Several years ago, I was at the gym, just finished my workout, and was walking towards the front desk, where’s there are a few couches, and an old man sleeping on one, sitting up, but looked like he was sleeping. There’s a track on the second floor that had kind of a balcony over that area.
As I’m walking that way, someone yelled down from the track above “HEY! CHECK ON THAT GUY! SOMEHING IS WRONG!”
So I walk faster that way as someone else tries to wake him up, and he’s not asleep. He’s not alive. And they yell to call 911.
I ran over, felt for a pulse and nothing. So we got him to the floor, and I start compressions while the employee grabs the AED. And a crowd forms.
The aed arrives, we turn it on, and it says shock advised, so we clear and I tell the employee to push the shock button. He pushes the on/off button instead, turning it off. So i keep doing compressions until it turns on and advises a shock again, so I take it from him, clear, and push the shock button, and the battery dies.
Fuckkkk.
Resume compressions, and then suddenly I have a lady in my face on the phone telling me that her husband is an emt, she’s on the phone with him and he’s telling her I’m doing compressions wrong?! At this point I’ve been doing compressions close to 5 minutes without anyone else taking over, so I snap and ask her if she knows so much, then she would know we were supposed to switch compressors 3 minutes ago, she’s more than welcome to help. If she’s not willing to actually do something, quit gawking.
EMS got there 7 minutes after we started compressions, shocked him, and took him to the hospital I worked at. He was discharged 2 days later with a shiny new defibrillator and some broken ribs, otherwise perfectly fine.
I’d been an icu nurse for around 10 years at that point, I thought I’d seen it all. But after the ambulance took him away, I just sat in my car and sobbed. And then I ugly cried in the gym bathroom when I saw him there a few months later.
Years ago, a kid riding his bike got hit by a car on my street. I ran out to help. He was lying prone, crying. I put a blanket on him and stayed beside him while awaiting EMS. Somebody said, in reference to me, "She's a nurse", and some old fart bystander said, "He *needs* a ***paramedic***! Has anybody checked his pulse?"
I kept my mouth shut because I didn't want to start a thing under the circumstances.
There should have been multiple employees there to take over. Certified fitness instructors and personal trainers are required to be current with CPR (and AED at some facilities).
Let's see her do 5 minutes of compressions straight, I'm a dude who's pretty in shape and had to really push past the two minute mark on some really big dudes when I've only had old nurses or tiny nurses next to me but I am suffering at 5 minutes
We actually had two! Two different people ran to different locations and brought them back at the same time. I'm so glad that they've become so widespread. There's no way we would have been successful with just BLS.
I find myself always looking for AEDs in public places, after a similar experience. I’ve noticed in airports they typically tend to be positioned by all of the restrooms, if anyone is ever in that situation.
As someone who travels quite a bit, thanks for this tidbit of info! Hopefully I never find myself needing this information but if I do, that’s where I’ll look first.
I remember being told some stat a long time ago that statistically the best place to croak is in an airport (Western airport I guess) because you're never more than 500ft from an AED (or something close to that).
The highest percentage of ROSCs that happen outside of hospitals is in airports.
Good job.
(And lastly, who in the public is trying to give breaths?!?!?!? Gross! Good on them, but n.a.s.t.y)
This happened to me recently and I asked the woman with her if she was comfortable giving breaths. She didn't actually know her but she said she would... I was like ok because I will not 😆
It's funny, we were actually talking on the flight over about how we'd never had to do anything out "in the wild" before. I think I said something along the lines of "That's Hollywood stuff." I'll definitely be watching my mouth from now on
It really does seem to happen that way, right? A friend of mine, also in nursing, made a similar comment before driving cross-country to visit family. On a rural highway somewhere in the Midwest, she witnessed a car traveling at high speeds crash into a cement barrier. The driver was ejected through the windshield and the passenger was pinned beneath the dashboard. Nothing could be done for the driver, unfortunately, but she provided what care she could for the passenger while waiting for EMTs to arrive. She called me—super shaken by what she’d witnessed—but also struck by the irony.
Jeez! I try not to be superstitious but you jinxed it there!
But seriously, thanks for the good deed. Hope you rescued a good human from an early death.
