ICU stuff

[amzyRN]

How much ICU should a new ER nurse know. I know I probably won't get the higher acuity patients right off orientation, but want to prepare for when I will need this information. The acuity is so high at my ER, I might be thrown in and I want to be prepared as much as possible.

[Pheebz777, BSN, RN]

I would say just be familiar with your drips, vasopressors, their preparations (single, double, quad) as well as certain drip protocols (heparin, DKA, insulin,etc). Knowledge of the ventilator and understanding their settings will help you manage your patient better when you get the ABG's. A firm grasp on hemodynamics and understanding the different classes of shock will help you manage low BP presentations. The more I type, the more I can think of but for an ER setting I think this is a good start.

[Lev, MSN, RN, NP]

CPR, when to call respiratory, understanding of ABGs, how to mix and titrate drips, when to give fluids and when to hold off, neuro assessments (different levels of consciousness), the intubation process/meds.

[NurseOnAMotorcycle, ASN, RN]

If you are new to the ER, more is better. However,don't sweat what you don't know. They will teach you! They don't want an inexperienced nurse caring for critical patients any more that you want to be that nurse. Your preceptor certainly won't leave you alone with a sick pt, and will definitely pick up any dangerous slack.

Here is what you need to know right away:

1. When to get help. Anyone sweaty, a heart rhythm you don't know, anyone who says "I can't breathe", any time you ask yourself "Should I be doing CPR right now?", anyone who falls, is shaking weird, any medication you are unfamiliar with, or any time the provider feels the need to stay in the room with a pt.

2. Prioritize your pts. Sure, it will only take a second to grab crackers for someone, but then they will need 10 other things and you will not be able to get back to the pt who needs to get to the OR stat. This leads to...

3. Know who can help with "everything else". Other nurses, techs, CNAs, transporters can be your best friends or your worst enemies. Treat everyone like an attending MD. That means disagree with them, even yell at each other, but always show respect (not condescension) while you are doing it. Coworkers who feel respected are more likely to grab that ginger ale for you so you can hang critical care meds for another pt. For example, asking a provider for zofran "your pt in 8 is vomiting, can you put in an order for zofran or do you want something else?" versus asking for someone to grab crackers "the pt in 8 is asking for some crackers, can you grab them or are you in the middle of something else?"

When I was getting ready for moving to the ER, my favorite book was:

Quick Reference to Critical Care: 97816�8314645: Medicine & Health Science Books @ Amazon.com

But you can never go wrong with Sheehy's. I know that AN members have loads of good resources and studying made me feel a lot better before I went, even though it was experience that ultimately taught me.

Sheehy's Manual of Emergency Care, 7e (Newberry, Sheehy's Manual of Emergency Care): 978�323�78276: Medicine & Health Science Books @ Amazon.com

Good luck! Post a lot and let us know how you are doing!

[emtb2rn, BSN, RN, EMT-B]

All of the above and know your hospital protocols.

[Lunah, MSN, RN]

If someone tells you they are about to die, believe them. (Within reason/not counting status dramaticus, but yeah.)