First code that shouldn't have been a code (long)

[MJJFan1, BSN, RN]

Okay people, I've been nursing for 1 year and 6 months to the day. i have never had to call a code or rapid response. I work on a tele floor. Here's the scenario:

0700:Day shift coming in, Nurse aid tells me "her IV is out" I go to the room with the aid, remove the IV and ask her how she's doing. She says "I need something to eat" I tell her "honey your gallbladder isn't working the way it should and the doctor wants to continue you on the ice chips, are you getting tired of them?" She say's "look at me. I'm getting weak because I haven't had anything to eat" (this woman is 100 years old, no a candidate for surgery and the only past history is ileus, and GI bleed). I say "let me get with him once he gets here and we'll se what we can do" she says "what's he doing, trying to kill me" and we all, including the patient began to laugh. I told her, "let me get another IV inserted, your doctor normally comes in by 0730. (he doc is one of those who will write you up for not having I/O charted, for not having an IV inserted......he likes to write people up.)

0715: Anywoot, me and the on-coming go to insert a new IV,(i couln't get one on her, they just blew everytime you flushed). We get the IV in and the on-coming says to her, "we're back in business (the on-coming is married into the patients family) well the patient doesn't say anything and she starts breathing really shallow. The on-coming looks at me a says "she doesn't look good" I say "dude, we were just shooting the s#### in here with her". She tries to get the patient to talk to her but she doesn't, she shakes her and the woman doesn't respond. I get a monitor, o2 monitor, and bp machine in the room : 35.7 72 24 116/64 83%.

We turn up the O2 to 4L, no change, the patient starts to close her eyes and the on-coming says "she's going to die, I'm calling a code" before I could say, no, get rapid response, a code is announced. Everyone comes charging in the room. I say "we really just need a rapid response, she has a pulse" but doctor preceeds with the code. Resource nurses come in and say "is she really 100 years old, my god!" I had someone call the family and they said they wanted everything done for her. Primary physician notified he said "just stop the response", told him the family didn't want that. He came to the room looked at her and said "I'm going to try and change the family heart" he tried and tried but they wanted everything done.

Well the patient got transferred to the ICU. I got her transferred, called report, and finally realized, school is out, my son has been at home alone for almost an hour and a half. Why did this happen to me? I called home and my son didn't answer the phone, so i think ok dad has told him not to answer the phone, then i think someone has gotten him, as my anxiety attack proceeds, the primary comes and says "why didn't you call rapid response?" I looked at him and said 'dude, my son is at home alone...............I've gotta go" he says "that's not what I asked you. I said "I thought a rapid response would be appropriate but a much experienced nurse thought the code was the way to go" he walked off

My question is, would you have called a code or rapid response?

[Aneroo, LPN]

Unless she was at the point where she needed to be bagged, I would have called rapid response. Throw her on a NRB at 12-15lpm (unless she's a COPD'er) and pray her sats come up. (Keep in mind I worked ER, so I don't know how it works like that on the floor, but we could get away with that in the ER)

[AllSmiles225]

I haven't been a nurse that long..nor do a work in such a high acuity place such as tele but the purpose of rapid response teams is to respond to the patient before a cardiac arrest. If the patient still had a pulse I would have called a Rapid Response. In our facility (sub-acute) if someone still has a pulse we CANNOT call a Code Blue--we have to call for extra people (Rapid Response) the code can always be reannounced as the patient is reassessed. Overall if the patient still has a pulse I wouldn't call a Blue as that implies the need to begin CPR which you wouldn't do if the patient is breathing and has a pulse. I think you made the right decision..lets see what everyone else thinks.

[86toronado, BSN, RN]

Rapid Response, definitely.

[squirtle]

I think rapid response, but you mentioned that the on-coming nurse who called the code was married in to the patient's family. If I understood you correctly, do you think that could have clouded her judgement when calling the code?

[flightnurse2b, LPN]

rapid response, definately.

and at 100 years old, if the pt was actually in an arrest, a code would have really been more hurt than good.... in my opinion, anyways.

[Roy Fokker, BSN, RN]

I would have called a rapid response - the patient had pulses and a measuarble BP.

A cardio/pulmonary arrest is a good indication for calling a "Code Blue".

Throw her on a NRB at 12-15lpm (unless she's a COPD'er) and pray her sats come up.

COPD or not - I would have popped a NRB on her (while the Doc/Respiratory was being paged). Besides the fact that recent studies have shown that compensated CO2 retainers don't switch to Hypoxic Drive to maintain respirations, Hypoxic Drive also doesn't kick in on a dime. It takes time.

What should be your bigger worry: perfusion or ventilation?

cheers,

[hypocaffeinemia, BSN, RN]

I was about to reply, but Roy beat me to it. When a patient is crashing you shouldn't particularly be worried about the hypoxic drive.

[ohgoodnessgracious]

Rapid Response. No COPD so I'd have gotten the NRB and popped her on it while on continuous sp02 monitor. Have someone call the doc ask for an EKG, accucheck what labs they wanted, have them come and do the ABG etc. etc. and check all my bases.

I'd have to agree with one of the above comments tho. The on-coming was related to the patient? Kinda weird. You'd think they'd have been wise enough *not* to call a code for their fam member! That or they were that freaked out by the situation, heh.