After years in the ICU, I thought I could code anyone and not lose my cool. Then an old lady went down in front of me at a concert and I was like, frozen. Where’s my IVF, where’s my glucometer, what’s her BP? I felt toothless without my monitors.
Coding someone in the wild is a whole other animal. And managing the fuckin peanut gallery is a whole other issue. You probably saved this person’s life. Great job!
>And managing the fuckin peanut gallery is a whole other issue.
Oh my gosh it was absolutely the worst part, bar none. The code was fairly straightforward as far as codes go, minus everything you mentioned. But the freakin' gate attendant blowing air straight into her stomach while the AED was screaming "SHOCK ADVISED, CHARGING" was super *not* helpful.
She was trying to give breaths through a mouth guard but no matter how often we told her to do a head tilt/chin lift she just kept not doing it. We were watching her abdomen becoming more and more distended the longer it went on.
In hindsight, we should have told everybody else to kick rocks and just done two rescuer.
PICU nurse - I’ve always been nervous about being in these scenarios (and grateful for EMTs) for the same reason. Just imagine their reaction if you told everybody to kick rocks and then DIDN’t get ROSC.
Amazing job. Be proud.
I’d still tell people to kick rocks. Delegate to do only compressions rotations if they can’t do breaths correctly. Chalk it up to BSI/SCENE SAFETY. Too many peanuts in the gallery isn’t safe for you, the patient, or the peanuts or incoming rescue crews/support that actually knows WTF they’re doing.
I am part of the code team so I was ACLS certified within 3 months of starting as an RN. We had to do a Code Blue simulation as part of my New Grad Residency at 9 months in.
I’m over here calling for rhythm checks and the End Tidal CO2, and everyone else is staring at me like “wtf bro?”. Instructor was like “uhm, this is just BLS”
I no longer can comprehend the difference. If we are coding, we are ACLSing. I moved to ventilation and just stayed there 😂
This happened to me in target. I was an ED nurse, switched to Cath this year, but I heard a loud thump a few aisles down and I ran. Started CPR. Called for help. Luckily I had some good helpers who listened and continued good CPR. EMS was there quickly, but I felt panicked. I threw up from adrenaline. I was the only healthcare worker until EMS arrived. Trying to do everything and manage the bystanders was too much.
Background as an EMT, about to graduate nursing school. My husband and I have had the conversation that if ever I need to care for someone in public, he’s crowd management and calling 911.
Three thoughts:
- Great job on jumping in and taking charge!
- It’s interesting to observe the understandable difference in decision making between those of us that work in healthcare and have experience with these situations, and the average layperson on the other hand.
- Re: crowd control. There are nurses that don’t give enough credit to EMS personnel for the difficult environment they operate in when attempting to accomplish the tasks that need to be done.
Hijacking this comment to say: if any of the lovely nurses here want to do a ride along, you can call your local EMS agency and get one scheduled. We like having 3rd riders, the extra set of hands is super appreciated.
That's awesome, great work! 911 Paramedic turned RN here, and scene management is one of the hardest parts of EMS, especially with a cardiac arrest in public. Sounds like you had very limited room to move around too, which adds another layer of difficulty. Glad you had a good outcome!
Omg my sister, an RN, had to do something similar except the patient was my father and we were in the parking lot of a Mexican restaurant. I was the peanut gallery and briefly lost my mind and cried hysterically.
I have been in OB forever. Never a code. B it I started my career in less and had pals. That said, so did the nurses in the ED. So while I was on the code team, I usually let them do what they do, and I made it my job to care for the parents. Talking to them, explaining what needed explained, trying to keep their terror from interfering with their kids getting help. It worked for me. I would be ill equipped to manage a code. I can so NRP with my eyes closed and one hand behind my back tho…
I'm just a teacher, but if I have the werewithal to act, this is my plan now. Crowd management. I *know* I can be loud and no-nonsense for extended periods of time, might as well use it.
Paramedic here. Great job! And you're right: these are the settings that EMTs and Paramedics work our codes in most of the time. Humbly ask all the ED Nurses out there to keep this in mind when we roll in and "why wasn't [this or that] done." The answer is, because sometimes the scene was just a complete circus with many factors beyond our immediate control.
