Would you wait for Dr orders?

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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?

Specializes in Trauma, Orthopedics.
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! 😁

If the guy is gasping and gray, I'm pretty sure we all know his o2 sat is in the toilet.

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Specializes in Cardiac, Home Health, Primary Care.

I agree with others that the Lasix would have been a no-no for me. I'd switch over to non-rebreather, further assess the patient, check PRN's for updrafts, anxiety meds, etc. and give if I thought it'd help (i.e. COPD history, in for pneumonia, etc.), and get the crash cart in the room ASAP to assess heart rhythm as well if he wasn't already on tele.

You can't know he needs Lasix unless you assess him first and know his history.

As others have mentioned it's possible you just did not explain the story clearly enough for us to know that you KNEW he needed Lasix.

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Specializes in Oncology.

Yeah, why would you give meds without an order when you had a rapid response team on the way? Only thing I would do in the meantime is increase oxygen, place on cardiac monitor if available, get IV access if none in place, and get a set of vitals. If they were making a convincing picture for pulmanary edema and had some crazy high IV fluid rate, I might turn down the fluid rate.

Twice in my career I gave meds without an order. Both times were before we had a rapid response team and when we had one poor hospitalist covering the entire building at night. He wasn't returning my pages.

The first time I started a run of K on a person with a potassium in the 1's. The second time I gave 25 of IV benadryl to someone having a terrible platelet reaction. Now that we have a rapid response protocol in place, I wouldn't do either one of those things. Both times I got lucky that the doctor was thankful and promptly ordered what I gave- and more.

I'm also wondering where this poor new nurse's charge nurse or preceptor was.

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I don't know what a "Cat Code" is. Is this a Rapid Response?

It sounds like this event occurred on the inpatient unit, in which case calling a Rapid Response, implementing high flow oxygen, ensuring IV access, and taking vitals would be the priority actions. The primary RN should also be reviewing the chart for the most recent labs, meds, assessments, pertinent medical history, code status, etc.

I would not jump to Lasix and a Foley. He could have thrown a PE, be having an MI, an aortic dissection, a pneumothorax, end stage COPD, none of which Lasix is going to help. And the time it takes to insert a Foley catheter is time I could be doing something else more critical.

Am I missing something?

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Specializes in SICU.

The rapid response team gets things moving quickly

I would never waste my time getting in a foley when the patient is gray. ( I mean seriously why would a foley be indicated at this moment?)

To OP I hope the next time a medical emergency happens on one of your patients you will be astute enough to call a rapid response and not worry about prescribing needless medications and interventions

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Specializes in NICU.
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?

So you wanted to practice medicine, and do it off the clock? Oy. I hope you have some serious . Assuming a "cat code" is a rapid response, why were you even going, when there is a designated team to manage just this sort of situation?

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Specializes in Tele, ICU, Staff Development.

Is there no Rapid Response Team (RRT) ?

ooops edit: now reading back more, I see there was. I think.

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Specializes in Pedi.
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! 😁

Useless in this situation. It won't tell you anything you don't already know.

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My first thought was a patient was coding in the CAT scanner. I'm not sure what a Cat Code is either.

We have protocols to use in a code (Code Blue where I work). ACLS.

I think the OP needs to clarify for us.

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No, I wouldn't give Lasix. I would've called a rapid response. I would've gotten more than one nurse in the room. Maybe called RT if they were already on the case for any reason.

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Specializes in LTC Rehab Med/Surg.

There's not much I do without an order. O2? That's about it.

My co-workers and I discuss this sometimes, and the young ones say they'd do this or that without an order.

I attribute that attitude to inexperience.

I have enough experience to know what I'd be risking if the MD didn't back up what I did.

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One of our cardiologists was very angry a night nurse wrote a "verbal" order for maalox at 3 am for a patient who was constipated. He said "I would have been happy to give that order if I had been called, but I do NOT appreciate orders being attributed to me that I did not give." The night nurse was livid, saying "Fine. He's going to be getting a lot of 3 am calls from me."

Another doc who was writing her notes at the time this exchange was made said "Hey, if you need an order for Maalox at 3 am and the patient's not allergic, please verbal that for me!"

I always erred on the side of caution. I never wanted to be in the position of needing that signature and the doc refusing.

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