Fertilize your Crops, and Plant the Seeds of Growth
Posted by Sean on September 14, 2008
Working in a Level 1 Trauma ICU is fast-paced to say the least. There isn’t much that happens on the unit that is in slo-mo. 
The staff takes this for granted sometimes. We are so used to the ‘pulse’ of the floor that what most would consider an emergency that warranted calling a ‘code’ and/or ‘condition’ we take as the typical day at work. This becomes apparent more so when we have GN’s and new employee’s on orientation. What has become a reflexive response for us, is new territory for them. And the only way for them to become ‘reflexive’ is to throw them in the pool and help keep them afloat.
The other day a ventilated pt’s heart rate went from the 80’s to the 220’s in a blink of an eye.
Of course we did what we always do. You follow your ACLS guidelines and protocols. You get a hold of the physician on the floor. We hooked the pt up to the defibrillator with defib pads attached.
In a matter of seconds we’re following protocols and taking orders from the Doc.
Adenosine 12mg IV push… Lopressor 5 IV push X 2… Recheck rhythm.. Reassess pt.. Draw up some Versed 4mg IV… Amiodarone 150mg IV push… Reassess..
During all of this.. we have 3-4 GN’s watching nervously… watching intently… taking notes… whispering amongst themselves.. while we’re doing our job.
It dawned on one of us. HEY.. How about we get the GN’s involved??!!
DUH!? 
This was a golden opportunity for the newer, less experienced nurses to get a real taste of what a ‘code’ is like. It was what we refer to as a ‘controlled code’. It had all the makings of a pt in distress, without the involvement of the flow of bodily fluids, rapid infusers, and surgical instruments. So this was the perfect learning environment. And to add icing to the cake we had over a handful of senior staff at their side.
Every nurse out there remembers that "Fear of Death" feeling you had in the pit of your stomach at your first code. I think it’s the only place a human being can feel excitement, fear, anxiety, nervous, curios, and down right awe all at once.
The only thing that can help a new nurse get through that first time is to help ‘control’ the environment with encouragement, guidance, positive reinforcement, and patience. And in this situation we had all that and more!
The ‘code’ was packed full of learning experiences. It had SVT, Sinus pauses, hypotension treated with vasopressers. We then had to reintubate the patient because in the thrill of the situation the patient bit the pilot tubing of his endotracheal tube. So with no cuff pressure they were getting no positive air volume. Re-intubation came with paralytics and sedatives, pulse ox monitoring, and some good ole’ Bag-valve mask oxygenation.
As you can see we had the works.
It was a successful ‘code’. The patient recovered with no residual injuries. The GN’s got their feet wet, and we not only helped a patient in distress but planted a couple seeds of growth in our awesome nursing profession.
We reap what we sow.
Carpe Diem
Strong One said
@ Mark YES we do. Some of us invite it, and others run from it!
@ Caroline It will get better. And besides, it doesn’t get much more sick than that!
Strong One said
@ Mark YES we do. Some of us invite it, and others run from it!
@ Caroline It will get better. And besides, it doesn’t get much more sick than that!
Caroline said
I remember my first code…it was just a few months ago; they cracked the guy’s chest at the bedside! I was freaking out. It wasn’t even my patient. I just hid in a corner with the other nursing students and med students and hoped no one would ask me to go get something…i.t was only my 3rd day and I had no idea where anything was yet. So on behalf of all GNs everywhere, thank you for forcing us to take the leap of faith!
Caroline said
I remember my first code…it was just a few months ago; they cracked the guy’s chest at the bedside! I was freaking out. It wasn’t even my patient. I just hid in a corner with the other nursing students and med students and hoped no one would ask me to go get something…i.t was only my 3rd day and I had no idea where anything was yet. So on behalf of all GNs everywhere, thank you for forcing us to take the leap of faith!
Mark Salinas said
You nurses have all the excitement!
Mark Salinas said
You nurses have all the excitement!
Strong One said
@ May I still love them!
Strong One said
@ May I still love them!
may said
sometimes, i kind of miss that adrenaline pumping situations in the ICU. only sometimes
may said
sometimes, i kind of miss that adrenaline pumping situations in the ICU. only sometimes