What critical vital signs would institute a rapid response

[uniquegifts1]

I'm still a little foggy as to what would be a signal to cal a RR obviously if pt looks in distress but what critical sbp? Pulse, o2, rr.. Thanks!

[psu_213, BSN, RN]

In the ER I had one particular pt who had COPD. Her sats were 88-89% on RA. She does not wear O2 at home. She was not in the ED for a respiratory reason. She was in no respiratory distress. ER doc (and a good one ) wrote for her to go to a floor, said that she did not need supplemental O2...per the doc's words, "she 'lives' with that sat all the time." Called the floor to give report and was told "she can't come here with that sat, we will call and RRT." Discussed this with the doc, she said "no way, her oxygen level stable, she is in no distress, she can go there." I charted this, spoke to the RN on the floor who reluctantly accepted her, and then sent her to the floor. Sure enough, they called an RRT when she hit the floor. There has to be more that just a number...some critical thinking would be nice.

[ayla2004, ASN, RN]

We dont have a RRT i would love it,we have parameters that triger an early warning score based on vital signs any more than 3 needs medical review. we call the in house medic or if concerned that a patient could arrest with or without a raised EWS we put out a CRASH call, our vital signs charts actually have this writen on this.

Better to put out a crash on a critically ill patient detriating tha oone that has arrest i.e.

dead one.

[PMFB-RN, RN]

In the ER I had one particular pt who had COPD. Her sats were 88-89% on RA. She does not wear O2 at home. She was not in the ED for a respiratory reason. She was in no respiratory distress. ER doc (and a good one ) wrote for her to go to a floor, said that she did not need supplemental O2...per the doc's words, "she 'lives' with that sat all the time." Called the floor to give report and was told "she can't come here with that sat, we will call and RRT." Discussed this with the doc, she said "no way, her oxygen level stable, she is in no distress, she can go there." I charted this, spoke to the RN on the floor who reluctantly accepted her, and then sent her to the floor. Sure enough, they called an RRT when she hit the floor. There has to be more that just a number...some critical thinking would be nice.

*** Ya, we sort of assume a certain level of competence, critical thinking and common sence. This has happend in our hospital too. I see it as a great oppertunity to do some teaching and educate the nurse who called me. Usually they will only do it once.

[KelRN215, BSN, RN]

In the ER I had one particular pt who had COPD. Her sats were 88-89% on RA. She does not wear O2 at home. She was not in the ED for a respiratory reason. She was in no respiratory distress. ER doc (and a good one ) wrote for her to go to a floor, said that she did not need supplemental O2...per the doc's words, "she 'lives' with that sat all the time." Called the floor to give report and was told "she can't come here with that sat, we will call and RRT." Discussed this with the doc, she said "no way, her oxygen level stable, she is in no distress, she can go there." I charted this, spoke to the RN on the floor who reluctantly accepted her, and then sent her to the floor. Sure enough, they called an RRT when she hit the floor. There has to be more that just a number...some critical thinking would be nice.

I remember when I worked in the hospital, they designed some ridiculous "early warning" tool that was (supposedly) a JC requirement. The criteria on the list were obviously designed for an otherwise healthy child. You had to rank patients based on neuro, cardiac, resp status and staff/family concern. One of the criteria for neuro was "pupils unequal or sluggish"... needless to say, working on a neuro floor there are some kids for whom this is their baseline. A kid who blew a pupil YEARS ago isn't at any increased risk of anything today because his pupil is still blown. Especially when he's alert, sitting up in bed playing video games. If you selected this, that automatically put them in the "warning" zone and you were officially required to take action. Imagine making that call to an MD- "I'm just calling you at 3am to tell you that Johnny's fixed/dilated right pupil is still fixed/dilated." I refused to select this for a child who was alert/at his baseline and I would often find that a patient I ranked as a 0 other nurses would have in the "warning" zone because they'd check the pupil response for something that was the child's baseline... or, worse, if the pupils had been intentionally dilated by ophthalmology. The cardiac floor refused to use this tool because every single one of their patients would have been on the verge of death according to it.