Learning thread (ER medicine) - page 3
Heres an idea. once you learn something new regarding ER medicine, post it here. it will become a nice discussion and we can all learn something. post something that you think most ER rns wont... Read More
Jul 6, '04Quote from thanatosOttawa Ankle Rules
This is the same concept as using the Ottawa ankle rules to determine the necesity for ankle films. Speaking of the Ottowa ankle rules, what are they, specifically?
Unable to bear weight immediately and in ED.
Tender on lateral malleolar tip or posterior aspect of lateral malleolus.
Tender on medial malleolar tip or posterior aspect of medial malleolus.
Answer yes to any = x-ray.
Ottawa Foot Rules
Unable to bear wieght imediately and in ED
Tender over navicular bone
Tender at 5th metatarsal base
Answer yes to any = x-ray
Ottawa Knee Rules
Unable to bear weight immediately and in the ED
Age 55 years +
Isolated patellar tenderness
Fibular head tenderness
Inability to flex > 90 degrees
Answer yes to anyy = x-ray
Jul 6, '04Quote from thanatosHmmm, specifically strep throat or just sore throat. Mono can cause sore throat and abdominal pain mimicing appy.bump...
isn't anyone going to take a stab at this one?
Jul 6, '04Quote from treddrnMy plan was to just read this thread to learn from it. But I have a suggestion for you. Why don't you post this one out in General Nursing Discussions.Speaking of strep throat........how come nurses are not educating their patients to toss the toothbrush? I thought the nurse was to educate their patient. I have had a lady to come to the ER 5+ times for strep throat and when I was discharging her, I advised her to toss the toothbrush and go to the dollar store and buy the pack that has a few in a box for a dollar. I told her that after she used one toothbrush that day that she needed to toss it in the trash and the next day use a new one. Then after a few days she can get a more suitable toothbrush that she would like. She told me that no one has ever told her that. Well, I haven't seen her and it has been several weeks. Maybe I am a bit extreme with using a different toothbrush for a few days but strep throat is not a comfortable feeling and there are risks involved. I am a new ER nurse and I have found out that no one in my ER educates about tossing the toothbrush. So far, my advise has been very successful. No one that has followed my advised has had to return for reoccurring strep throat.
For years we have told pts to put their tooth brush in Listerine to soak (as opposed to replacing it) but I recently saw something someplace claiming Listerine doesn't do much for that elusive 1% of germs.
I don't just want to take your post and move it around, but thought you might do it. May make great conversation to know how other nurses have helped their pts prevent recurrence.
Jul 6, '04What a great idea for a thread, thanks Chris! FYI: I just added (ER medicine) to the title, to help people realize what the thread is about at a glance. I think that this thread might start a trend in all the specialty forums, at least I hope it does, because it's a great way to share knowledge with one another! I just learned a lot! Keep up the questions
I think I'll post an announcement in all the specialty forums to encourage nurses to start threads in their specialty forum.
Jul 6, '04Ive got one.
What do you say to the irate mother who has brought her child into the ED at 2 oclock in the morning for a c/o that he has had for 2 weeks, and who is now lecturing you on how it is unacceptable to have to wait for 3 hours to be seen? My answer- "well Im sorry ma'am, but this is not Burger King, and unfortunately, we do not do things 'your way right away' here in the ER. Unfortunately, the gentleman who needed a tube put down his throat so that he could keep on breathing took precedent over the cough that your son has had for the past 2 weeks. And yes, youre right, we should have more people working here, but unfortunately, (and I dont know why) there arent too many people who are eager to be standing here in my position trying to explain why the wait is so long".
Yes, i said this to her among other things, and yes, I was bad, and yes, i should try to be more empathetic, and yes, i had a tone with her all the while, but hey, you know you've said worse (me too) and it felt good dammit!
sorry if this really isnt related to the original post, but it is kinda an ER question, isnt it? I think it might fit under psych-social area, no?
