I had given report on a couple of my patients and walked around the corner to give report to another nurse when the charge nurse saw me and asked me to get the rapid response cart. A rapid response cart has many of the same things that a code cart does. Items that we may use in an urgent situation, but not when a patient may need defibrillated (shocked) or intubated (having a breathing tube inserted). I ran and got the rapid response cart, while another nurse paged the rapid response team. When I was almost to the room she told me that the patient was coding and sent me for the code cart. Overhead a code blue was being called throughout the hospital now. When I returned with the cart 2 people (other than the patient) were in the room.
One of them was watching, the other was doing chest compressions. I opened the cart and turned on the oxygen tank, grabbing tubing and and AMBU bag. An Ambu bag has a mask to place over a patient's nose and mouth, a self-inflating bag, and a port to which oxygen can be connected. In his haste to be helpful, the person doing chest compressions stopped to help me. Knowing that minimizing breaks in compressions increases survival rates I began compressions, while he hooked up the oxygen tubing.
I could feel the ribs cracking and rubbing together. Crepitus is the medical term we use to describe bones rubbing together. I had heard about ribs cracking during CPR, but had never done CPR before, even with 4 years as an Air Force Medic. I had imagined the ribs would break at the cartilage joints where they connect to the sternum. They actually broken along the sides of the chest. The crepitus decreased as time went on, perhaps because the edges of bone were becoming rounded. An ICU nurse showed up after about a minute or 2 of CPR. She began asking who did what, and why hadn't they called a code sooner. I looked her in the eyes and told her that now wasn't the time for critiquing, it was time for her to do her job.
She looked as me for a second, seemingly in disbelief that a nurse who didn't even work in the ICU dare speak to her that way. However, she then began running the code as was her job. Other ICU nurses, residents, and other doctors soon arrived and the room got very full. Occasionally the dying patient seemed to gasp for air. It was hard to tell at first if these were real breaths, but as time went on it was apparent that they were agonal gasps. These are seen in dying people, sometimes even after heart function has ceased. It was more of a reflex, than a breath. Gurgles could be heard with compressions. The patient was intubated, suctioned out and given breaths via the AMBU bag. The smell of stomach contents was apparent and at times it seemed vomit was being coughed up. The smell is one I remember to this day.
Every few minutes we would stop compressions briefly and check for a pulse. Large defibrillator pads were attached to the patient's chest, which allowed us to watch the electrical impulses of the heart on the monitor. On the monitor we would see very erratic electrical activity. The rhythm looked far from normal and did not improve with time. Eventually the rhythm changed to asystole (the flat line you see in the t.v. shows and movies). After about a half an hour, a doctor finally 'called the code' as we say. That meant we were stopping our attempts to revive the patient.
I had participated in my first full blown code involving chest compressions. The patient wasn't mine. I knew I had done nothing wrong, in fact I was surprised at how well I kept my cool. Still it was a sad occasion. The man had no family present and though he was in his 80's, had not been expected to die so rapidly. I would remember this day, for ironically my own grandfather had passed away too. The smell seemed to linger on my hands and in my nose for days. My shoulders and pecs were sore from doing compressions.