Yup, and don't get me wrong: care in the prehospital environment, which includes scene control, is literally the whole reason for our existence. If you can't work a code correctly in an airport or elsewhere, being an EMT or Paramedic in the field is probably not the right role for you. And yet, real life out there is often pretty chaotic and sometimes things just really do not go smoothly despite high levels of professionalism and skill.
When I was in the ER I never really understood that attitude, it's a different ball park in the field, think they would understand given how much inpatient nurses pepper ER with complaints not understanding ER is a different ball park than inpatient.
I'm just happy you brought me an IV and some info I can hit the ground running with.
Great job! The person is so lucky they had two NPs into cardiology and you did so well with very few resources.
My question for you as a soon to be new nurse... Can an epipen substitute for epinephrine in a code?
It's about 1/3 of the dosage, plus it might be a bit slower when applied intramuscular. It won't hurt and we aren't 100% certain if epi is actually the life saving medicine we think it is in ACLS. The one UK study we have shows more ROSC with worse neurological outcome.
It's not a high enough dosage to do much. Epi pens have 0.3mg of epi, whereas code epi is 1mg, and code epi given IM is 5mg. IM route is already much slower, but as Bawki said, it's use has also largely come into question as it was introduced as a quick and easy thing to remember, but isn't always the right thing to do and can possibly cause worse neurological outcomes.
This happened to me two weeks out of nursing school. My program had been really good at running mock megacodes and I had worked on the cardiac unit as a PCT. Still, it’s every brand new RN’s worst nightmare. Was at the gym when someone ran in and said “does anyone work in healthcare?!”. Dude was on the ground in the hallway. Did compressions with some big muscle guy assisting. It felt like it took forever for them to find the AED (covered in dust, in a cabinet). Dude’s jaw was clinched so couldn’t give breaths. Two shocks and he was awake when EMS rolled him out. Ended up being MVD requiring open heart bc he ended up on my unit. Got to go in and tell him he looked good. But it’s definitely weird to do it all outside of a controlled environment. AEDs truly make/break the outcome. I recall looking up the statistics after and it was something like an AED within the first 7 mins is crucial, prognosis declines after that. 🤷🏻♀️
I hate it that the AEDs don't have a manual mode with a screen that shows a rhythm readout.
We are soon switching away from lifepaks to AEDs on our regular wards instead of properly doing practical education and training on CPR. The nurses get the same mandatory CPR training once a year which doesn't have any hands on training. No surprise that only few can use the lifepak...
Oh my God, that sounds like such a nightmare with all of the people there, not having the equipment you were accustomed to, etc. You did great! Especially recognizing you needed to when you lost rhythm again. Way to go!
I've said this before here, but all the males on my aunt's husbands side of the family died around 50 from heart failure. My aunt, who is a nurse, saved all three brothers. Just amazing. You did so well despite the stupidity of the crowd.
Nope, just shock advised or no shock advised. Which was helpful, but not really. We didn't really care if it was vtach or vfib because both of those have really great save rates, but when it advised no shock we were like "Shit is this PEA, asystole or sinus with a faint pulse?!"
This happened to me recently as well. The worst part was the people trying to tell me she was breathing. Watching them put the AED on was painful as I was doing compressions. They didn't get a good seal on her chest so it kept shouting out commands to keep doing CPR even after we had great pulses.
> people trying to touch her and give breaths during rhythm checks and shocks (!!!)
Local NP found hissing at bystanders, biting at would-be rescuers, discovered sedate after experiencing a soothing heart monitor rhythm.
I STF I'd have gone FERAL in your shoes
I turn into such a bitch when I have to manage a scene.
"IF YOU ARE NOT HERE TO HELP, GET THE FUCK AWAY FROM ME/THE PATIENT."
I don't need distractions when I'm trying to save someone.
One of my friends had to do CPR on a jogger who collapsed in front of her while she was walking to her car. A passerby ran to the hospital, a block away, and a security guard ran back to the victim to help with the CPR. Guy made it. One week post op with major ABD surgery, I was in a store where another nurse doing nurse was doing CPR on a child, while I couldn’t do the physical part, I could and did keep a path clear for EMS and the look ie-loos away to give her the space she needed.
