I was in a similar situation. The patient had a No Code order, but was clearly septic (tachy, hypotensive, diaphoretic, source of infection, lactic and white count through the roof, etc). She was declining steadily on my shift, and I was torn. Do I call the doctor and initiate severe sepsis protocol (which would likely end with her intubated), or do I allow her to continue declining? I went with my gut, called the doctor, got some orders that would stave off some of the worse symptoms without doing SSP, and as I hung up with the doctor she died. I was glad I at least called and got orders, even though in the end it was futile. That was an awkward call to the doc 10 minutes later, though.