New and experienced nurses alike can get flustered during a medical emergency. But maintaining your cool is the best way to stay focused and function well, along with the rest of your team.
Depending on where you work, the frequency of a code blue or other emergent patient situation varies. Those in critical care and the ED will see unstable patients more frequently than those on an inpatient unit. No matter where you work, staying calm during an emergency is key to performing at your best.
Follow these tips for keeping your cool during a patient emergency.
Know where your equipment is
It might sound obvious, but code equipment is easy to overlook because you pass by it all the time. Routine code cart checks are a great way to familiarize with life saving equipment. But don't wait until it's your turn to check.
When you find yourself with a free minute, or even just before work, review where the code cart is, as well as the oxygen tank and ambu bag. Make a diagram of the drawer contents and laminate it so finding the meds and supplies you need during an emergency will be second nature. And make resuscitation medications and dosages review part of your daily routine.
Press that code blue button
There comes a moment where you go from managing a decompensating patient to not being able to manage it on your own anymore. Recognizing that early is key to starting the resuscitation immediately, and that starts with calling other team members to help. No one wants to call a code unnecessarily, BUT you and your patient are much better off if you press the code blue button sooner rather than later. You should never need to apologize for calling a code, even if the patient winds up stabilizing.
Watch Nurse Alice's webinar on recognizing the signs of clinical deterioration.
Keep going back to CPR
Document vital signs. Get those IVs in. Have meds and fluids and the defibrillator ready as quickly as possible. But it always comes back to the ABCs: Are they responsive? Is the airway open? Are they breathing? Does the patient have a pulse? And if the answer to each of those questions is no, compressions and respiratory support are essential while prepping for more advanced resuscitation methods.
Think of the defibrillator as a dear friend
The defibrillator is intimidating to almost everyone. But early defibrillation in ventricular fibrillation induced (VF) and pulseless ventricular tachycardia induced cardiac arrests is critical to the patient's chances of survival. The defibrillator is your friend. Get comfortable with checking it, setting it up and dialing the appropriate jules for a given patient.
Have a job you feel comfortable with
If you're an excellent documenter, be the one to pick up that code documentation form and stay focused on that task. If you excel at drawing up meds, go directly to work there. Everyone needs to have a certain degree of flexibility, but when you know your strengths and play to them, you will function better as a team.
Practice closed-loop communication
"Sarah, can you get the epinephrine?" or "I am getting the epinephrine." Closed-loop communication is an effective tool to ensure each member of the team knows what he or she is being asked to do and who is doing it, something that is especially difficult in a high-stress, fast-paced situation.
Practice with coworkers
Basic Life Support (BLS), Pediatric Advanced Life Support (PALS) and Adult Cardiovascular Life Support (ACLS) training sessions are essential tools for nurses to learn and re-learn recommendations and to practice those ever-important resuscitation skills. But when possible, scheduling team practice sessions every so often, and even mentally rehearsing a code, will help keep those skills fresh and make everybody more comfortable when the real thing happens.
Ask the question
The code is in full swing and everybody is working incredibly hard. The docs and nurses are working seamlessly as a team. You think to yourself, "Did anyone send off the blood work for labs?" But you figure someone must have thought of it — everyone seems to be in control.
When you have a question, even if it seems obvious, ASK IT. All first responders, no matter how experienced, can get tunnel vision. You might have a surgical patient who seems to have been overmedicated with opioids, but what if they're actually extremely hypoglycemic and no one's been thinking in that direction? You could be the one to get to the bottom of the inciting incident.
Evaluate with your team
A code should always be followed with a debriefing, where the team can discuss what went right and what could have been better. Was the communication as clear as it could have been? Would an earlier intubation have been a better choice to avoid hypoxic bradycardia? Was pulseless V. Tach. not recognized early enough? Or maybe the response time was immediate and an early defibrillation was successful and the communication was effective.
Evaluation gives the team a chance to process what happened in a less tense environment and to help improve performance for future emergent situations.
Nerves are normal
It's normal to get flustered when your patient takes a life-threatening turn. Keep breathing. Stay calm. Rely on your team. You got this.
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