Question for medical workers who've dealt with emergencies.

[Crescent Cat]

What was it like for you the first time you've had to preform CPR on someone? I've taken CPR class 3 times so I know what to do, but I'm a very high strung person. I'm afraid that if I'm ever in a situation that I'll need to preform CPR I'll panic and I won't be able to do it. People say that the reason a person panics in a situation like that is because they don't know what to do, so it shouldn't be a problem for me, but I still feel like I'll be too nervous to actually do it.

How do you get through your first emergency situation?

[kpzra]

It was my first ride along as an EMT student when i did "real" CPR, not classroom CPR. I took over for a fire fighter, so I didn't have to break the ribs. I get into a rhythm but I also didn't have to worry about breaths since we tubed him right away. The next one I was first on the chest, so I broke the ribs, same with the third. Never really kept count, some I don't want to remember. As a Paramedic, I can't panic. If I do people can die and I would have lost my job. There honestly is nothing that can prepare you for it, but training can get your mind in the game and the body will follow.

If you feel you cannot do it, don't start. While no lay person has successfully been sued for doing CPR , they have been sued. You are not supposed to stop until you are relieved by someone or until you are too tired (unless they start responding on their own).

[jedimaster91]

I've never (*knock on wood*) had to do CPR on someone. But I have been in my share of emergencies. The latest was a guy whose stress test was very abnormal and both the doc and I were holding our breath praying we could get him into the cath lab in time. I honestly didn't realize until later how close a call it was because I was so focused on getting my job done so someone else could do theirs. It helps to remember you have a specific task to do and you keep doing it until it's done (patient responds) or something changes (EMS arrives and takes over). The training does take over. Sure, there might be that initial burst of panic, but soon after comes the I've-got-to-do-something feeling. And then you do what you're trained to do. Adrenaline is a wonderful, wonderful thing.

ETA: As kpzra mentioned above, real CPR breaks ribs. You have to or your compressions won't reach the heart. So be prepared for that.

[crazylegs]

My first CPR came in as a 'concern for welfare' - I was the first person on scene & started the process.

Luckily I'd just completed my volunteer ambulance crew training where I'd done a resus scenario twice a week for about 4 months so I dropped into training and I just got on with it.

The sensation of CPR on a person is very different to a dummy and physically it's easier - mentally for some people it's a lot harder, depending on personal experience & the scenario involved.

If you're particularly worried see if your local ambulance service allows members of the public to do observation shifts - even if you don't get to see CPR being performed you might be able to chat with the paramedics/EMTs about it to set your mind at ease.

[trailerparkmedic]

The first (and only) time I did CPR, the patient was already intubated so all I was doing was chest compressions. I was still a nursing student so there was still a little bit of the student thinking--"Well, there are a bazillion other people in here who know what they're doing, so it's going to be ok." It wasn't too scary because my preceptor was there and I didn't have to break the bones.

The first emergencies I've had to handle as a nurse, where I'm the actual one taking care of them, OMG it's on me! were completely terrifying. The key is to just swallow your fear and let the training kick in. You'll know what you need to do.

[Sapphire Silk]

That's a great question, Cat. I actually devote an entire Simulation Lab for my senior nursing students to giving them an idea on what doing a "Code Blue" will be like for them when they graduate.

I never saw nor was involved in a Code Blue while I was a nursing student in my LPN or ADN programs (saw one in my BSN program but by then I was a highly experienced nurse).

My first code came four weeks into the job as an LPN. I had just finished orientation, and was on my own on the 11p-7a shift. This code was a comedy (rather tragedy) of errors as you will see.

Cast of Characters:
Me:
Temp Agency RN (TA): an employee of a staffing agency filling in a hole in our schedule.
Robin: our illustrious charge nurse, who'd been my preceptor in orientation and who absolutely ROCKED!
C: Our CNA, whose name has vanished with the sands of time.
Mr. T: a patient whose name has been redacted (no, not that that Mr. T.)

At about 4am, TA comes into a patient room where I'm hanging a piggyback IV antibiotic. She is red in the face, flustered and panicked.

TA: Pan, where's Robin?
Me: In the conference room (our break room). Whatever is the matter?
TA: Mr. T is dead.
Me: <gulps> Oh. Is he a code?
TA: Yes
Me: Did you call it (I hadn't heard it paged overhead)?
TA: No, he's dead!

TA then runs out of the room while I I follow her into the conference room.

TA: Robin, Mr. T is dead!
Robin: (who is very calm) Is he a code?
TA: Yes.
Robin: Did you call it?
TA: No! He's dead!
Robin: (sternly now) Call the code!

C runs out of the conference room and towards the patient room as I hear the code paged over head. I run out after her and grab the crash cart, and start to follow. TA grabs it away from me abruptly, pulling it over to fall on the floor. The defibrillator goes bing bang boom down the hall and shatters.

