Yeah, and?

So I got my ACLS certification two weeks ago. This means that I can now go along to the codes and rapid responses in MyHospital. Supposed to go to three, then I can be "Team Lead #2" for three, then "Team Lead #1". That's what I was told.

The idea of being "Team Lead" when somebody's dead and I'm supposed to fix it is a little as yet horrifying to me. I know sometime I'll learn and get over this, because I see that other people do and have. I do want to do this. It's part of my job, the most basic part. How I've had the dumb luck to not be present for any codes on my unit these five months is likely just the nature of MyHospital's ICU. We are not a trauma shop.

So a few nights ago, it's 2030, and the chimes ring. I think "yay!", but don't tell anybody that. I know you're secretly perky and happy about chimes only for a very short while in your nursing career. "Rapid Response, room 5432" I tell a few people I'm going...actually, I ask, cos I'm not used to this. Bump into J, the resource nurse, on my way and we're off to room 5432.

A respiratory therapist is already there. I also L, who I know from my old unit, and she is directing everybody and bossing people around. (This is a common pose.) I say hi. She doesn't acknowledge me...she's giving report on the patient: 90something year old woman, DNR, respiratory distress, sats 77%, history of COPD, CHF, CAD, DM, and PME...Pretty Much Everything. L is actually not the patient's nurse, and she's not even on our shift. I roll my eyes because I can.

Sure enough, there's a little old lady in bed breathing badly...with a nasal cannula on (and in her nose). She's tachy, but I don't see a blood pressure on the dynamap. There's one RT so far and the patient's nurse (M) and some other random person, the house supervisor and me and J (resource nurse) all in the room. Heckovit is, what I'm seeing is yeah, not good, but er, not four alarm fire alarm. Maybe only two. Or one and a half. I've had my patients be like this and I've fixed them. Okay. This is not scary or intimidating. (Part of me is a little disappointed. Isn't that awful? Cos the little old lady in bed is having a four alarm fire drill day.)

J does something I didn't expect her to do: she pushes me up to the bedside first. Takes me a split-second to think: Huh?...Oh...Good.

I ask "Can I get a blood pressure?" Nurse M tells me the dynamap isn't working right. I don't actually glare at her for that, yay for me. Her thinking returns, and she gets a manual pressure while I lung-listen and I hear: (drumroll please)

COPD lungs.

I ask: "When did she get the MedicationName last?" Patient was just like you'd expect for a 90something 80lbs soaking wet COPDer...inspiration but no expiration, fine crackles, dim in the bases. Woman's got no alveoli left. Whaddya think you're gonna hear? This isn't an acute PE, this isn't any acute anything, this is get some oxygen into her mouth and calm the little old lady down. Little extra Os, little roxanol does wonders for the mind and respiratory status for any elderly COPDer. Get the bp down, get the heart rate down, it's fine.

Then C, one of the RTs comes into the room and says, "Guys...I just did a treatment a half hour ago and gave her some MedicationName then." Her gestures are clearly saying, chill, it's all good. She gently pushes a few people aside, and puts a simple mask on the patient. Because, hey, she's mouth-breathing so the nasal cannula is doing er, nothing for her. Good intervention.

J asks me what I heard. I shrug. "COPD lungs." I shrug again, and realize that I shouldn't take a shrugging-duh tone in a rapid response so I report what I heard. J nods. J also appears to be thinking shrug-and-duh of the situation. J asks somebody if they still need ICU, and when we get the go ahead, we go home.

And that was it.

Now, I know that is likely not a typical rapid response. Often times, we hear the chimes for rapid response and five minutes later we hear them again for a COR to the same room. And rapid response is a great system, and I'm sure it averts a lot of awful things. It's there for any nurse who needs extra help. And if I'd been nurse M, with L there, maybe I would want somebody different at my back. At least, a few months ago, I would have been alarmed at my guppy-breathing ninetysomething year old. I'd have at least wanted respiratory there. And C did show up, so it's a good system.

I can do this. This little bit. I would've had the sense to do the next step and put the cannula into the patient's mouth. I would have gotten a mask. Walked away from there feelin pretty okay. I was grateful to J, for putting me at the bedside. Was cool of her, and there's no rule that she has to be cool about anything.

The most fun thing? Coming back to my unit and people asking, "So...did you fix em?" Getting to nod and say: "We fixed em....Well, C fixed em. But yeah. Fixed."

That was cool.

And that's my story. I can handle a 1.5 alarm fire drill. Not too bad.