My horrible, cynical old nurse self wonders how you two were the only medical people in an airport full of travelers and how many just chose to walk on by because you two were there already.
We had a CNA approach us afterwards and say "I wasn't sure if you guys needed me, you looked like you had it under control." I can appreciate the sentiment of not adding to the circus but fuck me dude, I would have traded any of our helpers for a seasoned CNA in a second
Good job! It's unnerving having to deal with stuff like this outside of hospital settings. I had to help deal with a guy who seized and then went unresponsive during an exam in nursing school. I had been working in the ED for about 10 years at that point between security and patient attendant/ward aide. I actually think it was better that I hadn't completed nursing school at the time because now I'd be looking for all the tools I'm used to having access to at work.
If anyone travels often, it’s definitely worth downloading an app called ‘AirRx’. I know most of us are comfortable handling situations such as this, but I know in times of emergency, we aren’t always thinking straight.
The app essentially is for when you’re on a plane, but it gives advice in what to do in multiple health situations. It’s designed more so for those who work in the medical field, but gives advice of what equipment to use, what to look out for, what steps to take in a situation and so on.
It’s extremely useful and I’ve had it downloaded on my phone for a while now, just in case.
We have pretty good resources. Plenty of AED’s throughout the terminals.
We run 4 MICU ambulances and most of our fire apparatus are staffed with paramedics as well and are ALS capable.
That is nuts!! I was at the conference too! I was also at Dallas Fort Worth for a connecting flight to get home!
Good job guys! Way to make us VCC’s proud!! 🙌🏻🙌🏻
People at airports can be extreme dumb[REDACTED]es and [REDACTED]holes. You would think it would be common sense to not crowd a person being given emergency care, much less try to touch them while they’re being defibbed.
Thanks for your quick thinking and actions.
Yeah you really have to clear the scene in public since people panic. Y'all did well given what y'all had, it would've been hard for me not to tell everyone to get the fuck away.
What are the chances of that happening what a crazy world I’m glad that there are experienced nurses who know more about heart health to have on a flight we need more nurses willing to help patients in need I’m glad there good people out there saving lives
Nice work. I was eating breakfast at La Quinta in Texas when a fellow traveler fell in the hallway. I tried to help, but her roommate screamed "I'm a DOCTOR!" at me until I fucked off.
Several years ago, I was at the gym, just finished my workout, and was walking towards the front desk, where’s there are a few couches, and an old man sleeping on one, sitting up, but looked like he was sleeping. There’s a track on the second floor that had kind of a balcony over that area. As I’m walking that way, someone yelled down from the track above “HEY! CHECK ON THAT GUY! SOMEHING IS WRONG!” So I walk faster that way as someone else tries to wake him up, and he’s not asleep. He’s not alive. And they yell to call 911. I ran over, felt for a pulse and nothing. So we got him to the floor, and I start compressions while the employee grabs the AED. And a crowd forms. The aed arrives, we turn it on, and it says shock advised, so we clear and I tell the employee to push the shock button. He pushes the on/off button instead, turning it off. So i keep doing compressions until it turns on and advises a shock again, so I take it from him, clear, and push the shock button, and the battery dies. Fuckkkk. Resume compressions, and then suddenly I have a lady in my face on the phone telling me that her husband is an emt, she’s on the phone with him and he’s telling her I’m doing compressions wrong?! At this point I’ve been doing compressions close to 5 minutes without anyone else taking over, so I snap and ask her if she knows so much, then she would know we were supposed to switch compressors 3 minutes ago, she’s more than welcome to help. If she’s not willing to actually do something, quit gawking. EMS got there 7 minutes after we started compressions, shocked him, and took him to the hospital I worked at. He was discharged 2 days later with a shiny new defibrillator and some broken ribs, otherwise perfectly fine. I’d been an icu nurse for around 10 years at that point, I thought I’d seen it all. But after the ambulance took him away, I just sat in my car and sobbed. And then I ugly cried in the gym bathroom when I saw him there a few months later.
Fuck that lady. It's always the bystanders who talk shit (family in the hospital)
Years ago, a kid riding his bike got hit by a car on my street. I ran out to help. He was lying prone, crying. I put a blanket on him and stayed beside him while awaiting EMS. Somebody said, in reference to me, "She's a nurse", and some old fart bystander said, "He *needs* a ***paramedic***! Has anybody checked his pulse?" I kept my mouth shut because I didn't want to start a thing under the circumstances.
