when to call a code

[kxvc]

I feel so stupid right now I have lost sleep over the events that transpired this morning.

Had pt come in POV. OD, unresponsive, and apenic. So, I say, "call a code."

Yes, pt had a pulse, but although I had doc at bedside I knew I would need more resources such as additional RNs, RTs, Rad, and anyone else that comes to help. Who knows how long pt was without airway.

ED the doc at bedside agreed a code should be called (even with pulse present).

I got some puzzled looks from some other staff tho, and I just felt so dumb for wanting to call a code immediately as I see my pt rolling down the hall and into the room.

In our ED there is no such thing as rapid response, that is something only used on the floor. If anything it can't hurt to call a code, right? OR should I only reserve that for pts in lethal rhythms?

Thanks guys, I felt like such a noob last night. That was only one of many blunders, but definitely the one I felt most stupid for.

[silentRN]

Patient doesn't have to be pulseless to call a code. Sounds like you did the right thing by following the ABC's. You protected his airway. Good job. Who cares about looks.

[Asystole RN]

When in doubt, call the code.

That is the professional burden the responsible must bear, sometimes you get ridiculed but erring on the side of caution is always the reasonable and prudent thing to do.

[suanna]

To call a code is more often than not a judgement call. As a rule for me- if I have a SBP>75, a rhythm that is compatible with life and have an effective open airway- I don't want a code. Once the Keystone Cops arrive and pile in, what may have been a busy but fixable problem becomse a fiasco. Controled aggressive management by prioritized critical thinking beats the 3rd year medical resident spouting ACLS protocals from a brain being driven by overheated adrenal glands. Not being there myself, a code may well have been your best call at the time, but before I call I ask myself- " Do I feel the code team will provide more insightful and effective interventions than I can provide with the resources I have currently on hand?" The more codes you participate in, the better your ability will be to make that determination.

[Medic/Nurse, BSN, RN]

Sleep tight! You did a good thing, the right thing and IMHO the only correct thing!

:anpom: :anpom: :anpom:

You did the exact same thing I would have done. Pt is emergenct (life threat) - you correctly recognized that you needed more resources - which (thanks to the quick calling of the "code") you got. The patient got what THEY needed and that makes you excellent.

Let 'em look. You - just smile in the secure knowledge that you did the right thing. I know that perception is big - but, no defense on your part is warranted in any reality.

I know that resources are limited in all areas of healthcare and all that jazz - but, really --- this seems like it's fairly clear cut - - any haters are just that!

When additional resources are needed for a patient in extremis - they are a bit "time sensititive". This means taht if you FAIL to get the patient what is needed they tend to get real still ...... Really - patient cannot protect airway, apenic (or even struggling or agonal) -- the fact that they had a pulse is something you want to maintain. Fail to correct the airway issue and I am certain that the pulse will NOT stick around long (that stillness thing). Good call - no - if's, and's or but's!

Never apologize for too much (which this was not!) too soon - as opposed to too little too late. Best interest of the patient.

Good job!

Practice SAFE!!!

[Medic/Nurse, BSN, RN]

Sleep tight! You did a good thing, the right thing and IMHO the only correct thing!

:anpom: :anpom: :anpom:

You did the exact same thing I would have done. Pt is emergenct (life threat) - you correctly recognized that you needed more resources - which (thanks to the quick calling of the "code") you got. The patient got what THEY needed and that makes you excellent.

Let 'em look. You - just smile in the secure knowledge that you did the right thing. I know that perception is big - but, no defense on your part is warranted in any reality.

I know that resources are limited in all areas of healthcare and all that jazz - but, really --- this seems like it's fairly clear cut - - any haters are just that!

When additional resources are needed for a patient in extremis - they are a bit "time sensititive". This means taht if you FAIL to get the patient what is needed they tend to get real still ...... Really - patient cannot protect airway, apenic (or even struggling or agonal) -- the fact that they had a pulse is something you want to maintain. Fail to correct the airway issue and I am certain that the pulse will NOT stick around long (that stillness thing). Good call - no - if's, and's or but's!

Never apologize for too much (which this was not!) too soon - as opposed to too little too late. Best interest of the patient.

Good job!

Practice SAFE!!!

I just saw the "down the hallway assessment" - if the patient looks like they are gonna die on first glance - then it is pretty safe to presume that you should act on that super quick.

Even teaching hospitals call "codes" "alerts" - and regardless of further patient assesment - without an aiway - you got nothing!

[arabianeyez83]

In our ER, we have a rescitation team...if we know the pt is coming through EMS, this pt would have went to our resuscitation room...if the pt was not like this initially and then became unresponsive, then the dr's and the nurses in that area would treat the situation as a code..but like a code would not be paged overhead or anything like that...unless no one was around..then we can page like resus team needed in room so and so, but ya that definately is a code.

[dthfytr, ADN, LPN, RN, EMT-B, EMT-I]

It's a short trip from respiratory arrest to cardiac arrest. You did the right thing. You knew what you had, their looks were looks of ignorance.

[Bumashes, MSN, APRN, NP]

At my facility, we call a code for respiratory arrest, cardiac arrest, or both combined. Otherwise, we have a Rapid Response Team we can call if the pt is just looking "grim" and circling the drain. We can call them sometimes even if we just have a "feeling" and need an expert's opinion. I think you did just fine!

[brownbook]

Yes call a code!!!!! You call a code BEFORE the patient needs BLS/ACLS in order to PREVENT the need for BLS/ACLS. Supportive personnel are there to maintain and hopefully improve the patients condition. It is the same as calling the fire department for a "small" fire. You don't wait until it is a raging fire, you call them EARLY to keep it a small fire. Do I have to say DUH!!!!!!!

[mamamerlee, LPN]

Yes to call a code before total arrest. I have called codes on patients who were still awake, aware, and responsive, and have been correct every time.

One was a patient that had rec'd 2 Units PRBC's, no furosemide, and started to cough and wheeze. By the time the team arrived, he was drowning, and needed to be intubated. The IV furosemide was very helpful, too!

Another was a pt who had an acute anaphylactic reaction at the very start of his first dialysis treament. The renal doc thought we could just call anesthesia, but there was no one in the office! I called the code despite her telling me it wasn't necessary because he was still talking, but he was already starting to swell. The anesthesia doc who arrived said 'another minute or 2, we would not have been able to intubate this guy'. The renal doc never acknowledged my thought process, although my fellow dialysis buddies seemed impressed!

Err on the side of your patient - you are likely to be correct.

[dthfytr, ADN, LPN, RN, EMT-B, EMT-I]

It's better to call a code when a patient's dying rather than wait for them to be completely dead. Stop losing sleep over it. You did good.