Check My Vital Signs

I went to the "Sim Lab" (simulation) today: where there is a robotic patient who goes through some variation of a code blue.  It was a little unnerving.  In a real code-blue (i.e. cardiac and/or respiratory arrest), my job is to protect my sterile field.  Seriously.  During a code, there are usually tons of people in the room, so I need to make sure all of my stuff stays sterile.  In my BLS training, I have learned to oxygenate, use an AED, give compressions, etc.  But in the codes I have seen, I stay in the back and observe.  In the Sim Lab, I had to participate.  I was the "First Responder," which meant that I had to go in and see what was wrong with the patient.  When I walked in, the patient seemed okay.  She was wheezing a little, but her vital signs were fine.  Then things started to go bad.  I called for help, and the rest of the group (made up of RNs, NPs and one other scrub tech) came in.  Before they got there, I had to grab a bag & mask from the crash cart, though I'm pretty sure I uttered a four-letter word trying to find it.  I hooked it up to the oxygen and started to bag her.  I knew it was just a simulation, but it still got to me.  I almost started crying.  Thankfully I got over it fairly quickly. 

During the second scenario, I was assigned to do compressions.  I came in and the NP who was the code leader told me to start compressions.  But I didn't.  I was watching the monitor, and it looked like the patient had a heart rhythm and a pulse of 120.  I didn't understand why I would need to do compressions if there was a pulse.  Another nurse tried to hook up the AED, but on that monitor, all it showed was noise.  After the second time she told me to start compressions, I did.  The monitors showed nothing, so I couldn't even tell if I was doing any good.  In the debriefing, they asked why it took so long to begin compressions.  I told them it was because I didn't understand what was happening.  I heard the term "P.E.A." thrown around, and only afterward did I find out that it means "Pulseless Electrical Activity," which means that you'll see stuff on the monitor (that's what electrodes do--they track the electrical activity of the heart, which usually corresponds to the heart beat), but the blood is not circulating effectively.  That's why she needed compressions.

So . . . here are the "pearls" I gleaned from this experience.  I need to speak up.  If I don't understand something, I need to ask.  In a real code, when emotions run high and there is an actual life on the line, and I still hadn't started compressions, I would have been yelled at (she was very calm and quiet when the NP told me to start).  And that's okay--people are used to it.  I need to listen to what the Code Leader says.  They know more than I do, and in the end they are responsible for what happens.  I also learned that you need to trust your instincts.  Especially with kids.  You just never know what's going to happen, and if they go bad, it happens fast.  I'm also glad that I work in a very high-acuity environment.  There are at least two doctors and a nurse on-hand in surgery, and I'm definitely the low-man-on-the-totem-pole, so I'm not expected to make big decisions or be in charge of anything important.  And I like it that way.