What to do when u find an unresponsive patient

Published

I am a new grad who just got off orientation. I never witnessed a code ever and in my nursing orientation my role in a code was never explained nor any policy given. That being said, a CNA came and motioned for me to follow her. I got to the room and she said she couldn't wake the patient. The patients nurse came in a few seconds later and we both tried to wake the patient and get a pulse. The patient was cool to the touch, somewhat stiff and had mottled skin. The patients nurse left to call a code. He is a very experienced nurse and left us there with no instruction. We believed the patient was dead and were not sure what to do. Within seconds more nurses arrived and nobody began CPR, the patients nurse didn't bring the crash cart with him after calling the code and so it wasn't there when the code team came. The patients nurse kept leaving the room so the doctor had a hard time getting information about the patient The whole thing was a disaster. I'm afraid I may be fired and lose my license . Is a nurse supposed to stay with his or her patient if they are unresponsive?

Specializes in Pedi.

Hit the code light. Help will arrive in ~15 seconds. If no pulse, begin CPR. Remember to put the CPR board/headboard/whatever your unit has under the patient otherwise your efforts at CPR will be futile. If pt a DNR or rigor mortis has set in, there's no need to begin CPR.

Up Vote Up Vote ×
Specializes in Cardiology.

This post kind of blows my mind. First of all, the CNA should've pressed the code button in the room or called for help, that's one of the first things you learn in code situations, don't ever leave the patient! Second, if you're a nurse you should've been required to take BLS in nursing school, they also teach you to never leave the patient and to immediately begin CPR. Even if the patient was a DNR, sometimes you don't know that immediately and you STILL start CPR and then either stop or continue once code status was established. The nurse taking care of that patient made many mistakes as well, he should've never left the room and he should've instructed one of you 2 to start CPR since everyone in the room was apparently clueless. What a disaster. If you're not comfortable with basic BLS skills and/or knowledge then maybe you should take the class again or ask someone for some help learning your role and figuring out what to do.

Up Vote Up Vote ×

If you happen upon an unresponsive patient, shouldn't you do a rapid response immediately?

Up Vote Up Vote ×
Specializes in Operating room..

Cool mottled skin, non responsive, no respirations = sure start CPR but dead is dead. And bringing them back after that much "down" time is not always the best thing.

Up Vote Up Vote ×
Specializes in Pediatric Critical Care.
Are you a nurse? Do you not have BLS/CPR?

1 assess responsiveness

2 activate code/EMS or send someone for help or yell "I need help in room 123 now"

3 check for pulse

4 if no pulse start compressions at a rate of 100/min (Staying Alive by the BeeGees)

5 do not stop for breaths as effective compressions are current EBP

6 once AED arrived attach pads and analyze.

I believe BLS is still being taught for adults WITH breaths, however, especially in a hospital setting where you have equipment such as a bag/mask. I would suggest following the BLS protocol to CYA.

Up Vote Up Vote ×
Specializes in Complex pedi to LTC/SA & now a manager.
I believe BLS is still being taught for adults WITH breaths, however, especially in a hospital setting where you have equipment such as a bag/mask. I would suggest following the BLS protocol to CYA.

Pediatric includes breath for initial. Adult is circulation then airway and breathing. Not all rooms have BVM as it may be kept on the code cart. One rescuer CPR is call for help the start effective compressions at 100/min until AED arrives or more help. Current EBP is effective compressions perfuses the currently oxygenated blood to preserve critical organ function for the first few minutes. If alone, adult is compression only. Too much time is wasted getting the BVM, adding O2, trying to get a good seal & properly position the head, when you could have completed 2-3 minutes of compressions in the same time

Up Vote Up Vote ×
I am a new grad who just got off orientation. I never witnessed a code ever and in my nursing orientation my role in a code was never explained nor any policy given.

Then why didn't you ask?! You work in healthcare (although it's a little strange to me that you just joined and this is your first post) so you know that patients will code. If it wasn't part of your orientation, you should have asked someone.

Up Vote Up Vote ×
Specializes in ICU.

Okay, guys, OP now knows that things didn't go like they should have. Let's cut OP a break.