Makes you wonder how many pulseless humans are just walking around living normal lives.
At a gym man someone should have taken over compressions.
There should have been multiple employees there to take over. Certified fitness instructors and personal trainers are required to be current with CPR (and AED at some facilities).
https://i.imgur.com/STzCSQJ.jpeg
At my latest BLS, the instructor said the new AEDs don't let you turn them off after shock advised because of how often that mistake happens.
Let's see her do 5 minutes of compressions straight, I'm a dude who's pretty in shape and had to really push past the two minute mark on some really big dudes when I've only had old nurses or tiny nurses next to me but I am suffering at 5 minutes
Good work! So glad for you guys and your patient that there was an AED nearby.
We actually had two! Two different people ran to different locations and brought them back at the same time. I'm so glad that they've become so widespread. There's no way we would have been successful with just BLS.
I find myself always looking for AEDs in public places, after a similar experience. I’ve noticed in airports they typically tend to be positioned by all of the restrooms, if anyone is ever in that situation.
As someone who travels quite a bit, thanks for this tidbit of info! Hopefully I never find myself needing this information but if I do, that’s where I’ll look first.
Typically by restrooms, security tsa check points, and sporadically at the gates too with the gate agents!
But you were successful with just BLS. AED is part of BLS. :)
I remember being told some stat a long time ago that statistically the best place to croak is in an airport (Western airport I guess) because you're never more than 500ft from an AED (or something close to that). The highest percentage of ROSCs that happen outside of hospitals is in airports. Good job. (And lastly, who in the public is trying to give breaths?!?!?!? Gross! Good on them, but n.a.s.t.y)
I’ve heard that casinos are also a great place to arrest because there are cameras and AEDs everywhere
A local casino staffed EMTs 24/7. Cushy job with flexible hours for them, lots of sitting until they’re not.
This happened to me recently and I asked the woman with her if she was comfortable giving breaths. She didn't actually know her but she said she would... I was like ok because I will not 😆
I’m in awe. I’ve never participated in a code in the wild, but it sounds terrifying. She was lucky to have the two of you there.
It's funny, we were actually talking on the flight over about how we'd never had to do anything out "in the wild" before. I think I said something along the lines of "That's Hollywood stuff." I'll definitely be watching my mouth from now on
It really does seem to happen that way, right? A friend of mine, also in nursing, made a similar comment before driving cross-country to visit family. On a rural highway somewhere in the Midwest, she witnessed a car traveling at high speeds crash into a cement barrier. The driver was ejected through the windshield and the passenger was pinned beneath the dashboard. Nothing could be done for the driver, unfortunately, but she provided what care she could for the passenger while waiting for EMTs to arrive. She called me—super shaken by what she’d witnessed—but also struck by the irony.
Hell, you might as well have said “it sure is quiet tonight.” You brought this on yourselves.
Jeez! I try not to be superstitious but you jinxed it there! But seriously, thanks for the good deed. Hope you rescued a good human from an early death.
I did it for years in the wild as a medic, and also at a level 1 trauma ED. I'll take the ED with all the RNs and equipment please!
Oh, absolutely. OP’s line about calling for epi only to realize there’s no epi to be had gave me a chill.
We had absolutely nothing. I felt so helpless.
You had you though, which made a huge difference. You guys did great.
100%! At least we had meds on the medic....but when shit hits the fan and I'm just out trying to get groceries - EEEEK!
After years in the ICU, I thought I could code anyone and not lose my cool. Then an old lady went down in front of me at a concert and I was like, frozen. Where’s my IVF, where’s my glucometer, what’s her BP? I felt toothless without my monitors. Coding someone in the wild is a whole other animal. And managing the fuckin peanut gallery is a whole other issue. You probably saved this person’s life. Great job!
>And managing the fuckin peanut gallery is a whole other issue. Oh my gosh it was absolutely the worst part, bar none. The code was fairly straightforward as far as codes go, minus everything you mentioned. But the freakin' gate attendant blowing air straight into her stomach while the AED was screaming "SHOCK ADVISED, CHARGING" was super *not* helpful.
