inessa says

      Thank you, Jeff, for sharing your experience. I think the attempt to resuscitate this patient was futile because of his size.
      The method of chest compressions you described is very creative. Thank you. I’ll keep it in mind, just in case…

    • karen ramsdell says

      wow great story…sorry the end was not so good. Unfortunately as we are seeing an increase in the bariatric population this story may be helpful in the future to keep in mind.

    • Inessa says

      Hi Jeff,

      I reread your story of the resuscitation of the obese patient and I am wondering, Do we have any written papers/research on how to approach the resuscitation of a very obese person?
      During our training do we even talk about it?

  14. Annette Boyle says

    Many thanks jeff for such a great site have just completed acls and thanks to your great site got top marks in mcqs.and passed course I have highly recommended you to colleagues .Keep up the good work .
    Annette

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