Jul 6, '04Quote from RNCENCCRNNREMTPI've only seen this w/ strep, but you're right...it can occur any sore throat, including mono. what is the mechanism?Hmmm, specifically strep throat or just sore throat. Mono can cause sore throat and abdominal pain mimicing appy.
Jul 6, '04Quote from RNCENCCRNNREMTP1) normal LOCHere is a stumper for you.
What are the NEXUS criteria for avoiding c-spine x-rays?
2) no ETOH on board
3) no focal neurological deficits
4) no point tenderness to posterior c-spine
5) no distracting injuries
btw...you did stump me, I had to look it up
Jul 7, '04I'm going to take a guess about the previous strept infection and appy s/s. In a child who has had a previous undx. group A beta-hemolytic strept infection 10-20 days prior to the onset of symptoms it could be poststrept. glomerulonephritis which includes abd. pain as one of it's symptoms.
what an awesome thread...keep um coming!
Jul 7, '04This is great...I will have to wake up and think of some questions to post. I am going to get my coffee and will be back.
Jul 7, '04WOW, this is a really good idea! Makes sense to me..
Quote from treddrnSpeaking of strep throat........how come nurses are not educating their patients to toss the toothbrush? I thought the nurse was to educate their patient. I have had a lady to come to the ER 5+ times for strep throat and when I was discharging her, I advised her to toss the toothbrush and go to the dollar store and buy the pack that has a few in a box for a dollar. I told her that after she used one toothbrush that day that she needed to toss it in the trash and the next day use a new one. Then after a few days she can get a more suitable toothbrush that she would like. She told me that no one has ever told her that. Well, I haven't seen her and it has been several weeks. Maybe I am a bit extreme with using a different toothbrush for a few days but strep throat is not a comfortable feeling and there are risks involved. I am a new ER nurse and I have found out that no one in my ER educates about tossing the toothbrush. So far, my advise has been very successful. No one that has followed my advised has had to return for reoccurring strep throat.
Jul 7, '04("succs is contraindicated in head trauma with intercranial pressure. u dont want the vesiculations, you can premedicate with lido to reduce them.")
Just to clarify a few misconceptions- Most research shows that succs is not contraindicated in the head injured patient. Yes it does cause a brief rise in intercranial pressure but the research shows that it does not have an effect on patient outcome. Now, there are several ways to counter the ICP increase. You could use fentanyl or thiopental as your sedative and they both cause a decrease in ICP. Lidocaine when used in combination with rapid sequence induction is a moot point. It has never in any research showed to cause a decrease in ICP for head injuries. What lidocaine is supposed to be used for is to blunt the gag reflex associated with intubation which causes a brief increase in ICP. If you are doing RSI with succs then there won't be a gag. Fasiculations are caused from succs being a depolarizing agent. Fasiculations become worrisome for a head injury or more so a unstable cervical fracture. They are easily delt with by given a small dose of a non-depolarizing agent such as vecuronium prior to the RSI. The problem lies in do you need the airway managed right now. When giving a non-depolarizer you need to wait 2-5 minutes to reach effect. So your RSI would go like this-
1. Vecuronium 1.0mg ivp wait 2-3 minutes and (2)Rapid push your sedative (etomidate, thiopental, versed, fentanyl etc.)(3) RAPID push your succs and wait for patient to become flacid- you should not see fasiculations.(4) intubate and confirm placement (5) longer sedative, pain meds and non depolarizing agent.
As for contraindications for succs: Burns over 24 hours, crush injuries, hx of malignanthyperthermia, neuro conditions (myasthenia, ms etc.) renal disease or other possible high K+ problems.
Last- someone mentioned that they take the temp on thier patients for an hour after succs use to look for MH. Long before your temp rises your CO2 will rise as well as an increased HR. Most books say if you wait for a temp increase you have lost the battle.
Hope this helps
Jul 7, '04I took TNCC last week and am taking ENPC starting tomorrow so this thread is so timely!
Okay, here is a question:
What is the normal urine output for an infant? Why is that of particular importance?