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?
its not wrong to call a code. Like others have said, if you felt a weak radial pulse, compressions not necessary, but like you said there maybe was some doubt, so its totally fine. You can also justify (if you ever had to, some people can be rude about it) that due to the seizure they are having a resp. arrest. Essentially they are. People who have seizures turn blue because theyre not breathing. When the seizure stops they breath again. If thats the fastest way to get help in your hospital, calling a code is not wrong. If you have a rapid response team, that also could have been implemented. A code is for a full on cardiac arrest, and or just a plain resp arrest. They may still have a pulse, but if they stop breathing, then that warrants BLS/ ACLS- hence calling a code. Sure when the code team arrives, usually the seizure is done and the patient is coming around, but at that moment, the right thing to do is call a code.
People who have seizures turn blue because theyre not breathing. When the seizure stops they breath again.
This is a generalization that is not typical of most seizures. Most people don't stop breathing during a seizure. During my 5 years of being a pediatric neurology nurse and 10 years volunteering at a camp for children with epilepsy, I can count on 1 hand the number of times I witnessed someone stop breathing during a seizure. When it happens, it is an emergency.
If someone turns blue and stops breathing during a seizure, they minimally need to be bagged and a code should be called. We always instructed our patients' parents to call 911 if the child stopped breathing, turned blue or had a seizure that lasted longer than 5 minutes.
Assuming this is not a rhetorical question, to put it simply, the smaller the sample size, the less precise the information is.
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I understand, and agree with everything that you have said in both of your previous posts. If we are going to continue to teach this paradigm, then yes, further study should be done.
The problem is this. No one seems to know where this came from, and why it was originally included in the ATLS curriculum as there is zero evidence to support it. Nor does anyone seem to know why it was removed. Unfortunately, both medicine and nursing continue to believe, and teach it.
And thus the intent of my previous post. Don't you think that there should be some evidence behind what we teach and practice?
Since you felt a pulse, I don't think I would have started compressions until I had them on a monitor. Calling a code does not mean you automatically start compressions. I would have wanted to make sure I had an Ambu bag ready in case they stopped breathing and need oxygen and breaths. If the patient was known to have seizures I might not have called the code if the seizures were part of the medical history and was a known occurrence unless something was different. Did the physician say to start compressions. I know your Charge stated to call a code, but calling a code does not equate immediately start compressions. Now if no pulse, no respirations, YES start CPR.
To the OP, as you mentioned you are a new nurse and you get the gist from these posts that calling a code was fine but starting CPR wasn't appropriate in this situation. Don't beat yourself up over it but instead use it as a teaching moment and take some time to further your education on BLS, rapid response/emergency situations, and seizure management.
Many users have mentioned that "calling a code" is basically a way to quickly get more help from the multidisciplinary team because of an emergent condition. Not every nurse would have called one for this particular situation (it depends on your experience level and the setting where you work), but your decision to call the code was justified and supported by the supervisor. Regarding CPR, you know that for the next time you would check a carotid pulse and if the patient was actively seizing you would assist them to a supportive position, maintain the airway, check the SP02 and blood glucose, and apply supplemental oxygen as needed. If you have a palpable pulse then you should focus on airway, breathing, circulation (ABC) and oxygenation until the patient regains consciousness. One thing to note, in PALS (for pediatric patients) if you have a HR of
OP, I agree with what many of the other posters have said. Overall, you did a good job! You got help when it was needed and worked to stabilize your patient. The appropriateness of starting chest compressions depends on your patient population (peds with a pulse
One thing I would suggest is to also seek feedback from your manager/educator on your unit. They will be familiar with what happened and can give you feedback on your interventions, critical thinking, delegation, and even on your documentation. They will be familiar with the criteria for calling a rapid response vs calling a code at your hospital and can guide you as to when each one is most appropriate (however- don't be afraid to call either if you feel it is warranted!!). As well, discussing this incident with your management shows that you have been reflecting on it and are seeking to hone your practice. They are lucky to have a nurse who is self-reflective and open to feedback!
I would not have called a code; I would have called a Rapid Response. I also would not have started chest compressions but would have turned the patient on their side and protected their airway. In the process of waiting for the RR nurse I would have got vital signs. If the patient maintained a pulse throughout the event I would have administered Ativan via verbal order from the RR nurse. If the patient lost a pulse I would have started compressions and called a code. If the lost their airway but had a pulse I would have administered O2 via Ambu bag and called a code. Hope this helps.
I started nursing back in the dark ages when there were very few seizure meds available and it seemed like every seizure patient was med non-compliant because of the side effects. Back then, seizures were pretty much weekly and we reacted like cavemen when a patient experienced one - jumped on top of them, held down arms and legs, jammed a tongue depressor in their mouth and put a thin, cheap hospital pillow under their head. I'm surprised we didn't kill them with our "care." Seizures are scary when they happen if you're not used to them. I think the OP did a great job (except starting compressions). But from a lot of the comments here, it sounds like epilepsy and seizure disorders are as misunderstood now as they were back when we were pinning the patients to the floor. It's important to remember that most seizures are NOT medical emergencies, so there's no need to panic. Assess the patient and initiate care based on what you find. And it's also important to observe the patient during the post-ictal period and remember, sometimes patients coming out of a seizure are confused and violent, so always be careful. I've seen post-ictal patients knock staff into next week and not even remember doing it.
At my work we would call a rapid response. I also would not have done chest compressions. When I had a patient seize I made sure they were safe and kept track of how long it lasted. I work on a medical-surgical/cardiac floor.
5 years Level 1 Trauma/ 1 year flight nurse....here is my take
You did the right thing. When in doubt, be over prepared. Especially when you are new. Would much rather call a code and not need it than to NOT do something for fear of being wrong, and trying to explain why you didn't act. No one will ever fault you for being OVER prepared.
Creamsoda, ASN, RN
728 Posts
its not wrong to call a code. Like others have said, if you felt a weak radial pulse, compressions not necessary, but like you said there maybe was some doubt, so its totally fine. You can also justify (if you ever had to, some people can be rude about it) that due to the seizure they are having a resp. arrest. Essentially they are. People who have seizures turn blue because theyre not breathing. When the seizure stops they breath again. If thats the fastest way to get help in your hospital, calling a code is not wrong. If you have a rapid response team, that also could have been implemented. A code is for a full on cardiac arrest, and or just a plain resp arrest. They may still have a pulse, but if they stop breathing, then that warrants BLS/ ACLS- hence calling a code. Sure when the code team arrives, usually the seizure is done and the patient is coming around, but at that moment, the right thing to do is call a code.