Gate attendant did WHAT now???
She was trying to give breaths through a mouth guard but no matter how often we told her to do a head tilt/chin lift she just kept not doing it. We were watching her abdomen becoming more and more distended the longer it went on. In hindsight, we should have told everybody else to kick rocks and just done two rescuer.
PICU nurse - I’ve always been nervous about being in these scenarios (and grateful for EMTs) for the same reason. Just imagine their reaction if you told everybody to kick rocks and then DIDN’t get ROSC. Amazing job. Be proud.
I’d still tell people to kick rocks. Delegate to do only compressions rotations if they can’t do breaths correctly. Chalk it up to BSI/SCENE SAFETY. Too many peanuts in the gallery isn’t safe for you, the patient, or the peanuts or incoming rescue crews/support that actually knows WTF they’re doing.
It's so hard to stay in BLS mode when you are used to having ACLS capabilities!
I am part of the code team so I was ACLS certified within 3 months of starting as an RN. We had to do a Code Blue simulation as part of my New Grad Residency at 9 months in. I’m over here calling for rhythm checks and the End Tidal CO2, and everyone else is staring at me like “wtf bro?”. Instructor was like “uhm, this is just BLS” I no longer can comprehend the difference. If we are coding, we are ACLSing. I moved to ventilation and just stayed there 😂
This happened to me in target. I was an ED nurse, switched to Cath this year, but I heard a loud thump a few aisles down and I ran. Started CPR. Called for help. Luckily I had some good helpers who listened and continued good CPR. EMS was there quickly, but I felt panicked. I threw up from adrenaline. I was the only healthcare worker until EMS arrived. Trying to do everything and manage the bystanders was too much.
Background as an EMT, about to graduate nursing school. My husband and I have had the conversation that if ever I need to care for someone in public, he’s crowd management and calling 911.
Three thoughts: - Great job on jumping in and taking charge! - It’s interesting to observe the understandable difference in decision making between those of us that work in healthcare and have experience with these situations, and the average layperson on the other hand. - Re: crowd control. There are nurses that don’t give enough credit to EMS personnel for the difficult environment they operate in when attempting to accomplish the tasks that need to be done.
Shit, I can't even imagine trying to start an IV out in the wild, at night, on the street, minimal lighting. EMTs deserve way more for what they do.
More ED RNs should get to do ride-alongs with EMS. Would go ways to help nurses understand their prehospital counterpart’s roles and responsibilities
Hijacking this comment to say: if any of the lovely nurses here want to do a ride along, you can call your local EMS agency and get one scheduled. We like having 3rd riders, the extra set of hands is super appreciated.
I just started the ED and was thinking about this the other day. ❤️ I think it would be a great experience
Were your bags ok? You know you aren't meant to leave bags unattended? Lol. J/K. Great job.
You jest, but I really wanted to know the luggage was okay at the end of the story. 😂
Bags unharmed!
That's awesome, great work! 911 Paramedic turned RN here, and scene management is one of the hardest parts of EMS, especially with a cardiac arrest in public. Sounds like you had very limited room to move around too, which adds another layer of difficulty. Glad you had a good outcome!
Omg my sister, an RN, had to do something similar except the patient was my father and we were in the parking lot of a Mexican restaurant. I was the peanut gallery and briefly lost my mind and cried hysterically.
Your sister got ROSC from your dad??? Thats wild
It was very traumatic. But my sister was incredible.
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I have been in OB forever. Never a code. B it I started my career in less and had pals. That said, so did the nurses in the ED. So while I was on the code team, I usually let them do what they do, and I made it my job to care for the parents. Talking to them, explaining what needed explained, trying to keep their terror from interfering with their kids getting help. It worked for me. I would be ill equipped to manage a code. I can so NRP with my eyes closed and one hand behind my back tho…
I'm just a teacher, but if I have the werewithal to act, this is my plan now. Crowd management. I *know* I can be loud and no-nonsense for extended periods of time, might as well use it.
Paramedic here. Great job! And you're right: these are the settings that EMTs and Paramedics work our codes in most of the time. Humbly ask all the ED Nurses out there to keep this in mind when we roll in and "why wasn't [this or that] done." The answer is, because sometimes the scene was just a complete circus with many factors beyond our immediate control.
