New to the ER in a level one trauma center - any suggestions?

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    I currently work in a small ED in a relatively small town. I just got a job offer in the main ED from a large inner city hospital that's a level 1 trauma center. Because this is such a huge change from the little ER I'm from its a little intemidating and I'm sure I will see and do many things I never have before. Does anyone have any suggestions for books I should read or things to review to better prepare myself for the much sicker clientel I'm about to be caring for? Please Help me prepare my fellow nurses!
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    Get a hold of a TNCC book, it will help you with trauma pts in the bay.. Don't stress too much, so much is on the job training and they shouldn't just throw in the trauma bay before you are ready.. Just keep learning, ask and get comfortable in your new surrounds. Wishing you lots of luck... I love trauma
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    Get the CEN core book too but don't stress out too much. The vast majority of what you get in an urban ER isn't much different than what you're used to just a lot more of it.
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    Thanks guys, I'm just worried I won't know some of the drips, meds or signs and symptoms of things I should be looking for with these types of patients vs what I'm use to which not a lot of neuro or cardiac because we fly it out to our sister hospital in the city which is bigger. Just hate the learning curb where you look like an idiot until you find your way. I'm a good nurse with great instinct and learn fast but I want to arm myself as much knowledge as I can going in there! Trauma has been my DREAM!!!!
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    Yes, but you have to take care of those patients before they get flown out so you know more than you think. Familiarize yourself with basic pressors because those are the ones you start out with in the ER. Start brushing up on EKG's so you can recognize evolving MI's. I imagine you got your share of traumas that needed the closest facility so you actually got the worst of the worst and had to stabilized them prior to sending them out. Trust yourself. The biggest difference is probably going to be the volume of patients that you see so time management is going to be really important.
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    That's why I love talking with other nurses...it's makes all the difference when someone understands what you're talking about. You're right...I just need to trust myself. Thank you for the support! I will be brushing up on those things for sure!
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    I've worked both level one and level none ER's. LOL! When I worked at the suburban hospital (which incidentally was way more busy than the urban ones) we were looked down upon by the Level One centers but we got all of the unstable traumas who couldn't be flown due to weather or aircraft availability and were too sick to make it all the way downtown. Man we saw some bad stuff and managed them with about 1/4 of the staff and none of the fancy equipment as the big centers. Same with stroke patients. We also got all chest pains and managed them until they were transported. In fact the "big" ER's rarely saw the chest pains. They went straight to cath-lab. Critical medical patients did not get transferred unless they need neuro. I'm pretty sure you've run Dopa, Dobutamine, Epi and Levo. Neo and Milrinone are more ICU drugs. Heparin, Cardizem and that stuff was probably pretty routine for you as well. You might see more trauma related to violence in an urban center but even in the lily-white neighborhood in the burbs we had our share of dump and drive-offs. Oh, and the "two dudes" are everywhere. You know who they are. They are the ones who shot/stabbed/beat up the guy who was just sitting there doing nothing as in "I was just walking down the street and two dudes came up and stuck me for no reason".


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