calling a code

[abbysmom]

this morning at 2 am a woman walked on to our floor in street clothes, asked for some help, and looked like she was going down. i got up to try to catch her but she hit the deck -- though i couldnt see her head and if it hit. then she started seizing. i'm brand new, all i could think was to call loudly for the charge nurse (there were only three nurses on the unit) and find out if she had a pulse and was breathing. she had a good pulse but erratic breathing. the charge nurse came running, took in the situation, and said call a code. i said she's breathing and has a pulse, but i really liked the idea of lots of people coming to help because i had no idea what to do about this very large lady seizing on our hall. instantly 25 people were there, and they took over. she had good vitals, wasn't responsive, but was deemed stable and was moved to her bed (oh, she was a pt who had recently been admitted but went MIA for several hours so i didn't know she was one of ours) --turns out we probably should have called a different team--the "rapid response" call--because she was breathing and had a pulse, and i think the code people were either irritated or disappointed that they weren't crucially needed. perhaps that is a harsh judgement on my part because they were very helpful and not derogatory at all. anyway, i just share this because i've had classes on codes, and my biggest fear has been that i wouldn't know when or when not to call one. i wonder if others have had situations that they weren't sure. it seems so cut and dry in class--when the pt isn't breathing or has no pulse--but on a night shift with 3 nurses and 2 patient care associates, and a whole bunch of crazy stuff happening anyway with our patients, anything else seems a catastrophe at 2 am.

[nyapa, RN]

Don't worry what they think. You are thinking about the wellbeing of another person. That's the bottom line. In a situation like that, just do it. If its a bit of overkill, well, all that's going to happen is that the team are going to get a bit annoyed. But your lady off the street will be ok...

Don't be afraid of calling a code.

[jmgrn65, RN]

call a code when no pulse or no breathing otherwise call the rapid response team. Some people are overzealous and call a code.

[vamedic4, EMT-P]

Code Blue is for a medical emergency at my organization, and if your organization didn't have a Rapid Response Team, then a Code blue call was the correct one to make.

Here's why...

Who knows what happened when the patient fell? Did she hit her head? Where was she prior to coming back on the unit? We know no history on this patient. She could be diabetic and hypoglycemic. She could be disoriented from hypoxemia...

Please remember that just because someone has a pulse and is breathing - this does not mean the situation isn't a medical emergency or that a code blue isn't what's needed.

Yes, when we're doing CPR, hooking up lines and bagging...call a code. That'll get everyone to you asap. In your situation, it probably would have been better to call the RRT, but since a code was called there's no harm, no foul. At least you had plenty of people there in the event the patient really needed aggressive management.

Either way, the patient got the care they needed and hopefully all turned out well??

vamedic4

[EmmaG, RN]

What he said

I once had a 30-something young lady admitted with abdominal pain who was doing quite well, then suddenly spiked and crashed within minutes (sepsis). Unresponsive, no palpable pulse or BP, weak respirations. Called a code and as the team arrived and started to work on her, the doc who responded was ranting because we'd called a code on a patient who "wasn't dead" (his words). Thinking of how quickly this woman had crashed, I told him, "Well, if that's what you really want just hang around a few more minutes and I'm sure she'll oblige."

[Tweety, BSN, RN]

It's always easy to criticize in hindsight but I agree that you should have calloed rapid response first and not the code.

It's tough when a patient is seizing becuase sometimes they look like they are not breathing or that they will stop breathing, which is what your charge nurse might have seen. I've seen several false alarms called on a seizing or immediate post-ichtal patient during those scrarey times when they are turning blue on you.

[nursemike, ASN, RN]

It sounds like your RRT would have been more appropriate. My facility still doesn't have one--the code team pretty much is our RRT. I find your rationale (and your CN's) hard to dispute. Certainly, this is far different than calling a code on a DNR or a stable pt.

One thing I can say from personnal experience--it's no fun at all to wonder whether you waited too long to call a code. In my case, it turns out it's generally agreed it wouldn't have mattered, but there's every chance I'll call too soon, next time, and sleep a lot better, afterward. (Not to say I plan to jump the gun. But if I'm checking code status, I'll probably be dialing...)

[Conrad283, BSN, RN]

The fact that this woman just appeared on the floor and collapsed warrants a code because they're not considered an admitted patient with the proper history and meds and whatnot. If this were a current patient, the appropriate action would have been to call rapid response. I think you did the right thing.

I remember I was leaving work with my wife and we were walking thru the lobby and we saw a clerk from the ER on his dinner break and he was staring (I knew he had a history of seizures) and then he started to have a grand-mal. Security was there and they called the ER for a stretcher because so and so was seizing, but no one can immediately. So, after what seemed like an eternity, they still hadn't showed up, so I had the guard call a code and then suddenly everyone appeared with the proper equipment. He was transported to the ER and then admitted.

[Nurse Lulu]

When in doubt call a code! I work in IICU, and we get most of the post code pt's. Rather have the code team annoyed, then a dead pt or "I don't know what happened, I found them at shift change."

[LauraMT]

I would have called a code too. We have "Code 3" at our hospital where you just call one department (respiratory, anesthesia, whatever). We have a rapid response team too, but I don't know what they would have done with no history and no idea who the woman was. My nurse manager prefers that you call a full code because in the case of code 3 here is what you hear overhead "Code 3 respiratory" then respiratory decides they need intubation "code 3 anesthesia" then they need labs "code 3 lab" so by this time you could have called a dang full code anyway and not many more people would be there. You can always send away the ones you don't need and if they're going to be snippy about it they can get their butts off the code team.

[flightnurse2b, LPN]

you did a good thing, when in doubt if the pt is breathing, call a code.. its better to be safe than sorry. but i would say next time try calling a rapid response first if her vs are stable.. that way the RRT/code team will still come to evaluate the situation and if the situation takes a turn for the worse, you already have help to run the code.