Been deflowered...... in the ER world that is.......

Tonight I had my first cardiac arrest patient - and yes, he died. In the ER (at least ours), you're no longer a 'virgin' once this happens.

For clarification (cause its not something most people have a clear understanding of and according to Kristine ( :) ), I cant speak medical talk to everyone "u know we all haven't been to nursing school!!" , a patient having a heart attack (MI) is not the same as someone in cardiac arrest. Heart attack is when an area of the heart is deprived of oxygen because of a blockage in a vessel that serves that area - and therefore the area of tissue dies. Yes, a heart attack can lead to cardiac arrest. Cardiac arrest is literally when your heart stops beating - the electrical component of the heart stops working. At that point, blood is not moving throughout your body - not to your brain, your lungs or your tissues. Not a good thing. For starters people who have a true cardiac arrest - unless medical attention is received within a FEW minutes - rarely make it out alive; something like 95% of people die before they reach the hospital. Sad & scary fact, but true.

Back to tonight; so when I picked up the zone I had tonight, I knew I had the room we save for codes - meaning if one came in, it was going to be mine. This was only the second time I think I've had that zone. Had the other trauma zone numerous times, but not this one. I can't say I was shocked when we got the call, last week there were several and the nurses that have been there a while say they come in droves. So I had a feeling there Doesn't be one. Doesn't mean I was happy or looking forward to it. This is however, my job. It was like 1030 when we got the call over the box from the ambulance telling us they were on their way with an estimated arrival time of 7 minutes. I was just about frozen in my shoes and OOOOHHH SSSSHHHHHHHHH******TTTTTTT was all I could get through my mind.

The ambulance rolled through the door at 1046, and I sort of begun taking it all in. First, let me say there are very 'few' things for a nurse to do in a code (its pretty much the same procedure each time we have one, there is only so much u can do depending on what physical state the patient arrives in). Hook up the heart monitor (BP cuff, Pulse ox, EKG); hook up the defibrillator, get IV access, strip the patient, and O2. Dr's don't have a ton to do either - they get a tube down the patient's throat for airway access, call for meds to be pushed, call for shocking, access and few other things There were at least 2 doctors, 5 nurses and 3 techs in the room, along with the 'recorder' (who takes the notes on the exact times things occur). Being my first one, most of the other nurses in the room sort of jumped in doing things, and telling me why and what they were doing. Nurses also push the meds, fluids and shock the pt. when the Dr. orders it. We couldn't get IV access through a peripheral line (arm, hand, etc), so the Dr. put in a femoral (where your leg bends @ the hip) line - better, larger access anyway, but not done by a nurse. Once that was in we began pushing fluids and meds per the Dr. There is usually one nurse who only pushes the meds, and the others do whwasn'ter else is needed. I wasn't the med nurse, I honestly was taking it all in. At one point we got enough of a response on the EKG monitor for the patient to be shocked, so we did. And yes, their arms fly up and the body kind of jumps off the bed. Nothing happened. Pushed more meds trying to get a response, but still nothing. The tech doing compressions needed a break, so I got a chance to do some. The Dr. did, however call the TOD (time of death) at 11:10. We did everything we could, but it just didn't work. 25 minutes, and it was all over. (This patient was 72, had extensive cardiac history and had recently left the hospital, so there were physical reasons for the arrest.)

Although I didn't do a lot of hands on during the code, I did get to do compressions on a real person - COMPLETELY different from CPR training. I did have to help clean the body up and prepare it to be seen by the family. I did go with the Dr. to tell the spouse (and let me just say last week was NOT the week to have that on my plate). I got real choked up when the spouse began to bawl - thought I was going to lose it - but I sucked it up and reminded myself there will be days like this, doing what I do. I had to take the spouse to be with the body. I had to start the death coordination form, which includes calling the donor hotline and telling them someone died. I did have to ensure the chart was in order, and that there was a death certificate pulled aside for the Dr. who was going to come in and sign it. I did have to help take the body off the bed (in a body bag) and place it on the little thing that goes in the fridge. I did also have to work another 8 hours knowing that a patient of 'mine' died. Not by any fault of my own, but none the less, was gone.

I still love my job and what I do - but have a much better respect for the fact that some days I will go home having a 'not so good' feeling.