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Called a code for a seizing patient

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Hi everyone, new grad here on my own after my first month orientation. I have not experienced a code blue before but went through a basic mock CPR during orientation.

Details: Came back from break, was doing my nursing rounds when one of my patients who was ‘stable' all morning suddenly began seizing so I quickly ran for the pt. My supervisor happened to be around and was by the bedside as well and said "pt is seizing call a code!". Pt eyes began rolling backwards, unresponsive to name and touch as she was seizing and decreased LOC. I checked for breathing and radial pulse (should've done a carotid pulse) and only felt a weak pulse. I initiated a code and began chest compressions and pt woke up after a couple of them and began vomiting blood etc. Pt never had an epileptic episode before and pt began stabilizing after medical intervention.

I am just reflecting on my nursing practice and judgment.. My question is whether we are supposed to call code blue for seizures? No one questioned my actions of calling a code and even said I did a great job. Thoughts?

What type of facility is this? In my facility (acute care hospital), we don't call a code for seizures. Do you have a Rapid Response Team? They may be needed in certain situations when a patient is having a seizure.

Can I ask why you started chest compressions?

Decreased LOC, unresponsive when I shook her shoulders and name albeit it appeared to be a seizure that lasted a few seconds. Couldn't hear her breathing and weak pulse. Also partly due to my nursing supervisor telling me to start a code.

We have an ICU nurse outreach team.

AnnieOaklyRN, BSN, RN, EMT-P

Specializes in ED, Pedi Vasc access, Paramedic serving 6 towns.

I would be more concerned about why you did chest compressions if you felt a radial pulse??

It depends on your hospital with regards to called a code. If you have a stat team I would do that instead, but either way if you are in a non critical care area you need some help. Just remember although seizures can be somewhat alarming to watch they are generally self limiting.

Also patients can initially have seizure activity when they first go into cardiac arrest, especially with VT and VF, so it was a good idea on checking for an actual pulse. If you feel a pulse however, especially a radial pulse there is no need to do compressions.

Annie

My CPR course I was taught to begin chest compression if you are in doubt, even if there is a weak pulse.

AJJKRN

Specializes in Medical-Surgical/Float Pool/Stepdown. Has 6+ years experience.

Ditto response/questioning of the chest compressions.

Next time, if able, maybe think about getting them on their side or head elevated, slap a pulse ox on for heart rate and O2 measurements, suction and oxygen readily available, and take a blood sugar. Try and always keep an eye on the time/length of the seizure with characteristics.

Either way it sounds like you did the best with what you had to work with. I wonder how much experience your nursing supervisor has and how long they have been away from the bedside, if any.

They're seasoned and experienced nurses, worked in ER/ICU for decades. Mostly why I did not question it. Now I am just reflecting on my actions.

Blood sugar, suction, pulse ox etc were all taken during/after my compressions.

Davey Do

Specializes in around 25 years psych, 15years medical. Has 42 years experience.

My question is whether we are supposed to call code blue for seizures? No one questioned my actions of calling a code and even said I did a great job. Thoughts?

Well, the proof is in the pudding, in that the patient survived and you got some experience and kudos, thesimplenurse. I also admire your actions in reviewing and requesting more perspectives on the situation.

We recently had a patient seize twice on the geriatric psych unit. The first seizure occurred serendipitously as I was on the phone to an NP who immediately gave orders for an IM Ativan 2mg and a phenytoin level. The episode was resolved with the IM and no rapid response was called.

I was discussing the possibility of getting a Rx of oxepam for the patient with the NP when the floor staff informed me the patient was having a seizure. The patient had a history of alcohol abuse, a diagnosis of a seizure d/o, and was complaining of feeling irritable. VS were within parameters and he told me he had never experienced anything more than irrtabilty when not drinking. He said he had never had a seizure as a result of not drinking.

There was some speculation as to whether the seizure was a true one, as the patient was subjectively labelled as "med seeking" by other staff. I merely said, "Hey- I'd rather error on the side of safety".

The second seizure occurred the next evening when the patient was found on the BR floor. The nurse handled the situation well. She got treatment and f/u Rx without calling a rapid response. She was questioned as to her decision, but believed she did all that was necessary in her endeavor to deal with the situation.

Calling a rapid response in either circumstance would have been appropriate, but some nurses are comfortable dealing with such situations. If I'm uncomfortable with a situation, I do not hesitate in calling a rapid response. But, like the other nurse, I am not going to pull away staff critical to an area when I can deal with the situation.

Sour Lemon

Has 9 years experience.

That all seems a little extreme, to me. I usually just monitor the length and nature of the seizure, give PRNs if needed/ordered, report to MD immediately if it's new onset, and report to MD during rounds if it's a known issue.

