ArticlesClinical Nurse

Code 5, Room 623!

If you work as a nurse in a hospital, you undoubtedly have a “code” in place for cardiopulmonary arrest.  Even if it isn’t your patient or you are not assigned to the code team, you probably get chills when you hear the code called overhead.

In my facility, a cardiopulmonary arrest is a “code 5.”  Various staff members are assigned to the code team each shift and when the code is called, those staff members drop what they are doing and run for whatever unit the code has been called.

As a staff nurse, I spent the bulk of my time working on a telemetry unit.  I worked on the same unit as both an LPN and an RN.  I loved the rush of the unit and even took ACLS as an LPN which set me up very quickly as a code nurse as a new RN.

If you’ve ever taken ACLS, there are several members of “the team” – two people who alternate between chest compressions and using the bag-valve mask for ventilations, the medication nurse, the recorder and the nurse in charge of the code.  Our code team was formulated in a similar fashion – the respiratory therapist who was assigned to the unit took care of ventilation needs, a couple nurses/aides with BLS training working on the unit would trade in for compressions, a telemetry nurse was assigned to be medication nurse (because of the fact that we had advanced heart rhythm training, it helped to anticipate which medications may be next), a med/surg nurse would be assigned to be recorder and an ICU nurse would be charge nurse and would assist the physician.  Each shift, the units would assign a nurse to respond to codes so that there was always a team in place.

On my unit, I had participated in many codes as both an LPN and an RN.  I’d had a few of my own patient’s code.  I’d also shadowed on codes on other units; but when I walked in for my shift that night to see that I was code nurse for the night for the first time, I knew without a doubt that I wouldn’t get off that easy.

The night flew by fairly uneventfully.  It got to be 0600 and I said to a coworker, “Wow, I might actually get out of here without a code tonight!” – which every nurse knows is jinxing yourself.

At 0615, I heard “Code 5, room 623.  Code 5, room 623.” I felt my stomach fall.  I looked at my patient and said, “Well, sounds like someone needs me.  I’m going to put on your call light to get you that blanket and my coworkers will know I had to go!”  And off I went.

I ran down one flight of stairs in record time and beat the crash cart to the room.  I watched a nurse performing chest compressions on a man who appeared to be in his 60s while another nurse stood by with a bag-mask valve.  All of a sudden, the room filled with people.  I took my post by the crash cart, took a deep breath and reminded myself, “You can do this!”

I do not recall what the man had been admitted for, but we were told that he had collapsed after walking back from the bathroom and was lucky to make it in to the bed.  He had no history of heart disease except hypertension.

As the other nurses worked at chest compressions, the respiratory therapist began to call out what was necessary for intubation. I assembled the necessary supplies and passed them to him and the physician. The ICU nurse put the pads of the defibrillator on the patient’s chest and an assessment of rhythm found the patient to be in asystole, a nonshockable rhythm.  Chest compressions resumed.

In the interim, I noted that the patient had two IV lines; I flushed both IV lines and started the requested IV fluids at a “wide-open” rate. I pulled out a dose of epinephrine from the cart, in the event that the next rhythm assessment found a shockable rhythm.

The rhythm assessment found a shockable rhythm so someone yelled, “EVERYONE CLEAR!”  The defibrillator shocked the patient and chest compressions resumed.  I was asked to prepare and administer and prepare epinephrine, 1mg via IV.  By the time this was complete, rhythm was assessed.  A bradycardia was seen on the defibrillator, with heart rates in the 40s.  Transcutaneous pacing was immediately began and the patient was transferred to the ICU.

I walked slowly back up to my unit.  I was certain that it was past the end of my shift.  When I got to my unit, day shift nurses were just beginning to get report – a life was saved in a matter of minutes.

It was not an ideal way to end the shift, but I knew that although we “save lives” often as nurses, that night I truly impacted the trajectory of someone’s life.

Krystina Ostermeyer

Krystina Ostermeyer is an RN. She has worked in a variety of practice settings, from a telemetry and stepdown unit, to an allergy and immunotherapy clinic, to most recently, a diabetes education office. She recently earned her certified diabetes educator (CDE) credentials and works with people with diabetes through all stages of life, from pediatrics to geriatrics. When she isn't working, she enjoys freelance writing. She also enjoys traveling with her husband and 2 year old son, walking, reading, cooking, spending time with friends and family, and enjoys craft beers and dark chocolate.

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