Stay calm and remember these tips when your patient codes. This will help you respond quickly and correctly every time.
This can be a very scary experience.
I still remember the first time a patient coded. It was such a scary experience for me that I doubt I will ever forget it. It happened around 2010.
It takes a little time to learn how to function with your fight or flight response, so I want to talk about that and encourage you.
There are practical things that you can do (and should do) immediately, but it is very difficult to access that information in your brain when a patient is coding.
3 Things To Do When A Patient Codes
There are three very basic things you should do every time a patient codes.
- Check Pulse
- Get on the chest immediately if you don’t get a pulse.
- Give Them Oxygen
Remember, if you check their pulse and they have one, that means their heart is beating enough and you don’t need to do chest compressions.
If someone stops breathing and the heart stops beating, and you have never had to deal with that before, you are probably going to freeze. Even though you logically know what to do, accessing that information in the midst of a life-or-death emergency is almost impossible.
Our Fight Or Flight Response
As humans, we all have a fight or flight response. When we see an emergency in front of us, our body reacts – it is innate. It is not something you are consciously in control of.
If you see someone code and you freeze, it does not mean you are a terrible nurse that is not able to do this. It means your body is doing what it was designed to do.
How To Regulate That Response
I’m going to share some ways that you can regulate your fight or flight response so you can be awake, alert, calm, and able to move quickly when you need to. I’ll share how you can move efficiently without freaking out and without freezing.
Spoiler alert: It takes time and repetition to get to that point. You may have instances when you are learning how to do this where you are going to freeze. That’s normal and it’s to be expected.
When you start getting used to the way your body responds, you will be able to actively tell your body, “Hey, thanks for alerting me, amygdala, but calm the heck down, so that I can use the pre-frontal cortex of my brain.”
It Takes Repetition
When I experienced my first code, I didn’t realize that it takes repetition to teach your body how to respond to trauma. It is normal to freeze and be stuck in the fight or flight response the first 5 or 6 times you see a patient code.
Do Not Be Too Hard On Yourself
Do not beat yourself up if you freeze in the middle of the situation. Just know that it is your body responding the way it is supposed to.
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With more repetition, you will get used to it and you will get better at it. Eventually, you will know the ACLS algorithm forwards and backward.
Memorize These Actions For When A Patient Codes
When that patient codes, you need to take a deep breath, tell yourself that you know what to do, and then just do it. There are 2 main things you need to remember to do – get on the chest and give them oxygen.
Take A Breath & Get On The Chest
Make it an instinct to get on the chest as fast as you can.
When they are coding, that means they are perfusing. They need something to beat their heart for them.
If the patient is sitting up in bed, you pull that CPR lever, let them go flat, and then you start compressions. Then you can scream for the code cart.
Focus On Airways
After someone is focused on giving chest compressions, the next important thing is the airway. Grab the bag valve mask (that I hope is already set up) and crank the oxygen as high up as it goes. Get the oxygen flowing to the bag and put it on their face.
Tilt their had back and put the mask on their face so the oxygen can flow to the patient.
My First Patient-Code Experience
I talk about my very first code in my book, Becoming Nursey. I basically had an identity crisis where I froze and thought, “I don’t know what to do!” Everyone else knew what they were doing, but I was worthless.
I felt frustrated and was afraid that maybe I wasn’t meant for this. Plus, I just watched somebody die. I got blood all over me, and they were dying in front of me. It was very traumatic.
Remember, if you freeze, it is ok. It doesn’t mean you are a bad nurse or not cut out for this job. You need to take a few deep breaths and tell yourself, “I’ve got this. Get on the chest.”
If someone is not on the chest yet (and they don’t have a pulse after you check), get on the chest.
After you (or someone else) starts chest compressions, get the bag of oxygen on the patient.
Please remember to keep your expectations of yourself normal. As a new nurse, you aren’t experienced yet. You are still learning – even a few years into the job you will still be learning. Give yourself grace and keep an attitude that responds to learning new things.