Why We Freeze When a Patient Codes

I’ve heard so many people mention how they just freeze when a patient codes. Many look back with shame or embarrassment that they didn’t know what to do in an emergency… especially since they’re the nurse and should know what to do.

I get it. I did that the first few times and was really upset at myself for not knowing what to do, even though I’d gone through so many classes and looking back what I needed to do was so simple and painfully obvious. It only added to my embarrassment and disappointment even more.

Now before we begin a complete self-assessment and assume the worst about our capabilities, let’s explore a possibility as to why this occurs.

Why We Freeze When a Patient Codes

The Polyvagal Theory

There is something called the Polyvagal Theory, which was first introduced in the 90’s. Essentially, this theory explains that when we see a perceived threat, our body has an innate response. We don’t get to pick how we respond, our body simply reacts.

Our vagus nerve controls this response, and there is a ladder that we go down. We are either in a safe zone (where authentic learning, communication, emotion, etc. all thrive), a danger zone (our HR increases, muscle tension, increased awareness), or in a life-threatening mode (decreased arousal where we either faint or freeze).

How many of us froze during our first codes? Or have seen (or been) a nursing student who fainted at clinicals? Or seen a new grad faint on their first day? Or have seen a patient or family member freeze or faint?

My guess is almost all of you have either been in that situation or witnessed it.

Below is a summary image I created (source) of the ladder and the theory of our physiological response.

I must reiterate, however, that this is a theory and not yet classified as evidence-based practice (EBP) but do see value in understanding it and its possible implications for practice. Many in the mental health field have begun adopting it into their therapy practices.

Remember, it doesn’t matter if your life is actually in danger or not… it’s if your body perceives it that way. Our perception is our reality.

In short, because of the polyvagal theory, you may have limited control over your reaction in situations that feel unsafe. If the situation feels life-threatening, freezing and fainting are very real possibilities. 

Remove the shame and blame

There is nothing wrong with us when we freeze.

It just shows that our body is doing what it’s designed to do when we perceive danger. The key is outsmarting our body so we can function within the pressure and also removing the shame of not performing.

The interesting thing is that many people live their entire lives in the bottom two (red/yellow) areas of the ladder.

This may be due to exposure to trauma, especially during our formative years. Newer forms of counseling and therapy leveraging this theory focus on an awareness of the ladder, or physiological response, and intentionally pulling ourselves up to the safe zone.

How do we climb up the ladder?

So, how do we pull ourselves up the ladder and back into the safe zone?

There are many tactics that can be utilized, but one of the most effective and easy to start is breathwork.

What is Breathwork?

To put it succinctly, breathwork is any type of intentional breathing exercise or technique. Usually, this is mean to induce a calming effect.

Breathwork is very easy and simple (I do this multiple times a day). You can do this very quickly and discretely, and I highly recommend this for new nurses before their shifts or when they’re about to do something new and intimidating.

Below is a video made by a psychologist who explains the rationale as well as how to breathwork less than 5 minutes.

Breath work can be done in as little as 3-minutes and can help pull you out of the sympathetic nervous system response and into the parasympathetic response. Other ways you can increase vagal tone are with cold showers or humming/singing. I think the breathwork is the simplest and easiest way to begin.

When your patient codes

So if you’re a new nurse and terrified of that moment when someone starts coding (asystole or a rhythm that’s not perfusing) in front of you, do your best to see through the dense forest of your innate response and simply remember to:

Get on the chest

Get on the chest

Get on the chest

Get on the chest

The most critical component of CPR is compressions.

You don’t need to feel the pressure to innately perform the ACLS algorithm perfectly. Get on the chest and perfuse their organs while yelling for someone to call a code and get the code cart. The absolute top priority is to get on their chest and perfuse their organs as fast as humanly possible.

Their heart isn’t getting blood to their organs. You need to do it for them. 

Again,

Get on the chest

Get on the chest

Get on the chest

Get on the chest

Reminder: If you freeze when you see a patient code, it means nothing about your capabilities as a nurse.

You can still be an amazing nurse even if your innate and natural response those first few times to seeing someone dying in front of you is to freeze. You can still be an amazing nurse, even if you freeze the first few times. With time and increased exposure, you’ll settle into learning how to function despite the immense intensity.

Hang in there students and newbies, it will get better.

If you want to learn more about the Polyvagal Theory, I really enjoy the Stuck Not Broken website from Justin Sunseri.

To learn more about what to do when a patient codes, check out this FreshRN® Podcast episode.