Rapid Response vs Code Blue?

At my facility, when we call a rapid response, we do not get a physician hence someone to intubate. It is correct to call the rr because you look at this pt is who rapidly decompensating and you think "oh hell nawww, he won't be able to keep up breathing like this for long!!" but, he is still breathing and "technically" OK (re: not in resp arrest).

So, what often happens is at my place, a rr will be called, the team gets there and the patient looks like respiratory garbage. They call a code blue to get someone in there to intubate. The patient is not dead, but intubating is the best choice for them right now.

I have heard rr for opiate overdoses, pt is breathing (barely) but unresponsive. All they need it narcan, usually and closer observation. Additionally, I had a little old sick lady who was baseline mildly hypotensive at change of shift but by med pass she was 75/35. I paged 2 different doctors to get orders. 10-15mins later I still have no response. I'm thinking "ohhh man, she isn't dnr so this is gonna get messy!" I called a rr, they came in less than 2mins, started hanging fluid boluses and transferred her to ICU in less than 7 mins with the intensivist ready to take the lead. The Dr called back after the pt went to ICU. I explained that I had called (and ohhh you betcha I documented it in the computer!) but I was scared the pt was going downhill too quickly.

Also at my facility, when a pt is admitted, we explain rr to families. Families are allowed to call a rapid on their loved one. We would hope that the nurse sees something first, but you never know. We would hope they would also let the nurse know something is wrong first, cuz its pretty awkward to hear a rr/code paged to your room overhead and you have no clue.

Lastly, we are making a big push to ensure rr are called before a code. It is saying that the nurses are "vigilantly" monitoring the pt for a change of status. Also, as most people know, even the best run codes do not always end "satisfactorily" so it is usually a better outcome when we catch a decline (aka weird new rhythm) vs asystole.

Also, important to note, from what I have heard and seen a few times, it is unusual for a patient to immediately and suddenly go into asystole. There is usually a rhythm change, first a slight one and then a major one (v tach, v fibb) before a patient has no electrical activity in their heart.

If your patient is still responding but is deteriorating call a rapid response (thank God for them because back in the day you had no option except to call the doctor which was generally someone on call who had no clue about the patient). If the patient is unresponsive and you can't find a pulse call a code. ICU head nurse says it is easier to downgrade from a code to a rapid response than it is to ungrade to a code. If you think you need help get it one way or the other.

vincent paul said:

Hi everyone! This question bothers me, " If the patient is pulse less (for almost 4 minutes) Code blue is activated and CPR performed; Can I possibly measure the arterial blood pressure by palpation? or NO BP that can be measured?

Good quality CPR should produce a measurable systolic pressure. This can be difficult to read for a NIBP machine or manually due to interference from the CPR itself, but with an A-line in it's usually readable, I've had patients that we've managed to keep a systolic of greater than 80 throughout CPR. A Lucas device (thumper) has been show to be able to keep systolic greater than 100 for sustained periods of CPR.

Yes this is a good question that I wish all nurses know the answer to I recently had a loved one on the telemetry floor that was very sick at the time and I asked for help on multiple occasions over a six hour period and I was told by the nurse each time that she was OK and three hours later she passed away and I had to let the nurse know that my love had passed away and then she called a code blue but it was too late.

This is an example of overthinking.

Some places the RR team is the same as the CB team. Some places the difference between RR an CB is a doctor responds.

A talking patient may need the CB team sometimes and an unresponsive patient may need the RR team sometimes.

Good discussion, but don't lets get carried away.

Know the diff? Call the right team. Don't? Ask, someone you trust and that person will make the call.

No big. We're all professionals here.

Jroebuck said:

Yes this is a good question that I wish all nurses know the answer to I recently had a loved one on the telemetry floor that was very sick at the time and I asked for help on multiple occasions over a six hour period and I was told by the nurse each time that she was OK and three hours later she passed away and I had to let the nurse know that my love had passed away and then she called a code blue but it was too late

Just a question for clarification: a patient passed on a tele floor, while on the monitor, and no one noticed until you said something?

I agree with Esme, don't get hung up on the words, just get help when you need it.

I respond to Rapids and codes and for each you will get an ICU rn, a doc, and an Rt. The only difference is a Crna will come to codes without being called.

One of the Swat rns at my first nursing job made it very simple for us to decide between the two. He said "I have ten minutes to respond to a rapid and three to a code, if you don't think your patient will last ten minutes, call a code."

Listen up, I'm a 25 years seasoned professional, MedSurg on the floor, I'll tell you right now this is a myth about rapid response, is a waste of time, only delays saving lives, call the damn code, don't wait for a second opinion it's stupid I've seen it done, and it's just political garbage. Saving the hospital money is what it's about, easy for a good nurse to see how silly a rapid responses is. Call the damn code patients first, damn the torpedoes.