Wednesday, November 11, 2009

The V-Fib came out of nowhere....

It had been a slightly rough start to the shift. I found out I had two patients with behavioural issues on either side of the station. Luckily my ETOH W/D had a sitter, but the other one did not.

She was under 50, but had had a recent stroke. Until a couple days ago, there had been no residual. But then she stopped being able to perform ADLs, and her husband brought her in. Now she was agitated, trying to crawl out of bed, and almost nonverbal. Plus she mostly only spoke a foreign dialect that only one of our CNAs (the one who was supposed to be siting with my ETOH) knew, so he was in there trying to keep her calm.

The offgoing nurse let me know that she'd gotten haldol a couple times his shift, and he saved a X1 ativan for me. A little before 1600, the ANM said that now might be a good time to give the ativan so the CNA could go sit with my other patient. Within 10 minutes she was calm and sleepy, all systems normal.

The MDs were concerned about her having seizures because of the location/type of brain damage she suffered, so we started her on dilantin.

I went to go print my strips. She was normal sinus rhythm. I turned to say hi to a nearby doctor, then turned back to the monitor to finish the strips. All of a sudden, V-Fib. For a split second I thought "This can't be real" so I went to go check on her.

There were 2 nurses outside her door, about to go in and do a skin check (THANK YOU GUYS SO MUCH FOR BEING THERE FOR ME!!! YOU ARE AMAZING NURSES!!!) They saw the look on my face when I went into the room, and followed me.

She was slumped over in the bed. It almost looked like an absence seizure or a stroke. Her tongue was protruding, and she was making blubbing noises. We sat her up a little more, did a shake and shout, sternal rubbing, checked for pulse. I had almost hit the code button when she took a deep gasping breath. We felt a moment of relief before we realized that she was probably not going to be taking another breath.

I hit the code button and we started CPR.

From that point, it's a blur of people and activity. Within 10 seconds there were at least 20 people in the room. It felt completely unreal. Like I was trapped in a TV hospital drama, except this was my patient.

I remember people hooking her up to the defibrillator. She was in Torsades de Pointes. The MD yelling for Mag, which was *not* in the cart where it should have been. Finally they bring another tray and we get the Mag for him.

We stop the dilantin infusion, start NS running full blast. Put a compression sleeve on the bag to make it go faster. Starting a central line. CPR still going, intubation in process. Everyone clear for the defibrillator. Still no pulse, CPR continues. I try to clear debris off the floor so no one slips. There is packaging everywhere. Another shock. I took over for chest compressions for awhile. More feeling of unrealness. Drugs are going in. Triple lumen central line in place in the groin. One of the docs stitching the line down to the thigh. That must hurt, I thought, then remembered my ACLS instructor saying "It doesn't matter what you do in the code. The person is dead and not feeling a whole lot" The MD forgetting to let go of the guide wire before the next shock until another doc told him to drop it. Shock again.

The pulse came back. I go give report to ICU who has a bed for her. She's on the unit even before I finish giving report.

From hitting the button to sending her to ICU was around 30-35 minutes. Part of me feels like it lasted so much longer than that. Part of me feels like it was over so fast. I totally forgot I had other patients. It was probably the most in-the-moment I've ever felt. It was also probably the most disconnected from reality I've ever felt as well.

The ANM congratulated us on doing a good job. I was certain I'd get in trouble or something. I must have done *something* wrong to make this happen. Turns out she had an MI related to an LAD blockage. Not my fault. Thank god.

I was pretty shaken so I took dinner early. Went to the garden near L&D. They have lavender and rosemary growing there. I laid on a bench, listened to some music on my phone, watched the clouds, and tried to will my heart rate to go down below 100.

I can no longer boast about never having a patient code on me. But I no longer have to fear it eventually happening. And that's probably the better of the two options.


  1. wow...what an amazing story...sounds like you had your head on your shoulder. i dread my first code. i would be afraid i would forget something

  2. Oh my gosh. The SAME thing just happened to me yesterday too, my first full code! My pt was not due to MI, but due to shock resulting from HELLP and DIC postpartum. I completely identify with everything you wrote about how you felt!