Learning thread (ER medicine) - page 4

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

  1. by   kevro1013
    Great thread!
    Here is one I had last week.
    Pt pressents with abd pain and htn (BP 230/120). Non-contrast Ct abd and pelvis shows non-disecting AAA. MD orders nipride to titrate for BP >160/90. What type of medication does this pt need prior to nipride and why?
    Kevin
  2. by   stretch thin
    Quote from TraumaInTheSlot
    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 know. you can even make it a trivia question.

    ill start, what kind of med do you never give a cocaine induced MI? (that ones easy)
    Ok, I've got a question. I had this 24yr old female come in last night. She is 5mths pregnant(>20weeks gestation) and she drank carbarator fluid. She has a know history of self mutilation, amphetamine abuse, huffing paint and drinking carbarator fluid in the past. Question is: Isn't this considered child abuse? Especially now she >20wk gestation. It's a viable pregnancy, correct? Any input on this would be great. We had a 2 1/2 mth old infant that we coded last night 2 to child abuse. I would like to prevent that from happening with this situation. Thanks
  3. by   qanik
    Quote from kevro1013
    Great thread!
    Here is one I had last week.
    Pt pressents with abd pain and htn (BP 230/120). Non-contrast Ct abd and pelvis shows non-disecting AAA. MD orders nipride to titrate for BP >160/90. What type of medication does this pt need prior to nipride and why?
    Kevin
    Betablocker to decrease shearing effect of nipride. Reasearch shows you are better off with a gtt of esmolol then a repeated single dosing of other beta blockers.

    Qanik
  4. by   susi_q
    I've enjoyed and learned much from this thread. Keep 'em coming.
  5. by   RN92
    What are the contraindications with giving succs bolus/drip (dose: alot!!) to cocaine overdose pt presenting in the ER for the 2nd time this week?

    There IS NO contraindications...give them as much as you want. :chuckle
    Im sorry - I couldnt resist.!

    Ok, now Im serious..I have found a good way of keeping beligerant, intoxicated, maybe confused/maybe not..pts from leaving the ER undetected. (you know, sometimes, when they get mad that they arent getting the attention they deserve - they will just leave unnoticed).
    ANSWER: I help them get undressed when they first get there - get them in a gown. Put their belongings in a bag. We keep their belongings at the desk. Pts arent going to leave the er without their wallet and clothes...and if they truly are confused and leave anyway - they wont get far in a gown without security or someone noticing them.
  6. by   magicman
    Clipped for brevity.....
    Quote from ERslave

    Ok, now Im serious..I have found a good way of keeping beligerant, intoxicated, maybe confused/maybe not..pts from leaving the ER undetected. (you know, sometimes, when they get mad that they arent getting the attention they deserve - they will just leave unnoticed).
    ANSWER: I help them get undressed when they first get there - get them in a gown. Put their belongings in a bag. We keep their belongings at the desk. Pts arent going to leave the er without their wallet and clothes...and if they truly are confused and leave anyway - they wont get far in a gown without security or someone noticing them.
    I LOVE THAT IDEA!!!!!
    I may need to try this the next time I get one of these "special" people.
  7. by   SOCALRACERX911_RN
    This is a refreshing thread, thanks Chris. Got tired of threads about how nurses should speak "more" better english. I do have a question, after a pt has been intubated and placed on a vent, what is prefered oral or naso gastric tube and why?
  8. by   kevro1013
    [QUOTE=qanik]Betablocker to decrease shearing effect of nipride. Reasearch shows you are better off with a gtt of esmolol then a repeated single dosing of other beta blockers.

    Correct! Betablocker gtt is started prior to antihypertensive to prevent reflex tachycardia. Most of our docs prefer esmolol.
  9. by   canoehead
    Normal urine output for an infant/child is 1-2cc/kg/h for whoever it was that asked.
  10. by   RN92
    Here's an easy one:

    1.) Your unconscious pt has a k+ level of 7. Besides kayexelate, how else can you get the k+ level down quickly.? (except for dialysis pts - then you couldnt use this method.) :imbar :uhoh21:

    2. With each pint of blood given to a pt - how much can you expect the hct and hgb to rise?
    Last edit by ERslave on Jul 25, '04
  11. by   Stitchie
    Quote from ERslave
    Here's an easy one:

    1.) Your unconscious pt has a k+ level of 7. Besides kayexelate, how else can you get the k+ level down quickly.? (except for dialysis pts - then you couldnt use this method.) :imbar :uhoh21:


    2. With each pint of blood given to a pt - how much can you expect the hct and hgb to rise?
    Insulin IVP, calcium gluconate IVP and 2 amps of glucagon IVP: changes the biochemistry and K+ goes back into the cells where it belongs.

    HGb will rise 1 pt for each unit; I expect the crit would rise similarly.

    Something I can answer finally -- gee I hope I'm right :imbar
  12. by   tridil2000
    Quote from libmi
    This is a refreshing thread, thanks Chris. Got tired of threads about how nurses should speak "more" better english. I do have a question, after a pt has been intubated and placed on a vent, what is prefered oral or naso gastric tube and why?
    not sure if this is right in theory, but i always drop an oral gastric tube. i've seen way too many pts develop sinusitus when on the vent, and i am sure placing a naso gastric tube aggrivates that potential, along with the unecessay trauma.

    which one is it??
    tia!
    tridiltrish
  13. by   RN92
    FYI: Did you know that if you need the height of a patient( for instance, bedbound pts that cant stand), you have pt stretch arms out to side. The distance from fingertips (from left and right) is same as pts height. Try it on yourself.

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