Your First Code

I frankly don’t remember my exact first code but I remember the first couple and the sheer anxiety. So many thoughts- “wait, is that MY patient? Omg, was it something I did? How do I get this bed down? There is noooo way I’m getting out of here on time.” All jokes aside, it’s really a sinking feeling whether you see it on the monitor or are searching for a pulse. Suddenly you go into fight or flight and fine motor skills are out the door. To be clear, this isn’t ACLS review- just experience and tip sharing. Firstly, press that code button! In the in-hospital setting, it is unlikely you will be alone for longer than a minute or two when that alarm goes off. Everyone responds when that alarm sounds and in a well-oiled machine, everyone will assume a role (med nurse, recorder, compressor). If it is your patient, you should be freed up to relay to the team the patient’s history, events leading up, and so on. You will be asked a
lot of questions so don’t get tied up doing another role that you can’t multitask.
One of the things I remember most is fumbling with the meds. And in a situation where every second counts, fumbling just compounds on itself and makes you even more nervous. Ahhh, vicious cycle! Another time my patient was in a specialty bed and I couldn’t find the quick release lever so putting the head down with the normal button felt like a lifetime! Chest compressions just don’t work at a 90- degree angle!

There’s a couple things I found helpful. First, don’t let your first code be your own patient. As a preceptor, I’d let my orientee go to codes, RRTs, or special procedures (ie central line insertion) if possible and I’d manage our patients. That exposure is invaluable. The first couple minutes of a code are extremely hectic but once compressions are started, pads are on, and roles are assumed, there is sometimes a few seconds between the next set of ACLS meds. This is a time I try to sneak in education- ask the med nurse to let you prepare the next round of epinephrine. Most hospitals use some version of a quick open box and syringe set- super easy to use for that lack of fine motor skills but it takes a time or
two to know what to do. Perhaps shadow the recorder. Do a cycle of compressions. Get hands on! Take initiative if no one offers to let you do these things and ask as appropriate. It may just not be something they think to include you on but it’s important! Codes are 100% teamwork and whether it’s your own
patient or someone else’s next time, you need to know how to help. Wishing you a drama-free shift and good luck!

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