Lead the pack

I got to run with the rapid response team last week, and it was way fun. They go to all the code blues, they visit all patients with suspected stroke, and they take calls from nurses and other staff when a patient is deteriorating. Aside from all the important medical/clinical things I learned (like giving an H2 blocker along with epi and benadryl during an allergic reaction), they also taught me to “lead the pack.”

You walk into a patient room and the family tells you that dad doesn’t look right. He’s diaphoretic, lips are cyanotic, pupils are nonreactive and you can see that he’s tachypneic. Everything in you is screaming “I need HELP!!!” and you know this is an emergency. Instead, you smile at the family, walk over to the patient, talk to him and do a sternal rub while you feel his thready pulse. As you slide the nasal cannula into position you calmly tell the family you’re going to grab a couple things and come right back. Smile. You step outside the room, gingerly closing the door, and frantically tell your charge nurse the situation. She’s calling rapid response while you’re calmly getting the dynamap and glucometer. Deep breath. Re-enter the room, smile, start taking vitals and continue with your assessment. Before long other staff are stepping in to offer help – another bag of saline, a non-rebreather mask, calling respiratory therapy.

The key is, the family didn’t see you panic. The staff didn’t see you panic. The patient didn’t see you panic. And because you didn’t panic, neither did they. Sure, on the inside your heart was racing, you were becoming diaphoretic, your eyes wanted jump out of their sockets, and it took incredible self-control to keep your voice calm. But on the outside you were Nurse Competent. Panic incites chaos and kills critical thinking. When you take charge and lead the pack as if everything is going as expected, everyone else follows that lead. They feel comfortable and confident following that lead.

Now, imagine that when you walked into the room the first time your eyes got huge, you started racing around the room, hollering for help, running to get the dynamap. The family would be in a tizzy, getting in the way, bringing on all sorts of distractions. Your colleagues would be racing around, doing tasks without thinking clearly.

The moral of the story is: lead the pack. Breathe. You were trained for this, and you have the resources behind you to get through it.

Prioritize.
Prioritize.
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