All ICU nurses are aware of the dreaded “triple alarm.” At least I’m under the impression that this is something common to all ICUs.

The triple alarm is part of the cardiac monitor and is just one of many noises, beeps, and cries that it produces. It is three loud high pitched beeps in a row, and it repeats itself over and over.

Beep beep beep
Beep beep beep
Beep beep beep

And on and on….

The triple alarm signals to everyone within what seems like a three kilometer radius that it has detected either V.Fib, V.Tach, or Asystole. In other words, the cardiac monitor is shouting, “OH MY GOD, OH MY GOD OH MY GOD!!!!!!”

So is the nurse, most likely!

However, the overwhelming majority of the times this alarms sounds, it is a false alarm. Moments after you hear it, you generally hear a nurse yelling, “I’m OK.” The general rule is that failing to shout, “I’m OK” is a signal to everyone around that you are, in fact, not OK.

So, it was 05:00 in the morning. We were all hanging out, enjoying a lull. It was that dreaded time of the morning in which your body completely rejects wakefulness, and every moment is spent struggling to keep your eyes open.

Then I heard it from another patients room.

Beep Beep Beep
Beep beep beep
Beep beep beep

I waited for the word that everything was OK

Beep beep beep
Beep beep beep
Beep beep beep

One nurse casually says, “Are you OK?”

“Uhmmmmm” Was the definitely unsure response. I could visualize the RN checking for a pulse and checking the Art line portion of the screen for a blood pressure.

“Do you need a cart?” Still casual.

“YES!”

A flurry of activity began. I waited a few seconds, probably about fifteen. I wanted to let everyone jump in before I went to watch.

As I went around the corner someone yelled, “Starting CPR!” And then the scene appeared before me. Several nurses and the junior resident were working on the patient. Where did the resident magically appear from at 5am?

The resident took charge quickly, calmly, and with purpose. “It looks like V.Fib. Everyone agree? I want 200j biphasic”

“Charging!” The cart nurse yelled**

Seriously? They already had the pads on? And hey look! that RN is doing GREAT CPR! My mind is racing, my eyes are wide.

“Everyone clear?”

Ka Chunk! The neat-o sound of the defibrillator.

“He’s moving!”

“We have a blood pressure”

The charting nurse and the cart nurse seemed bored–they were talking about something else. I know them though; they’ve done this a billion times.

“CBC, electrolytes, chest x-ray….” the resident is still making orders while everyone wanders back to their patients. Crisis averted.

No exaggeration here: I’m almost positive that the time from the triple alarm to CPR was less than fifteen seconds, and to defibrillation was about thirty seconds.

Exciting stuff!

**When a code is called at our hospital, whether it is in the ICU or on the floors, it involves three RNs from the ICU: One RN is the medication nurse who is in charge of getting IV access and pushing meds. The second RN is the cart nurse who prepares meds and passes off supplies. The third RN is there to chart everything going on. The floor nurses (or other nurses if the code happens in the ICU) are there to get supplies, prime IVs, etc.

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