I saw my first code in inpatient rehab. As a nursing student/extern, I helped transfer him from the toilet to the wheelchair, where he proceeded to code. I had the other person hold him still so he didn't fall out of the wheelchair and break a bone while I hit the code button and ran out to the nurses' station to bring immediate reinforcements and the code cart.

It took at least eight nurses a good five minutes, AT LEAST, to figure out what to do. Seriously. It was "Do we put him in the floor?" "No, he'll be too hard to get up." "Well, how do we get him in the bed? He's over 300lbs." "Someone should get the lift!"

*cue multiple nurses standing around looking confused while someone goes to look for a lift*

*cue the unit secretary calling into the room asking why the code button was pressed*

"IT'S A CODE!!!" "What?" "A CODE BLUE!!!" "Do I need to call it?" "YES!!!!!"

It took the code team getting there to even get the patient in the bed. Let's cut the OP a break. When you've got a WHOLE BUNCH of people that have never seen a code before in a room attempting to code somebody, BLS training does not automatically kick in. It's a hot mess. OP has learned and will be a better responder next time.

Up Vote Up Vote ×
Specializes in Psych ICU, addictions.

I also have to wonder how frequently the patient's nurse and the CNA were rounding...I mean, if the patient was found cool, mottled and stiff, that patient hadn't been visited by one of them in a long while. Or the nurse/CNA may have poked their head in but did no more assessment than that.

OP, remember this: we all die. No one gets out alive. The fact that it was this patient's time to clock out is doesn't necessarily mean you did something wrong. In fact, the code could have been called much earlier and been run flawlessly, and the patient still may not have made it.

Up Vote Up Vote ×
Specializes in Hospice.
Okay, guys, OP now knows that things didn't go like they should have. Let's cut OP a break.

I saw my first code in inpatient rehab. As a nursing student/extern, I helped transfer him from the toilet to the wheelchair, where he proceeded to code. I had the other person hold him still so he didn't fall out of the wheelchair and break a bone while I hit the code button and ran out to the nurses' station to bring immediate reinforcements and the code cart.

It took at least eight nurses a good five minutes, AT LEAST, to figure out what to do. Seriously. It was "Do we put him in the floor?" "No, he'll be too hard to get up." "Well, how do we get him in the bed? He's over 300lbs." "Someone should get the lift!"

*cue multiple nurses standing around looking confused while someone goes to look for a lift*

*cue the unit secretary calling into the room asking why the code button was pressed*

"IT'S A CODE!!!" "What?" "A CODE BLUE!!!" "Do I need to call it?" "YES!!!!!"

It took the code team getting there to even get the patient in the bed. Let's cut the OP a break. When you've got a WHOLE BUNCH of people that have never seen a code before in a room attempting to code somebody, BLS training does not automatically kick in. It's a hot mess. OP has learned and will be a better responder next time.

I've been in more than one code where we were all on the floor. I hate when it happens in the bathroom!

Up Vote Up Vote ×
Specializes in CVICU, post-codes.

If the patient is a FULL CODE, you do everything. It's not up to you. That was what the patient wanted done. It doesn't matter how old they are or how hopeless it seems, if that is my patient's wish, you bet your butt I'm going to be starting compressions and calling a code.

It is so VITAL to know your patient's code status. If they would or wouldn't want to be intubated, if they want compressions and meds, but no intubation. If you are the patient's nurse in that situation, you stay at the bedside and try and figure out why the person coded and help give information - did they become hypoxic? Are there electrolytes out of whack? How was their BP before this? Your ACLS H's&T's.

Whenever you find someone without a pulse that is a full code, you immediately call the code to get help and then start compressions and BLS if you don't have ACLS. Time off of the chest is detrimental to any sort of meaningful recovery for a patient whose heart isn't beating on its own. Your hands are pumping blood until their heart can do it again.

Floor codes are generally sort of a mess, the more familiar you are with BLS and ACLS, the more you will feel more comfortable with a code situation. I'm sure there is a ton you learned from this experience that you will be able to implement next time.

Up Vote Up Vote ×
+ Join the Discussion