I'm pretty sure I said something like "Oh, shit!" at this point, though I don't really remember. I do remember running up two flights of stairs to the next floor to get another defibrillator because at that hospital, at that point in time, there was only one crash cart per floor, not per unit (as most hospitals are today, never fear).

By the time I got back down to the unit and the patient room, the "Code Team" has arrived: 2 ICU nurses, the House Officer (an MD who was in the hospital 24/7 to deal with emergencies like this), the pharmacist, and the respiratory therapist.

I can see C doing chest compressions on Mr. T. He is half curled in the fetal position, though laying on his back, and I can hear this horrible squeak! squeak! on every downstroke of CPR.

ICU Nurse: I can't believe you people called us down here to do CPR on a dead man! She was royally pissed, as was the other RN.

House Office: Now, now, they really didn't have a choice. They had to call the code.

At that point, the House Officer called Time of Death, and we all went out to the nurses station to do the documentation and straighten up while TA and C wrapped the patient in a shroud pending arrival of the funeral home. The ICU nurses continued to complain as they left, but the HO was really nice to us about it; he said he understood the fix we were in.

In case the state of Mr. T's body is unclear: he was in full rigor mortis. The man had been dead for a couple of hours.

I found out later that TA had gone into the room at midnight, hung a unit of blood (presumably with Robin, since it has to be done with two nurses and she hadn't done it with me), went back at 4am to hang the 2nd unit and found the man dead. She hadn't checked on him in the entire 4 hours, in spite of a nice neatly written set of every 15 minute vitals that she'd been keeping on him in accordance with hospital policy on the transfusion of blood products.

Did I mention he was in full rigor? Do you see the problem?

Yes, children, TA had been falsifying the documentation. We never saw her again. I don't know if she got reported to the Board of Nursing or not, though I do know the agency was told TA was never welcome to come back to our hospital again.

As for how I felt? Scared certainly. Unsure of what to do. Almost in a state of shock at the circumstances. After it was over, my hands shook for almost an hour.

I found the shakes to be a consistent part of CPR for the next couple of years. I could step in and do my job when the moment came, but after it was all over I fell apart, and needed time to pull myself back together, regardless of what the outcome was. That didn't really change until I started working in the ER, and did codes all the time as opposed to once or twice a year.

Getting additional training helped. I took Advanced Cardiac Life Support (ACLS) when I started working on a cardiac step down unit, and Pediatric Advanced Life Support (PALS) when I started working the ER. After I started working the ER as an RN rather than an LPN, I took the Trauma Nurse Core Course (TNCC). These courses gave me knowledge and experience, and confidence to step into any situation and deal. And that's what it really boils down to: training, experience, and confidence.

Cresent Cat, don't worry too much about anything other than chest compressions. You won't have to do them very long at one stretch: 2 minutes is about all most people can handle because it is so exhausting. You'll probably feel ribs or the sternum break at some point. Don't stop! It's normal for this to happen, and rarely results in complications. It's crucial to get the right depth and the right timing. We don't do the 5:1 compressions and breaths with a pause for the breath that they teach you in CPR class. The person doing compressions just keeps going, and if the breath gets in it gets in. Circulating the blood (which is already oxygenated) is the most important priority.

To get the right rhythm, sing "Da Da Da Da Stayin' Alive Stayin' Alive" over and over in your head. Inside voice, not outside voice. The tempo of that song is the right pacing for CPR. "Bump bump bump Another One Bites the Dust" is the right tempo as well, though a bit morbid for some folks

But just get it going and ignore everything else going on. A code is controlled chaos: a lot of noise from the machines, the staff, and the doctors all trying to squeeze into a very small space to do what they need to do. Many people get tunnel vision and that's OK; there will be other people who will be making sure everything gets done. Two minutes, and they'll pull you out to rest.

You can do it. You'll probably be amazed that you just step in and do it. Most people do.

Then you'll probably fall apart later, like I used to do

Sorry for the length and the thread jack. Hope this helps.

[telecom_goddess]

omg I had no idea the ribs broke during CPR

And as for Mr T I have no words.....rigor mortis is a sure sign someone has been dead for quite a while. How in the world do you NOT catch that?

[dalesys]

....rigor mortis is a sure sign someone has been dead for quite a while. How in the world do you NOT catch that?

Adjusting the tint on the video so you can stay in your chair....

[kpzra]

*snip* Two minutes, and they'll pull you out to rest. *snip*

If there are enough people, I've done 10 minutes it took to get to the hospital. My arms were jello the next day.

[Crescent Cat]

Holy crap, Panacea! I have no words for that TA. No words at all. I have to wonder what goes through whatever passes as a mind for people like that.

Thanks to everyone that has replied. My mind has been put to ease. I guess I just need to stop over thinking it and just let it happen when the time comes. Hopefully it never will but if it ever does I'll be ready to break some ribs (in a life-saving way of course)!

