Would you wait for Dr orders?

[AcuteCare4Life]

This week has been busy at our little hospital. The heat is getting to many folks. I had just clocked out when "Cat Code" paged overhead. Stopped just a moment and thought "Hell, I better go.". Arrived to find a male pt very diaphoretic, gray and gasping like a guppy fish. First thought? Oh, they might have waited too long! Turns out the RN was a new grad/hire early in orientation. She had been trying to notify the Hospitalist of the pt's condition and when the Hospitalist called back, told new grad/hire "Stop calling me! I'm dealing with a critical pt on 3rd." The preceptor called the Cat Code. Everyone arrived and soon whisked the pt off to ICU and intubation.

Now here is where the title comes in. Would you have waited for Dr orders? Especially after the Hospitalist responded the way he did? My instinct was to swap over the NC for a non-rebreather, insert foley, give Lasix and then explain to Hospitalist what was happening to the pt. What are your thoughts?

[flyersfan88]

I'm not giving anyone Lasix without an order, let alone without the doctor even acknowledging the condition. What would indicate the need for Lasix? Do they sound wet? I'm confused, nothing in this post indicated that.

I would've put on a non rebreather and called a rapid response/anesthesia. Not sure what a cat code is but I'm assuming it's similar? I also don't know why you'd do anything other than that.

[RescueNinjaKy]

I'm still fairly new as a nurse but why give lasix? What was the indication. I mean if it's a hot day and they're diaphoretic, wouldn't lasix be counter productive and make them more dehydrated.

Also switching them from nc to a non rebreather is within your scope of practice, and some facilities have a standing order to go ahead with a foley if the patient is retaining. But other than that, to give lasix without an order is practicing medicine. That is a huge issue that can potentially get someone fired and to lose their license.

If the hospitalist is not responding or responding in that manner then you call another person. You notify charge, get their opinion also and you get another doctor. Get another hospitalist. If it was an intern you pages, then you page the senior resident, if that doesn't work, you page the attending, and if that still doesn't work get a different hospitalist or call a rapid. A doctor will show up for the rapid. There are other options you can take before you practice out of your scope.

[Larry3373]

I don't know what a "cat code" is, but assuming it is the same as a rapid response where an icu/ER RN, the house supervisor, and respiratory therapy respond, I would have called this code if I couldn't get orders. The nonrebreather doesn't sound like a bad idea while you are waiting for them to get there assuming they are still breathing. I would not be giving lasix or inserting a foley without an order, because this seems to be practicing medicine without a license, unless there was already an order in the chart. I think that you are assuming cardiogenic pulmonary edema, but the practitioner may disagree. If they stopped breathing you would do bag mask ventilation and call a code.

[JBudd, MSN]

Definitely switch the 02, but a foley is not going to save him. All it would do is delay the life saving measures (NO wait! don't intubate until I get the foley balloon inflated! )

As had been said, absolutely NO to the Lasix. That is why you have the rapid response folks, who as you pointed out, had the pt in ICU and tubed appropriately. The preceptor was there and took care of it correctly.

[MunoRN, RN]

I assume "cat code" is actually "cath code", AKA a STEMI code? Your facility should have either a rapid response protocol, which should include a treatment protocol for flash pulmonary edema including a CXR, EKG, and if indicated nitro and lasix. Calling the cath code should get you a cardiologist who can order the lasix or other meds as appropriate. You don't necessarily want to give everyone having an MI lasix since that's usually contraindicated in a right sided MI, so there are some assessment steps that should occur first.

[Horseshoe, BSN, RN]

Another vote that the OP is not real clear.

[RNperdiem, RN]

I hope this new grad had a charge nurse right there to call a rapid response or code, put a non-rebreather oxygen mask on, page a respiratory therapist etc. A gray patient is going downhill fast.

I wouldn't give any meds unless they are code meds that are part of ACLS.

In your hospital, is the hospitalist the only MD around? I have worked in small hospitals where on nights the only MD in the building is the emergency room MD.

[sommer0515]

O2 sat anyone?? And as a new grad, it pains me to know it took the newbie or her preceptor that long to call the code themselves! 😁

[Karou]

I wouldn't have given Lasix or inserted a foley, but would have probably placed a NRB as I called a rapid response. Once the response team arrived we could have given Lasix if indicated. Foley wouldn't be my top priority but would place as soon as we get the patient stable or transferred.

[Dranger]

O2 sat anyone?? And as a new grad, it pains me to know it took the newbie or her preceptor that long to call the code themselves! ������

O2 sat means nothing when it comes to actual ventilation and perfusion. Get an ABG to really see a picture of their respiratory status. ABGs can be done per protocol by most ICU RNs. O2 sats are good for routine monitoring but not in situations like these.

Non-breather mask->BIPAP/CPAP->Tube

Lasix wasn't an order and is a waste of time at this point.

I want to know why this guy was still even on a NC....

[Mulan]

Did you clock back in?