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?

[Bobjohnny]

A CAT code is the same thing as a rapid response at some facilities. Same thing, different terminology. We don't know from OPs conveyed story why they were giving Lasix or inserting a foley. But, am I the only one who's seen an RRT have standing orders? I know there's a bunch of crap I can order at a rapid response if the hospitality doesn't respond for some reason.

[SarahJ08]

I'm confused as to why you went to the room after you had clocked out? What business did you have being there?

[MunoRN, RN]

A CAT code is the same thing as a rapid response at some facilities. Same thing, different terminology. We don't know from OPs conveyed story why they were giving Lasix or inserting a foley. But, am I the only one who's seen an RRT have standing orders? I know there's a bunch of crap I can order at a rapid response if the hospitality doesn't respond for some reason.

I would hope facilities that utilize a RR nurse have a protocol they can use. I use a RR protocol that has various tests and meds, all based off of some sort of defined indications.

Given the description the patient would get a 12-lead and a portable CXR, based on that there is a STEMI protocol, NSTEMI protocol, flash pulmonary edema protocol, etc. If the CXR showed flash pulmonary edema and the 12-lead didn't raise concerns for using them then the patient would get NTG, lasix, and morphine if additional vasodilation is needed as a fluid "sink" while the lasix kicks in. BiPAP is also in the protocol which would be likely used for such a patient. I then discuss the patient with the intensivist and they transfer the patient from the hospitalist if indicated, if the patient doesn't need to move off the floor then I discuss the patient with the hospitalist.

[Altra, BSN, RN]

A CAT code is the same thing as a rapid response at some facilities. Same thing, different terminology. We don't know from OPs conveyed story why they were giving Lasix or inserting a foley. But, am I the only one who's seen an RRT have standing orders? I know there's a bunch of crap I can order at a rapid response if the hospitality doesn't respond for some reason.

Yes, our RRT has protocol orders. But the actions being discussed here , the way that OP has described her scenario, are those of the bedside nurse taking care of the patient.

[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! 😁

Seems my statement wasn't clear and only caused everyone to say how useless it would be. It was simply my observation of what clues could have used to determine the level of severity. But thanks for the input.

[OCNRN63, RN]

"Cat Code" short for "Catastrophic Code"? Never heard of this.

[MunoRN, RN]

"Cat Code" short for "Catastrophic Code"? Never heard of this.

Unless it refers to some sort of feline invasion I would guess it's a misunderstood way of saying cath-code.

[TinaMari]

I have heard of a CAT (Critical Assessment Team) Call at one hospital. It's essentially the same thing as a Rapid Response Team (RRT).

[thevez]

Put patient on nonrebreather, crank that oxygen up, call rapid response. That'll sure get their attention.

[DisneyNurseGal, BSN, RN]

In my hospital, we can add change modify orders for oxygen as the situation presents, but must obtain order within 30 minutes. In some situations we have even started fluid boluses if no s/s of overload exist. Beyond that I would wait at least for the verbal order on any medication.

We can call a "rapid response" where a team who consist of ICU charges, respiratory and others for situations that are not a full code but need attention STAT. Those individuals have standing orders to start certain medications based on algorithms.

[Anna Flaxis, BSN, RN]

I have heard of a CAT (Critical Assessment Team) Call at one hospital. It's essentially the same thing as a Rapid Response Team (RRT).

Oh, that makes sense. Thank you.

[Tex.]

ACLS. Do it. Work those algorithms, baby!!

The foley can wait, and the Lasix should wait until you have a physician or NP involved at the bedside or via phone.

*Edited for spelling