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Tom Sharon
Medical intervention actions as lifesaving measures


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Nurses Are the First Responders: They Need Standing Orders

For the balance of this ICU discussion, I speak to the family member because the critically ill patient is usually too sick to give attention to how the staff provides the services. This discussion pertains to those cases where all life-sustaining measures are to be employed for the patient. Families who have requested that the doctor sign a do not resuscitate (DNR) order need not be concerned with first responder emergency procedures.

Standing orders are a set of medical intervention actions that nurses are required to initiate as lifesaving measures before any of the doctors arrive on the unit. You will want the intensive care nurses to be able to perform the following actions in case there is a lifethreatening emergency:
 
1. Start intravenous lines.
 
2. Initiate cardiopulmonary resuscitation –CPR- (unless there is a DNR order on file).
 
3. Give certain drugs as appropriate for stimulating heart rate, slowing heart rate, correcting lethal heart rhythms, raising blood pressure, removing excess lung fluid, and correcting blood acidity.
 
4. Provide intravenous fluid boluses (fast infusion of normal saline) for shock or blood loss.
 
5. Defibrillate when appropriate (zap the patient with the paddles to correct a lethal rhythm).
 
As a family member of a critically ill patient who enters the ICU, you should ask to see a copy of the standing orders. If the charge nurse can't or won't show you one, say that you simply want to be certain that there will be an immediate response in case something happens, whether the doctor is in the unit or not. Make it known that you are aware that response time is the most important factor in saving lives. Also, ask the charge nurse to tell you who is responsible for responding to emergencies. Go to those nurses and doctors and tell them how concerned you are about your loved one. Make them promise every day that they will do everything they can. The purpose for asking for this repetitive reassurance is to cause them to think a little more about your loved one's needs.

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