One minute my patient is alert, eating her lunch and due for discharge that afternoon; the next minute she is unresponsive, suddenly incontinent, flaccid, and bradycardic with an unreadable blood pressure.
What happens next, in my opinion, is scarcely short of miraculous…and I’m not talking flutter of angel wings, heavenly music, instant recovery, but the workings of a system in place honed and perfected to handle any emergency situation arising within the four walls of a modern acute care facility.
Within minutes (if that) of slamming one’s hand on the code blue button an entire team of highly trained professionals are abruptly ending conversations, running down stairwells, slamming through doors and arriving at the bedside to do what they do best: save a life.
Organized chaos ensues: nurses perform CPR; placing lines, leads, pads, cuffs and probes to monitor oxygen, heart rhythm, blood pressure and, if necessary, to shock an unresponsive heart back into a viable rhythm. Respiratory therapists take their place at the head of the bed and ensure a patent airway. Code leader immediately asks for relevant history and patient data and starts directing situation-specific algorithms and interventions. Pharmacists stand ready to help with any drug related situations and questions. One nurse is recording every shock, drug, interventions, responses and timing of everything. Anethesiologists and ICU nurses are taking orders and working in sync starting necessary iv’s, obtaining labs, bolusing fluids, pushing drugs. All are keenly aware of the code leaders calm voice through it all directing, reviewing, questioning, probing : the how’s, the why’s, what’s underlying diagnosis, where are we at now, what’s the blood pressure, anyone have any suggestions, lets review the data, let’s get an EKG, lets call the neurologist, lets infuse another liter.
The outcomes, of course, are varied. Sadly, some patients don’t make it despite heroic interventions. Many, however, do and are usually transferred to the ICU for close monitoring. My patient was one of the lucky ones. She gradually regained consciousness and became appropriately responsive, and I squeezed her hand assuring her she was in good hands as they wheeled her off my unit.
There is always a certain “feel” to a unit following a code blue. A certain calm or “release”. A doctor here or there charting or making phone calls. A now empty patient room that looks like a tornado just released its fury in there: tubing and packaging splayed on the floor, IV start kits ripped open and a desecrated crash cart shoved to the wall, monitors blipping vaguely, equipment pushed to the side and empty Iv bags hanging. I wander back out to the nurses station and attempt to focus on the screen in front of me …oddly enough I can barely keep my eyes open even with the adrenalin still coursing through my veins. Well, not so odd: I barely slept the night before and its well past break time. Such is the life of a nurse…My charge practically shoves me out the door for lunch and another day continues on…
Oh, and I haven’t even mentioned Rapid Response Teams!…those are my favorite 🙂