Should have I called rapid response?

Casey_93, ASN · Feb 18, 2021

It's my understanding that fluids are bolused in when a patient is dangerously hypotensive from Septic Shock. Yes, your patient's BP is a little low but that's certainly not dangerously low.

You need to clarify the course of action between the experienced nurse and the NP to avoid future confusion like this. You can't work better as a team if you're not speaking up.

Fr3sh_RN · Feb 18, 2021

if theyre already in septic shock it means they don't respond to fluids. and they would need pressors

I don't usually worry about that BP also, but her bp last 48hours around 120s to 140s systolic.

so when should you begin bolusing? whats definition of hypotension?

NP wanted to call rapid response only due to change in responsiveness. the experienced nurse was able to wake patient up thats why she said theres no need to call rapid.

Casey_93, ASN · Feb 18, 2021

3 minutes ago, Fr3sh_RN said:

if theyre already in septic shock it means they don't respond to fluids. and they would need pressors

This is true. I still get Septic Shock confused for Sepsis in general. Thanks for the clarification!

MunoRN, RN · Feb 18, 2021

The role of Rapid Response can vary from hospital to hospital, but I've never worked in an ICU where we call Rapid Responses since the typical purpose of a RR is to have the patient evaluated by a critical care nurse, so I'm not sure what purpose calling a RR on a patient already in the ICU would serve.

Two isolated BP readings don't really offer a lot in terms of guiding what interventions the patient may require. What's the lactate? SVO2? etc. A decreased LOC which could certainly be due increased fatigue resulting from sepsis or just being critically ill, or analgesia, sedation, etc also is pretty non-specific. While other indicators of volume status would certainly be helpful, lack of urine output alone would suggest hypovolemia as the appropriate response of the kidneys in hypovolemia would be to hold onto fluid.

MunoRN, RN · Feb 19, 2021

11 hours ago, Fr3sh_RN said:

if theyre already in septic shock it means they don't respond to fluids. and they would need pressors

I don't usually worry about that BP also, but her bp last 48hours around 120s to 140s systolic.

so when should you begin bolusing? whats definition of hypotension?

NP wanted to call rapid response only due to change in responsiveness. the experienced nurse was able to wake patient up thats why she said theres no need to call rapid.

I'm guessing that I'm misunderstanding your post. Fluid resuscitation is a primary intervention for septic shock, with a 30ml/kg fluid bolus being the standard intervention prior to pressors in Sepsis bundles without it pressors are of little use. There's certainly some debate about the specifics of the role of fluid resuscitation in septic shock, such as how best to assess for adequate fluid resuscitation, long ago it was by wedge pressures, then CVP became more standard, now assessment of the SVC (diameter and compressibility) is considered more accurate.

LovingLife123 · Feb 22, 2021

I’m very confused as to why a rapid is called in the ICU. The rapid response team are generally ICU nurses. I guess I would want to understand the role of the rapid response team in your hospital.

Fr3sh_RN · Feb 22, 2021

its at ltach. rapid would get our critical MD at the bedside and other nurses in proximity to help evaluate the pt. pt was on our tele floor.

0.9%NormalSarah, BSN, RN · Apr 6, 2021

I’m sort of confused how we have a vented patient who we did not know hadn’t peed all day...like who is dumping the foley? Or are we using external collection methods? Is this trached long term care patient? I’ll admit if that’s the case I don’t know a ton about that as I’ve only worked ICU, but this was posted in critical care so I’m looking at it through that lens.

I wouldn’t be too concerned about that BP unless it was a huge change, and there are other reasons for lower BP. You’re already doing all the right things with a sepsis work up, so maybe if BP was down-trending I’d ask for a fluid bolus to see if the patient is responsive. I’d also bladder scan the patient to see if they’re just retaining before assuming no urine has been made. It’s totally possible the patient is dry, or that they’re in AKI, or that your foley has a blockage and needs a flush. I’d just personally investigate a little more and then call the provider with all my info.

Nurse Pompom · Apr 12, 2021

On 2/15/2021 at 2:28 AM, Nursing_excellence said:

Pt had infectious workup done d/t high temp. Procal was high. Wht ct 22 from 14 . Cxr diffuse b/l infiltrates. UA pos. Pt already on vent. 100% VCV/AC 300/14/9/40. Resp 30s to 40s. NSR 70s to 80s on tele. Started on IV abx. Bcx pending. Called NP cause BP 103/50. Was 120/60 this am. And pt was hard to arouse. She was responding to painful stimuli and follows commands like opens mouth during oral care, but tonight initial assmt. Was not opening eyes. And AM CNA, who is doing overtime, [this happened at 2000] said pt hadnt peed whole day. NP said to call rapid response due to change mental status. IDK how to page rapid overhead so I asked one of the seasoned nurses to call rapid. She asked what for. And told her the situation. She went and assessed my pt. Pt woke up with pain stimulus. Recheckef BP 103/67. She said pt OK. And cancel rapid. Do I get in trouble for not following the NPs order to call rapid? Im still worried bc pt hasn't put out urine. And BP staying soft . And I don't want to play catch up later. And I wonder why they cant just give me order for fluid. isn't that what you do for susp sepsis?

Yes, imo you should have called a rapid. A rapid puts you in the clear. What do you do if the patient codes? "Well, the seasoned nurse told me not to even though the NP said to". Rapids aren't code. Rapids are a good tool so you don't get to a code. Better safe than sorry.