Clinical question?

[amzyRN]

So, during my orientation on a new job, one of my preceptors told me to give some noncritical meds prior to a Code 3 coming into our room-5 minutes out. Because I was on orientation I did it, but ordinarily (on my own) I would be getting my room ready for what was going to be rolling in before giving a noncritical med. Was my thinking wrong? I like to have my monitor set up, IV start kits ready, flushes, primed NS bags and stuff. Maybe it was just that she knew how Codes happen at the new facility or something. I know that sometimes eta's are wrong and I like my room ready to go.

[Guest374845]

Code 3 means lights and sirens. Was it a cardiac arrest or just a lights and sirens arrival?

Not right or wrong depending on how you manage your time.

[amzyRN]

It wasn't a full arrest, severe hypotension ALOC, lights and sirens.

[offlabel]

It's the ER...emergencies there are not really emergencies as defined by conventional wisdom...these things are routine. They are, by definition, not out of the ordinary, because it is after all, the emergency room. Part of the ER is routine care and that should take as much priority as "code 3" traffic because nothing is routine in the ER. A sore throat can turn into a full blown resuscitation while you're off getting coffee and "code 3" traffic can be utter BS....your obligations are the things that are in front of you at the moment. They are not to be discharged because of what "might" be on the way...

[offlabel]

Code 3 means lights and sirens. Was it a cardiac arrest or just a lights and sirens arrival?

Not right or wrong depending on how you manage your time.

Oh, yes there is...

[amzyRN]

This patient already had her work up complete, she was getting a meclizine. I do see your point if it had been a new patient without all her labs and stuff back. I don't like being unprepared if I have a potentially critical patient I am going to be receiving any moment. I did give the meclizine and by the time I was done the new hypotensive guy was in my room getting his care and I had missed part of the EMS report. It was a legit code 3, severe hypotension along with ALOC is an esi 1. I think if I had been more prepared I would have given the meclizine first, but in my previous experience, a critical arrival is priority over a routine/comfort need.

[Kuriin, BSN, RN]

ETA 5 minutes out? Uh...yeah, I would get the room prepared just like you would have. Sounds like someone came in for vertigo or migraines and that is just not a priority. You have to make sure you have your RSI kit ready, all your airway supplies, make sure you have everything ready for the code 3.

IMHO, you did the right thing. If ETA was more than 5 minutes and you knew the patient would be fast to take the medication...then, maybe, sure.

[JKL33]

Part of the ER is routine care and that should take as much priority as "code 3" traffic because nothing is routine in the ER. A sore throat can turn into a full blown resuscitation while you're off getting coffee and "code 3" traffic can be utter BS....your obligations are the things that are in front of you at the moment. They are not to be discharged because of what "might" be on the way...

I get how you're looking at this offlabel, but you are imagining situations that weren't the case here. In this scenario we were not told what "routine med" was ordered, but we can reasonably assume that, since the patient has already been examined, the OP wouldn't have used the word "routine" to describe the urgency of the order if there were also other orders for that patient that conveyed an increased acuity.

A known patient who has already been assessed to not have an urgency/emergency will never outright trump a reported incoming Code 3. Code 3s are routine in the ED due to three basic things: 1) they happen often enough 2) we are well-trained to handle them and 3) the setting is prepared for them accordingly - both as a matter of long-standing preparation and immediate preparation. They wouldn't be routine at all if they were nothing more than unprepared sh*tshows every time one rolled in and people were scurrying for basic supplies when they should be performing immediate interventions. Everyone needs to know the limitations of their own environment and prepare accordingly as much as possible. That's the basic tenet underlying the radio report to begin with; that we can't control the accuracy of the report is neither here nor there.

Now, if the OP had said that the first patient was having some sort of problem and she needed to decide what to do first - attend to the first patient or get the room ready for the second - that's an entirely different matter and yes, the one who is already present and is having a problem is obviously the priority.

[Kuriin, BSN, RN]

It wasn't a full arrest, severe hypotension ALOC, lights and sirens.

So...likely septic shock? Most likely on its way to arrest without RESUSCITATIVE MEASURES. This is ESI 1. Migraines are ESI 3-4.

offlabel, you are totally wrong on this one. Code 3s will always trump a migraine unless the CT shows there's something that warrants immediate measures.

[Guest219794]

This patient already had her work up complete, she was getting a meclizine. I do see your point if it had been a new patient without all her labs and stuff back. I don't like being unprepared if I have a potentially critical patient I am going to be receiving any moment. I did give the meclizine and by the time I was done the new hypotensive guy was in my room getting his care and I had missed part of the EMS report. It was a legit code 3, severe hypotension along with ALOC is an esi 1. I think if I had been more prepared I would have given the meclizine first, but in my previous experience, a critical arrival is priority over a routine/comfort need.

I am guessing that there are two issues here-

1- Giving an orientee the best clinical experience possible.

2- Efficiently running an ER.

In all likelihood the preceptor knows how to prioritize shock vs benign positional vertigo. (Or whatever). OTOH, the ER may, at that point, had a greater need to clear beds than educate a new nurse. It happens.

And, despite the fact that you personally did not prep the room, etc..., the hospital based care had begun before report was even finished. And, Mr Vertigo left the hospital 1/2 hr earlier than he might have otherwise.

Personally, had I been your preceptor, I would have tried to maximize your critical care experience. But, I could see letting you take a minor hit for the greater good.

OP- I wouldn't read too much into this.

[gemmi999]

It really depends. When we get a call that a code 3 is coming in to one of my beds (or really any bed, now that I think about it) I ensure the room is getting prepared by a tech. But then I round on my other patients, take care of the little things, so that I can focus on the critical patient for the next 1hr plus that they need. I update vitals/give PO meds/make sure no one is up for d/c.

The way our system is I can't access meds until the patient is registered, so I can't pre-prime IV fluids, etc. I would have given the routine med, too, just so I don't have to worry about that patient for a bit.

[amzyRN]

I think she probably wanted me to maximize flow like hherrn mentioned. Had it been a full arrest or something unique coming in, I would have asked her to give the med so I could help out. Whatever her rationale was, I'm just glad to be done with orientation and feel more confident with my thinking process after hearing some of the responses. Had I been on my own and had to help manage this patient, the vertigo with her work up done/critical information back, would have had to wait or another person could have medicated and discharged her. Thanks you all for answering my question, I appreciate the feedback.