Walk me through your ER

[Sassy5d]

I'm just looking for a quick, condensed version of what your ER is like.

I've only worked at 1, a place I hear used to be 200x's better before the inner city hospital closed, and now all the inner city folk come to visit me.

I was discussing with a coworker the other day, that I feel confident in many things.. But I don't get much exposure to 'major' things. I'm not saying I wish I walked into full arrests, active mi's, ect.. But it seems when I work, we're always crowded with 'abdominal pain' that is really just low pelvic pain with d/c. Toothaches.. Ect. Truly, level 4's.

Let me live vicariously through you :)

[Pacsun4567]

We are the smallest ER in size in my city but we see the most patients. We are not the trauma center but due to our location many of the assaults stabbings and gsws end up walking through our door (don't want to call an ambulance). Thankfully these are relatively rare in my city anyway, but I've seen my share. We also see a large number of walk-in clinic type visits. Although it is not terribly difficult to find a GP in my city if you are motivated, many people prefer to use the ER. We also have many temporary residents in our province in general and our city in particular (oil $ gas). Although my city has a children's hospital 30% of our patients are pediatrics. Again, if they call an ambulance little buddy is not coming to us, but if mom chucks him in the back of the car we are likely to be on the receiving end. We get a lot of very sick peds walk ins. We are also the Rapid response team for the inpatient peds unit in our hospital. Because of walk-ins we are responsible for transporting patients to the big medical centre in a nicer part of town. Thankfully our children's hospital sends a transport team, but traumas, cath lab, neuro etc. get shipped out post stabilization and the nurse rides along in the ambulance to monitor drips and the patient and to provide an extra set of hands for ACLS if the patient crumps. I love my ER. It is true we see all that belly pain and UTIs etc. Sometimes I think it would be cool to work in a trauma centre, but I wouldn't want to move away from my hospital in the 'hood! Plus, a doctor who I work with (and works at both hospitals) once told me "you think it would be exciting over there, but it's all oncology" (they are also the cancer centre).[/quote']

I could have written this myself!

[Emergent, RN]

Level 3 ER in a two hospital town, both hospitals level 3s. We alternate trauma days with the other hospital. Lots of gang activity, therefore GSWs, knives, etc. Anything really big gets stabilized and airlifted to Harborview, the regional trauma center. We see plenty.

We also have all the social problems, homelessness, drug and alcohol abuse. Meth is big.

We have 20 rooms, one doc, one mid-level works 10AM-8PM. The other works 3PM-1AM. All our rooms are really nice, sliding glass doors, flat screened TVs, all individual. They are a real draw on a cold winter night to our disenfranchised population.

[ohiobobcat]

I work in a 12 bed ER- we are a stabilize 'em and ship 'em kind of place too. The closest trauma centers are about 1 hour away in different directions by ground (faster with lights and sirens, obviously). We have a 2 bed "trauma bay", a room set up for psych patients, a gyn room and 2 triage rooms that can be used as treatment rooms if absolutely necessary. We very rarely put patients in "hall beds". We are staffed with one physician at all times, and a mid level provider who works from 1000-2000 with anywhere from 2-4 nurses depending on the time of day. We have 1 ED tech who fills mostly a secretarial role so the nurses do almost all of the patient care including transport to other departments, walking samples to lab (no tube system), and helping pt's out to their vehicles if needed. We see just about everything, from lacs to abd pain, traumas, snowblower vs. hand (we get a lot of those this time of year!), CVA, MIs, etc. We do a lot of transfers by ground/air for specialized care.

[DayDreamin ER CRNP]

Level 1 trauma center. We get everything from medication refills to sore throats to abdominal pain to GSWs. We have a lot of traumas come in like MVCs 40+ mph, GSWs, stabbings, boating accidents, and assaults. On a typical day in medical you'll see chest pains with maybe an active stemi, usually at least one stroke pt a day being flown in,lots of abdominal pain, vag bleeding in preg, SOB, and SI/HIs. Of course random things in between but that's the typical pt flow we see daily.

