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I do not care if I sound stupid for asking

Emergency   (615 Views | 3 Replies)

FloForLyfe has 2 years experience as a BSN, CNA, RN.

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Hello, I have no experience in Emergency Medicine and I am not sure if this is even an Emergency Medicine question, really.

I know that the guidelines for rapid response are always "it all depends". But I am sure I am not sure why/when I would call a code for:

Shortness of breath - if it does not resolve? (what about a patient who reported chest pain, but then it resolves? he has chronic CAD so is this an emergency?)

Anxiety/agitation - only if it could result in eminent harm?

Wet lungs - only if it is not being treated currently?

"Urine Output <30ml/hr X 2 hours"- how come I am being laughed at? should I accept this, give up totally, or call the provider behind their back?

Implementing the ABCD’s During a Code Blue Response in an Adult Patient Self - Instructional Module

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1,882 Posts; 18,889 Profile Views

Hello, I have no experience in Emergency Medicine and I am not sure if this is even an Emergency Medicine question, really.

Nope. Not really an ER question, but OK

I know that theguidelines for rapid response are always "it all depends". But I am sure I am not sure why/when I would call a code for:

While your guidelines require some judgement and an understanding of the individual patient, it's not really "it all depends". Use the guidelines to inform your decision making.

As far as when to call a code vs rapid response? When the patient is likely to deteriorate in the time it takes for a rapid response.

shortness of breath- if it does not resolve? (what about a patient who reported chest pain, but then it resolves? he has chronic CAD so is this an emergency?)

SOB completely depends on not just the severity, but rate of onset, whether or not it is progressive, etc. A patient with a subjective complaint with stable vitals speaking in full sentences and no new wheeze is completely different from sudden onset, pain on inspiration, 2 word dyspnea, SPO2 82%.

Chest pain resolved. Get an EKG, notify doc.

anxiety/agitation- only if it could result in eminent harm?

If it is new and unexpected, that is an emergency until proven otherwise.

wet lungs- only if it is not being treated currently?

New finding, mild symptoms = inform doc. Expect CXR and lasix.

New finding, moderate and progressive symptoms, concerning signs or symptoms = rapid response.

New finding, severe symptoms or rapid deterioration = code blue most hospitals- unless rapid response is truly rapid, well equipped and highly competent.

"Urine Output <30ml/hr X 2 hours"- how come I am being laughed at? should I accept this, give up totally, or call the provider behind their back?

If you are working with nurses who don't understand what normal urine output is in a patient sick enough to warrant a foley, this is not an environment conducive to learning.

You may be able to fix the patient, but you can't fix stupid.

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279 Posts; 2,539 Profile Views

What does your facility do for rapid response? I know of some hospitals where a whole team of people, including an EM physician show up to the bedside, and others where just a good critical care nurse responds.

When I worked rapid response it was basically for when the nurse couldn't handle the situation themselves. If you know what you're doing just call the doc and handle it yourself. You should ask your charge nurse and other nurses in your unit for help before calling the rapid response nurse, if your charge says to call then call.

That being said if you find a patient agonal breathing, completely unresponsive and can't find a pulse, that would be a code and you press the blue button.

Are you working in ED? Every facility I worked in rapid response didn't handle the ED because the physicians are right there. Rapid is basically a middle man between the physician and you in a rapidly deteriorating patient.

Chest pain but VSS? Call the hospitalist. Chest pain with BP 70/50 and dizzy? Call rapid STAT.

Edited by murseman24

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