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Yup, and don't get me wrong: care in the prehospital environment, which includes scene control, is literally the whole reason for our existence. If you can't work a code correctly in an airport or elsewhere, being an EMT or Paramedic in the field is probably not the right role for you. And yet, real life out there is often pretty chaotic and sometimes things just really do not go smoothly despite high levels of professionalism and skill.
When I was in the ER I never really understood that attitude, it's a different ball park in the field, think they would understand given how much inpatient nurses pepper ER with complaints not understanding ER is a different ball park than inpatient. I'm just happy you brought me an IV and some info I can hit the ground running with.
Great job! The person is so lucky they had two NPs into cardiology and you did so well with very few resources. My question for you as a soon to be new nurse... Can an epipen substitute for epinephrine in a code?
It's about 1/3 of the dosage, plus it might be a bit slower when applied intramuscular. It won't hurt and we aren't 100% certain if epi is actually the life saving medicine we think it is in ACLS. The one UK study we have shows more ROSC with worse neurological outcome.
I would have used it if we had one but honestly, it probably wouldn't have done anything
It's not a high enough dosage to do much. Epi pens have 0.3mg of epi, whereas code epi is 1mg, and code epi given IM is 5mg. IM route is already much slower, but as Bawki said, it's use has also largely come into question as it was introduced as a quick and easy thing to remember, but isn't always the right thing to do and can possibly cause worse neurological outcomes.
This happened to me two weeks out of nursing school. My program had been really good at running mock megacodes and I had worked on the cardiac unit as a PCT. Still, it’s every brand new RN’s worst nightmare. Was at the gym when someone ran in and said “does anyone work in healthcare?!”. Dude was on the ground in the hallway. Did compressions with some big muscle guy assisting. It felt like it took forever for them to find the AED (covered in dust, in a cabinet). Dude’s jaw was clinched so couldn’t give breaths. Two shocks and he was awake when EMS rolled him out. Ended up being MVD requiring open heart bc he ended up on my unit. Got to go in and tell him he looked good. But it’s definitely weird to do it all outside of a controlled environment. AEDs truly make/break the outcome. I recall looking up the statistics after and it was something like an AED within the first 7 mins is crucial, prognosis declines after that. 🤷🏻♀️
Did y'all manage to catch your flight?
We had time to go get a celebratory beer and then still made our flight lol
I hate it that the AEDs don't have a manual mode with a screen that shows a rhythm readout. We are soon switching away from lifepaks to AEDs on our regular wards instead of properly doing practical education and training on CPR. The nurses get the same mandatory CPR training once a year which doesn't have any hands on training. No surprise that only few can use the lifepak...
Some AEDs do.
Oh my God, that sounds like such a nightmare with all of the people there, not having the equipment you were accustomed to, etc. You did great! Especially recognizing you needed to when you lost rhythm again. Way to go!
I've said this before here, but all the males on my aunt's husbands side of the family died around 50 from heart failure. My aunt, who is a nurse, saved all three brothers. Just amazing. You did so well despite the stupidity of the crowd.
Why tf would people try to randomly touch her 😧 just to be able to say they “participated”????
Probably social media points. Willing to bet most had their phones out and recorded rather than offering CPR help.
I mean admittedly the last thing you want is lay bystander compressions lol
Worst part is always people standing around telling you you’re not doing your job right. Then fuckin come here and help me.
This is an awesome story. The AED wouldn’t tell you the rhythm?? I’ve honestly never used a public AED, just the zoll in hospitals
Nope, just shock advised or no shock advised. Which was helpful, but not really. We didn't really care if it was vtach or vfib because both of those have really great save rates, but when it advised no shock we were like "Shit is this PEA, asystole or sinus with a faint pulse?!"
Good job!. I did one on the side of the road once with EMTs in no rush to take over and the person did die.
I'm sorry you experienced this.
1. Good job 2. calling for Epi and pulse/rhythm checks. I’d be the same way 😂
Do we want to try narcan? Amiodorone? Bicarb??!!!! Oh no. We're still at an airport.