This is pretty much my ED too. We have about 90 beds with 6 trauma bays, two of which are reserved for Level 1s. We now have a 10-bed observation unit which has really helped us with our pts that really aren't sick enough for admission but not quite well enough to go home yet; i.e. N/V/D that we can't stop, asthma / SOB, some cold/flu, etc. We also have a Fast Track area that we use during specific hours for our priority 4s and 5s. That has helped our bed flow significantly!!

[devulms21]

I work in a 30 bed level II trauma center. Only hospital in a town of 75k. Very busy. We see everything- typical chest pains, abd pains, tons of pysch, drug seekers, MVCs, occ GSW or stabbing (fairly rare). We get patients flown into us from lots of the surrounding community hospitals. We get plenty of pediatric patients. We fly out the very sick pediatrics, complex ortho stuff like mainly pelvic fractures, sometimes will fly out complex neuro stuff but have several neurosurgeons here. There is a big burn center about an hour away so we send out all major burns as well. Codes are common too

[z.RN.]

I work in a level III center that goes from being 19 beds to 30 beds depending on the time of day and or staffing levels. Children's hospital in town so don't see critical peds but a ton of routine peds. We see a lot of cp and MI because we have a large cardiac practice located here, not much trauma because there is a level II down the street about a mile. Other than that the usual belly pain, pain rx refill, lacs, cough, and tons of psych as always.

[BrnEyedGirl, BSN, MSN, RN, APRN]

68 bed Level I Trauma Center,...today GSW to the head, 12F ejected from MVC, 2 acute MI's (intubated one of them), 3 Class I strokes,...all arrived withing 45 minutes of each other,.............my feet hurt :)

68 bed Level I Trauma Center,...today GSW to the head, 12F ejected from MVC, 2 acute MI's (intubated one of them), 3 Class I strokes,...all arrived withing 45 minutes of each other,.............my feet hurt :)

I LOVE those shifts... especially when I'm floating within the department...

they FLY by

[emtb2rn, BSN, RN, EMT-B]

I LOVE those shifts... especially when I'm floating within the department... they FLY by

Yeah, love to be the float on those kind of days.

[ChuckeRN, BSN, RN]

I work in a Level III Trauma Center in a Navajo Reservation. The closest Level I is 80 miles away so for obvious Level I's, they are flown directly from the event site. Otherwise, we get everything. In a town of 10,000, we saw 35,000 patients in our ED in 2013. We have 8 beds, with 2 trauma beds. We also have a Fast Track ED across the hall with a separate entrance with 10 rooms that closes at 1AM.

For a Res with zero alcohol allowed, the majority of our major events are ETOH related. Plus, loots of diabetes related patients from hypo and hyperglycemias to patients coming straight from the dialysis center a mile away.

And because Native Americans pay NOTHING for medical care, people have no qualms about calling 911 and getting an ambo ride for things like a sore throat.

[ZooMommyRN, ADN, RN]

Started out at a 10 bed rural ER in Florida. Saw alot of everything and loved it, kind of miss it lol Now I'm at a level one pediatric trauma center, we have 28 beds right now and 2 trauma bays (or adult side has 99 beds *yikes* lol) and everyday is a new bag of tricks. Because it's a major University & research center we get alot of special needs and congenital kids, skews your perception of sick vs not sick population. Glad my kids are teens because I'd have been a neurotic mom! They also don't tell you that most pediatric cancers are diagnosed in the ER setting that aside I love it still

[mybrowneyedgirl, BSN, RN]

89 bed Level 1 Trauma center with our own helicopters and fixed wing airplanes. Tooth aches to aortic dissections. 3 Trauma bays but it's being remodeled to accommodate more and include an ICU in the ED. Typically 3:1 patient ratios. Some 4:1. Trauma bays have 2 nurses and 1 medic but staff all helps out if more is required.