Vitals and a blood glucose check are good ....a rapid response could be useful if the seizure is prolonged, but I wouldn't call one otherwise.

It's good that your facility is supportive of you being proactive, though. No one should be scared to call a code or rapid response in a case where they're uncertain.

BSN16

Specializes in ICU, trauma.

Sometimes I don't question nurses when they call a code blue when it actually isn't because it gets people there a lot faster than a rapid and you get a doc there stat.

However, if they had a radial pulse it means they were stable-ish and had a systolic BP above 80. You are right though you should have checked a carotid or femoral. Was the pt still seizing when you checked it? IMO very inappropriate to start CPR.

Edited by BSN16

A "code" is just another name for an emergency in which there is sufficient evidence to believe that a patient's aerobic metabolic requirements are suddenly and unexpectedly not being met.

It doesn't specify what kind, i.e. full arrest, uncontrolled bleeding, respiratory failure. It doesn't obligate CPR any more than some other emergency intervention that is specific to a patient's need at the time.

So, calling a "code" in this situation was the correct thing to do. CPR was not. But stuff happens and no harm, apparently, was done, so all's well.

JadedCPN, BSN, RN

Specializes in Pediatrics, Pediatric Float, PICU, NICU. Has 15 years experience.

A "code" is just another name for an emergency in which there is sufficient evidence to believe that a patient's aerobic metabolic requirements are suddenly and unexpectedly not being met.

It doesn't specify what kind, i.e. full arrest, uncontrolled bleeding, respiratory failure. It doesn't obligate CPR any more than some other emergency intervention that is specific to a patient's need at the time.

So, calling a "code" in this situation was the correct thing to do. CPR was not. But stuff happens and no harm, apparently, was done, so all's well.

You took the words out of my mouth. I don't have an issue with the calling a code part if that is what felt appropriate at the time - better to falsely call a code than to not call one when it is needed. However I believe starting CPR was inappropriate. The take home lesson should be just because a code is called, even if it is appropriate, doesn't mean you should automatically jump into compressions.

Edited by JadedCPN

CrunchRN, ADN, RN

Specializes in Clinical Research, Outpt Women's Health. Has 25 years experience.

Seizures are scary. Next time maybe slow down a bit. You have time. You did a great job though.

[…]

However, if they had a radial pulse it means they were stable-ish and had a systolic BP above 80. You are right though you should have checked a carotid or femoral. Was the pt still seizing when you checked it? IMO very inappropriate to start CPR.

The old rule of thumb” that a radial (femoral, carotid) pulse indicates an SPB of ≥80 (70, 60) mmHg originated from the ATLS course. This is not accurate, and using this method is generally an overestimation of the actual SBP.

Anna Flaxis, BSN, RN

Has 14 years experience.

In my experience, a Code Blue is for a cardiac or respiratory arrest, and I'm not sure why one would perform chest compressions on an adult with a pulse.

It is reasonable to call for assistance if your stable patient suddenly begins seizing.

Anna Flaxis, BSN, RN

Has 14 years experience.

The old rule of thumb” that a radial (femoral, carotid) pulse indicates an SPB of ≥80 (70, 60) mmHg originated from the ATLS course. This is not accurate, and using this method is generally an overestimation of the actual SBP.

First, please note that this is a single study with an n=20. This is not a large enough sample size to be statistically significant. Second, please note that in Group 1, the group in which radial, femoral, and carotid pulses are present, 8 out of 12 patients (67%) had an SBP >/= to 70, and 11/12 (92%) had an SPB >/= to 60.

We would need to conduct more experiments with greater sample sizes to be able to draw a reliable conclusion.

Also, please see: Accuracy of ATLS guidelines for predicting systolic blood pressure

Edited by Anna Flaxis

NurseHeart&Soul, MSN

Specializes in ED, Critical care, & Education.

Thesimplenurse~

Congratulations on surviving your first code!!! This experience is now behind you. Phew! One of the most important aspects of learning is taking time for reflection, thus I commend you on being vulnerable, sharing your experience, and asking for input from others.

It sounds like there might be some confusion about what a "code" means. Simply put, it's typically a patient who could be having a rapid decline in condition and you need stat help. Often this is or respiratory or cardiac nature but could be anyone who is suddenly unstable. A code calls in more resources so all hands on deck can help stabilize the patient. Some facilities use Rapid Response Teams to help with this but not all.

In your situation it sounds like you interpreted "call a code" for start CPR. They are not synonymous. Regardless, sounds like no harm was done to the patient, resources were obtained, and things turned out okay. Experience gained, lessons learned....awesome! Enjoy your nursing journey! Congratulations on your new job!