[Sapphire Silk]

If there are enough people, I've done 10 minutes it took to get to the hospital. My arms were jello the next day.

I did it for 25 minutes once. It's amazing what you can do when the adrenalin kicks in.

But I was pretty much useless the rest of the night.

omg I had no idea the ribs broke during CPR

And as for Mr T I have no words.....rigor mortis is a sure sign someone has been dead for quite a while. How in the world do you NOT catch that?

It's hard to catch if you never go in the room.

As for the ribs; yeah, it happens most of the time. It's creepy at first, but after awhile you learn to ignore it.

[Seshat]

Crescent Cat: I know you asked medical workers and I'm not one, but lay people with training can have very similar experiences.

In emergencies, I have a split second of panic, then my mind goes deadly calm and I just ... take over doing what has to be done.

My father was a former ambulance driver. My girl guide leader was a senior nurse in a hospital. Mrs Windsor (guide leader) made sure that both the guides and the brownies learned as much first aid as was appropriate to their ages; and Dad was also teaching us on a regular basis. So I can't recall any time when I didn't know basic first aid - at least to the point of 'what I could handle/what I needed to call an adult for'.

As a child, I coped with Dad cutting his fingertips off. (No, I'm not kidding.) Mum handled the immediate emergency, I collected what Mum and I might need for a long wait in the emergency room and locked up the house, and made sure the neighbour was willing to grab my brother when he got home and look after him.

In my adult life, I've stopped to help strangers twice (both times minor issues, easily handled with the first aid kit kept in my car).
I've handled three kitchen fires.

Earlier this year, Dancer (my husband) woke me up to tell me there was a car on fire outside our house. I don't think I've ever dressed any faster in my life!
He got on the phone to emergency, I checked on exactly where all our animals were, grabbed the cats' boxes and the dog's leash, and stacked them near the front door. Then I grabbed other things we might need to take with us if we had to evacuate. At that point, the fire engines arrived, and Dancer was able to let them assess the situation and then ask if we needed to leave the house. (We didn't, though they wanted us at the back of our house. We ended up with slightly scorched fencing and plantlife, no other damage to our property.)
(Oh: there was noone in the car, so nobody was hurt.)

Basically, I'm trying to say that my experience matches Panacea's. Emergency kicks in, and you go into 'deal with it' mode. If someone competent is doing the most critical task (Mum dealing with Dad's hand, Dancer calling 000); you figure out what the next most critical task is and do that. You keep stepping down 'critical' levels until there's nothing helpful for you to do.

If you have nothing immediately helpful to do, then you have two choices: document the scene for the behalf of investigators, if it's the sort of emergency that will need to be investigated. Or get the hell out of the way of the people handling it. If you choose to document, stay the hell out of the way while you do.

Hm. Actually, that reminds me of another emergency - one I witnessed, but was too far from to actually help in. But I could mentally document it, and dropped in to the police station to file a witness statement. (Road rage incident; noone was hurt. I never heard anything about aftermath.)

Panacea is also correct about how shakey you can feel afterwards. If you become shakey and useless once you know the whole thing is over - don't worry about it. It's normal and human.

And yes, experience in handling emergencies does help with aftermath shakiness. I get less of it now than I did when I was younger.

[KatherineB]

As a non-medico who has had to deal with her fair share of medical and other related emergencies, I would ask yourself how you deal with other crises when they come up. Do you go to pieces? Get super-efficient and try to organise everyone? Follow orders from whoever is in charge? Act independently if you see something being done wrong/omitted? Stay out of the way and let other people take care of the problem?

The thing is, how you respond in a non-medical emergency is probably not dissimilar to the way you act in a medical emergency. Training will take you so far (and is, of course, absolutely vital!). What matters is whether that training will kick in at the right moment or whether you are better off sitting back and letting other people do the hands-on stuff while you take care of the less immediate but just as important jobs.

[Dasota]

Not a medical worker, but I had to be there for my mother a lot and keep my calm during quite a few small emergencies as well as one big one.

The big one was when my mom had set her face on fire in the wee hours of the morning and my dad had already left for work. In the immediate time from when my mom woke me up until my dad got to the emergency room, I was calm and focused and cracking some fairly weird jokes with the EMTs/Paramedics, once my dad and I went into my mom's room, I couldn't stay long and left the room and found a place to lose it finally.

[telecom_goddess]

wait...your mom set her face on fire?

The biggest emergency I had wasn't medical, but a valve broke off on a toilet and was sending high pressure water out and flooding my bathroom/apt. I called 911 cause I didn't know where the damn water cutoff was, I had already tried the "emergency" number for the management office and they were of no help. The fire dept was very helpful.

But yeah I just went into automatic pilot and while it was not a fun day it all got dealt with and nothing major was damaged.