What 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.

What do you say...?

Ive 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?

Originally Posted by RNCENCCRNNREMTP

Hmmm, specifically strep throat or just sore throat. Mono can cause sore throat and abdominal pain mimicing appy.

I've only seen this w/ strep, but you're right...it can occur any sore throat, including mono. what is the mechanism?

Originally Posted by RNCENCCRNNREMTP

Here is a stumper for you.

What are the NEXUS criteria for avoiding c-spine x-rays?

1) normal LOC
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

I'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!

This 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.

Sarah

WOW, this is a really good idea! Makes sense to me..

Originally Posted by treddrn

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.

Contraindication for succs

("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

Qanik

I 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?

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