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The First Loss: Grab the Crash Cart

Article originally posted on katiedukeonline.com 

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It’s pretty obvious when you work in healthcare that one day you will have a shift that you lose a patient. As a nurse I found myself in this situation quite often working in the emergency room, however, as an NP, it was a moment I feared. Would I know what to do as the provider in an emergency? Would I be able to respond quickly and effectively and safely as the one in charge of care? I’m not even kidding when I say this is something that haunts a new NP, or any new provider for that matter.

It was just another night, I was working with my favorite group of nurses, and it was close to midnight when I heard Marie yell, “I need an NP in here now!”
Cue my “Oh Sh*t face”.

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There are two situations that are no good in the hospital:
1. Anytime you see someone running — (Unless it’s me running to the break room because there’s free snacks up for grabs, and in that case, GTFO of my way)
2. Anytime you hear someone yell “I need help in here!!”

That’s hospital code for “Something is going DOWN!”

I will spare any identifying details of what exactly happened but what I will touch on is what was going through my head when I went into that patients room.

She was not in arrest when I ran in, but actually having a neurological event. I ordered O2, suction, Ativan, and to call the patients primary NP to the bedside as she was on another unit at the time. All I knew was what was directly in front of me: female, acute neurological event, breathing, has a pulse……for now.

Next I heard one of the nurses yell from outside at the telemetry station, “VFIB!!”

We immediately started CPR and got the crash cart in there and I hooked up the defibrillator and slapped the pads on and shock was advised and subsequently delivered. I got out my “cardiology emergency algorithm quick pocket guide” and like the new NP I am, flipped the pages super duper extra quick while simultaneously starting round 1 of ACLS.

I’m sure there’s an app for that, and I will be downloading it asap.

My adrenaline was on full fledged FUEGO! (That’s Spanish for “Fire” lol)

My hands were shaking. It was myself and one of the other NP’s who’s a year into her first NP job. We looked at each other like — OK. HERE WE GO!!!

CPR is in progress and IV’s were secured and the code team was enroute. I delegated and gave everyone roles and clearly that was the ER Nurse in me. Thank you ER!

I had never been in a code with my new role as an NP and I knew that time would eventually come but I was definitely hoping it wasn’t 3 weeks out of orientation.
But. It. Was.

So now there’s 8 people in the room and the team is looking at me for direction and I felt a sense of accountability and responsibility and leadership that I’ve only heard about from other providers when they recant their first code.

Pulse check. No pulse. VFIB. Charge. Clear. Shock. Continue CPR.

And here arrived the code team.

THANK YOU HEALTHCARE GODS FOR THE CODE TEAM!!!!!

I have never been so happy to see a code team in my life. Comprised of ICU and Medicine residents and fellows, they came in and joined our efforts and took over as code coordinator/team lead.

The patient was intubated and then we lost the IV. Anesthesia tried to pop in an EJ (external jugular) access and they also tried to get one in the foot and both attempts were unsuccessful.

So I kicked into ER Nurse mode and grabbed her deep AC (antecubital) and secured an 18G in and kept it moving.
*Drops Mic

During a code you have to act and think faster than you ever will in another situation. Mistakes are made and IV’s are missed and intubations can be unsuccessful and numerous other issues, so when I got that puppy in and it worked, there was a silent cheer of relief in the room.

Push some Amio. Start the Amiodarone drip.

More shocks. More rounds of ACLS. A total of more than 10 for the final count. Persistent PEA Arrest (pulse less electrical activity) ensued and after 48 minutes the team had exhausted all measures and efforts and it was futile at that point.

Time of Death pronounced.

Sometimes we succeed in a resuscitation and someone we do not. There are so many factors and etiologies that are out of our control, but we always give every patient ALL WE HAVE AND ALL WE CAN.

Even if the patient is elderly and lived a marvelous life and the death was almost expected, at the end of pronouncing it we all need to take a moment. Death is something that affects all of us. Even if we see it every week at work. It’s still someone’s loved one. Someone’s mom, dad, child, sister, brother, friend, spouse. A lot of us take a piece of that with us. It’s how we cope.

We thank each other for our collective efforts and teamwork and we then have a moment of silence and then return to our other patients- who don’t always have a clue what just happened but are ready to remind us they’ve been waiting for 30 minutes for someone to bring them pain medications or turn the lights off.
Let me tell you that doesn’t always go over smoothly, but do you blame us?

Just another night at the office.

The next few hours I found myself wondering all of the “what ifs” and all of the “did I’s?”. Did I respond fast enough? Did I miss something? Even if you followed everything down to the book, and did what any prudent provider would have done, you can still expect some form of post code “inner questioning” to go on. At least that’s what I found myself doing.
Either way there is always a lesson to be learned and an experience to grow from. I took a piece of that patient with me that night, and after all of my years in healthcare I can say that most all of us do.

Healthcare is very humanizing.

KD

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Scrubs Staff


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