Last night I had a hospice resident who also happens to be a full code. This individual presented with an acute and significant change in condition. Primary Dx mets cancer. He presented with sudden decreased LOC, unable to follow simple commands, one sided facial drooping and could not grasp at all with that same side. Also unable to swallow. Acutally, seemed unaware that there was anything to swallow when a cup was placed on his lips. He was staring off into space and would occasionally offer one-syllable responses when prompted after several attempts. VS's were stable in otherwise no acute distress. I sent him out after speaking with his hospice nurse citing the code status. I was unable to reach family for their input. He looked mighty CVA-ish to me. However, with the mets and not being a MD with all the fancy equipment I can not rule out a brain mets that caused the acute change. Either way, I did not feel comfortable with the situation at all and erred on the side of caution and obtained the order to send out. What would you have done or have done under similar circumstances?