I have been a Registered Nurse in Intensive Care and Emergency Medicine for the past 7 years. I have performed CPR and other lifesaving measures countless times throughout my career. I think the main components for a successful resuscitation are education, exposure, debriefing, and self-care. It is very important for new nurses or medical student to have proper education prior to being put into a life-saving situation. In my opinion, ACLS, PALS, and TNCC are the courses I rely on most working in a Level I Trauma Center. Having a strong educational foundation allows practitioners to have more confidence when they face a real life scenario. I think it is important to not only keep certifications active, but also to review materials and practice mannequin CPR when available, especially if there are long periods without a resuscitation event. I have trained with a few systems that give feedback on compressions and breaths in order to improve your skills, which is very helpful. Familiarizing oneself with the location of life-saving equipment in the department and the resuscitation rooms is important, so that you are not scrambling to find things during an emergency. Equipment such as the EZ-IO drill, Lucas compression device, and the Thoracotomy tray are essential in my department, so making sure your necessary equipment is stocked and ready to use in case of emergency is crucial.
I think a progressive approach to one’s involvement in the resuscitation is important if this can be accommodated based off of staffing in your department. For example, we usually assign new medical students to the compression role during CPR because it requires the least amount of critical thinking. We also provide real-time feedback regarding compression technique. This allows them to observe the resuscitation during position changes while also getting hands-on experience. If they have been part of several resuscitations, it may be appropriate to find them a more challenging role such as finding vascular or intraosseous access, pushing meds, or bag-mask ventilation. This step-wise exposure approach is helpful, as it aims to not overwhelm practitioners while they become more comfortable with the often chaotic scene during a life-saving event.
Although it is not often possible in a busy department, it is great to have a post-code debrief when possible. This allows everyone involved in the event to discuss things that went well and things that can be improved next time. It can also be used for decompressing emotionally after a particularly challenging event such as a pediatric code or a death. One of the most difficult parts of a resuscitation is having to go back into the unit and care for other patients as if nothing has happened. I think this gets easier with time and experience, but it is easy to be caught off guard by the emotional impact of a code or trauma. If you are having a difficult time emotionally after a resuscitation, it is important to let someone know whether it is a coworker, manager, or educator. They may be able to help, even if it is covering your patients for a few minutes while you get some fresh air outside or referring you to an employee assistance program for mental health counseling. It is important to always ask for help when you need it so that the stress does not compound and become unbearable.
If a debrief is unavailable, it is important to take some time after your shift to decompress. Self-care is an extremely important part of reducing burnout in this profession. I don’t know that anything can 100% mentally prepare you for a traumatic resuscitation, but self-care is essential to avoiding vicarious trauma. Have a plan in place for decompressing after a stressful day. This could be journaling, calling a loved one, or seeing a therapist. Some other self care measures might include physical activity, meditation, avoiding isolation, distraction, or breath work. Practice good sleep hygiene when possible. Cultivate hobbies and passions that you have outside of work and school. Lean on those in your social circle for support when needed. Most importantly, practice self-compassion. Remember that you are only human and that this career has the potential to negatively affect your mental wellbeing. Too often we have seen medical providers pushed to suicide from stress and trauma. I think the most important takeaway for future students would be to ask for professional help when you need it. There is no shame in asking for help and it will allow you to maintain a long and rewarding career.