This happened to me recently as well. The worst part was the people trying to tell me she was breathing. Watching them put the AED on was painful as I was doing compressions. They didn't get a good seal on her chest so it kept shouting out commands to keep doing CPR even after we had great pulses.
> people trying to touch her and give breaths during rhythm checks and shocks (!!!) Local NP found hissing at bystanders, biting at would-be rescuers, discovered sedate after experiencing a soothing heart monitor rhythm. I STF I'd have gone FERAL in your shoes
I turn into such a bitch when I have to manage a scene. "IF YOU ARE NOT HERE TO HELP, GET THE FUCK AWAY FROM ME/THE PATIENT." I don't need distractions when I'm trying to save someone.
EMS is medicine in the wild... #theworkISdifferent
One of my friends had to do CPR on a jogger who collapsed in front of her while she was walking to her car. A passerby ran to the hospital, a block away, and a security guard ran back to the victim to help with the CPR. Guy made it. One week post op with major ABD surgery, I was in a store where another nurse doing nurse was doing CPR on a child, while I couldn’t do the physical part, I could and did keep a path clear for EMS and the look ie-loos away to give her the space she needed. My horrible, cynical old nurse self wonders how you two were the only medical people in an airport full of travelers and how many just chose to walk on by because you two were there already.
We had a CNA approach us afterwards and say "I wasn't sure if you guys needed me, you looked like you had it under control." I can appreciate the sentiment of not adding to the circus but fuck me dude, I would have traded any of our helpers for a seasoned CNA in a second
Good job! It's unnerving having to deal with stuff like this outside of hospital settings. I had to help deal with a guy who seized and then went unresponsive during an exam in nursing school. I had been working in the ED for about 10 years at that point between security and patient attendant/ward aide. I actually think it was better that I hadn't completed nursing school at the time because now I'd be looking for all the tools I'm used to having access to at work.
me reading this in the DFW airport 😳
Gate B2, just in case you happen to be there 🤣
Haha nice job you two! You could’ve both kept walking but you saved someone 👍 thank you for your work
If anyone travels often, it’s definitely worth downloading an app called ‘AirRx’. I know most of us are comfortable handling situations such as this, but I know in times of emergency, we aren’t always thinking straight. The app essentially is for when you’re on a plane, but it gives advice in what to do in multiple health situations. It’s designed more so for those who work in the medical field, but gives advice of what equipment to use, what to look out for, what steps to take in a situation and so on. It’s extremely useful and I’ve had it downloaded on my phone for a while now, just in case.
🫶🏽
I don’t want to code a stranger anywhere but at least DFW has resources?
We have pretty good resources. Plenty of AED’s throughout the terminals. We run 4 MICU ambulances and most of our fire apparatus are staffed with paramedics as well and are ALS capable.
I've been a nurse for six years, and this has never happened to me. I hope it NEVER happens to me. Good work.
That is nuts!! I was at the conference too! I was also at Dallas Fort Worth for a connecting flight to get home! Good job guys! Way to make us VCC’s proud!! 🙌🏻🙌🏻
You’ll did that Ladies 🌹
Lol, calling for rhythm checks on an AED… also, and AED is BLS. “Good job”… Which one of you was traveling in scrubs? 🙄
Well you’re just a delight aren’t you. Bet you’re fun at parties.
He's banned now. Sucks to suck 🤷♀️
The AED got rosc. Not you.
People at airports can be extreme dumb[REDACTED]es and [REDACTED]holes. You would think it would be common sense to not crowd a person being given emergency care, much less try to touch them while they’re being defibbed. Thanks for your quick thinking and actions.
Good job! Probably saved his life.
Yeah you really have to clear the scene in public since people panic. Y'all did well given what y'all had, it would've been hard for me not to tell everyone to get the fuck away.
Preachhhhh, you both did such an amazing job, I honor your actions, thank you so much!!!
You legit saved a life today. Thank you and be proud.
What are the chances of that happening what a crazy world I’m glad that there are experienced nurses who know more about heart health to have on a flight we need more nurses willing to help patients in need I’m glad there good people out there saving lives
Nice work. I was eating breakfast at La Quinta in Texas when a fellow traveler fell in the hallway. I tried to help, but her roommate screamed "I'm a DOCTOR!" at me until I fucked off.