New to ER - tips, tricks, recommendations & prioritization? - page 2

So, after 6.5 yrs as RN/shift charge on a step down unit, I moved to the ED! Very excited to work with the excellent team! Though I know how to be a nurse, being an ER nurse is a whole new world... Read More

  1. by   IrishErin
    Quote from NurseOnAMotorcycle
    Ok I had someone tell me this tip that was So Simple and SO BRILLIANT that I felt dumber just hearing it....

    MD orders 1000ml NS bolus stat then 200/hour continuous when that finishes...

    A 27 year veteran of emerg nursing told me: "Run the bolus as a secondary IV then the primary 200/hour will take over automatically when it's done."
    What an awesome tip!! Thanks!
  2. by   CodeteamB
    Quote from IrishErin

    What an awesome tip!! Thanks!
    What pumps do you guys use? Seriously, I want them if they run fast enough on the secondary line to give a healthy adult a bolus (
    ours max at 999 ml/h). I do use this trick for bolusing CHF pts and Peds though
  3. by   IrishErin
    Quote from CodeteamB

    What pumps do you guys use? Seriously, I want them if they run fast enough on the secondary line to give a healthy adult a bolus (
    ours max at 999 ml/h). I do use this trick for bolusing CHF pts and Peds though
    Ours max at 999 as well, so I usually end up hanging by gravity if a bolus is required, then attaching them to the pump afterwards
  4. by   NurseOnAMotorcycle
    I run it at 999.
  5. by   CodeteamB
    Quote from NurseOnAMotorcycle
    I run it at 999.
    Oh, ok, I was all excited!

    I'm a pressure bag kinda gal, to be honest. I rarely use a pump for saline.
  6. by   sserrn
    We're required to run everything on a pump, so a simple L bolus takes an hour :-/
  7. by   NurseOnAMotorcycle
    I only use pressure bags if someone's coding badly. If I need a pressure bag, there won't be an order to follow it up with 200/hour. It'll be followed up with another pressure bolus order.
  8. by   CodeteamB
    Quote from sserrn
    We're required to run everything on a pump, so a simple L bolus takes an hour :-/
    Yikes! We don't have enough pumps for that. If you aren't fluid restricted or getting a med that requires close control it's gravity or a pressure bag (which we do use pretty frequently).

    I can just picture one of our physicians barking "a liter in an hour isn't a bolus"

    LOL.
  9. by   sserrn
    I couldn't agree more...but policy is policy, unfortunately!
  10. by   Jeana18
    Thank goodness for this post! I swear I am in the same position right now. I just recently got hired and I'm on my first month, almost, of working in the ED. I'm experienced, about 3 years in, and I feel so incompetent.

    Everyone's comments were very helpful. Thanks!

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