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AnnieOaklyRN, BSN, RN, EMT-P 22,187 Views

Joined Oct 24, '06. AnnieOaklyRN is a RN, Paramedic. She has 'Previously ER RN, 17 years in EMS (yes, I still love it) , IV RN 8 months!' year(s) of experience and specializes in 'IV RN, (911) Paramedic'. Posts: 2,011 (32% Liked) Likes: 2,225

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  • May 19

    To much liability!

    If you are just going as a parent and not expected to provided health related care or advise that's good, but I would not say you are willing to take the "nurse" role on this trip, as you will not be covered for liability and why take the risk!!!

    Annie

  • May 19

    It was nurse's week?? Who knew....

    Annie

  • May 19

    It was nurse's week?? Who knew....

    Annie

  • May 19

    To much liability!

    If you are just going as a parent and not expected to provided health related care or advise that's good, but I would not say you are willing to take the "nurse" role on this trip, as you will not be covered for liability and why take the risk!!!

    Annie

  • May 19

    To much liability!

    If you are just going as a parent and not expected to provided health related care or advise that's good, but I would not say you are willing to take the "nurse" role on this trip, as you will not be covered for liability and why take the risk!!!

    Annie

  • May 18

    Hi,

    as others have said it depends on the physician and their comfort level with sedation. I find when the general surgeons do it, they often do not sedate well enough. Our ED docs which often times use Fentanyl and Versed or just order Propofol, which my opinion is the best option.

    Chest tubes are VERY painful and I think it's kind of inhumane when they do not sedate well enough, unless there are good reasons not to like BP etc.

    Annie

  • May 2

    Hi,

    If a person is awake enough to eat and drink they do not need a nasal airway in.

    This is going to sound blunt, but that doctor is a moron! He is going to increase the chances that she actually aspirates her food and drink. What is he thinking???? A nasal airway is not going to have any effect on a patient coughing up thick mucous from the lower airways, the point of a nasal airway is to help open up an airway for an OBTUNDED patient!

    I would seriously stop feeding this patient until the nasal airway is removed!


    Annie

  • Apr 30

    Hi,

    If a person is awake enough to eat and drink they do not need a nasal airway in.

    This is going to sound blunt, but that doctor is a moron! He is going to increase the chances that she actually aspirates her food and drink. What is he thinking???? A nasal airway is not going to have any effect on a patient coughing up thick mucous from the lower airways, the point of a nasal airway is to help open up an airway for an OBTUNDED patient!

    I would seriously stop feeding this patient until the nasal airway is removed!


    Annie

  • Apr 30

    Hi,

    When a patient is having an inferior MI, you should always do a right sided EKG ( V3, V4, and V5 on the right) PRIOR to giving NTG. The right ventricle is very dependent on after load and preload especially if its infarcting, thus as another poster eluded you should be giving fluids to the patient, not NTG, after you assess lung sounds of course. Also the right sided leads will not have crazy amounts of elevation, and it can be very vague because the right ventricle is a lot smaller than the left ventricle, thus the waves are smaller.

    That was rather negligent to begin patient care with NTG before he had an EKG or IV in place! Please don't ever let that happen again. Tell you clinicians to read the research, as NTG has never been proven to lessen morbidity or mortality in MIs! Morphine has been shown to INCREASE mortality. If a narcotic needs to be given, which in most cases it can help calm the patient and take the edge off, Fentanyl should be given instead of Morphine, especially if a STEMI with right side involvement is present.

    Please encourage your nurse manager to provide increased education on the management of STEMIs and chest pain patients, as it would seem the knowledge is lacking, or at least that is the picture you are painting.


    Annie

  • Apr 30

    Hi,

    When a patient is having an inferior MI, you should always do a right sided EKG ( V3, V4, and V5 on the right) PRIOR to giving NTG. The right ventricle is very dependent on after load and preload especially if its infarcting, thus as another poster eluded you should be giving fluids to the patient, not NTG, after you assess lung sounds of course. Also the right sided leads will not have crazy amounts of elevation, and it can be very vague because the right ventricle is a lot smaller than the left ventricle, thus the waves are smaller.

    That was rather negligent to begin patient care with NTG before he had an EKG or IV in place! Please don't ever let that happen again. Tell you clinicians to read the research, as NTG has never been proven to lessen morbidity or mortality in MIs! Morphine has been shown to INCREASE mortality. If a narcotic needs to be given, which in most cases it can help calm the patient and take the edge off, Fentanyl should be given instead of Morphine, especially if a STEMI with right side involvement is present.

    Please encourage your nurse manager to provide increased education on the management of STEMIs and chest pain patients, as it would seem the knowledge is lacking, or at least that is the picture you are painting.


    Annie

  • Apr 29

    Hi,

    When a patient is having an inferior MI, you should always do a right sided EKG ( V3, V4, and V5 on the right) PRIOR to giving NTG. The right ventricle is very dependent on after load and preload especially if its infarcting, thus as another poster eluded you should be giving fluids to the patient, not NTG, after you assess lung sounds of course. Also the right sided leads will not have crazy amounts of elevation, and it can be very vague because the right ventricle is a lot smaller than the left ventricle, thus the waves are smaller.

    That was rather negligent to begin patient care with NTG before he had an EKG or IV in place! Please don't ever let that happen again. Tell you clinicians to read the research, as NTG has never been proven to lessen morbidity or mortality in MIs! Morphine has been shown to INCREASE mortality. If a narcotic needs to be given, which in most cases it can help calm the patient and take the edge off, Fentanyl should be given instead of Morphine, especially if a STEMI with right side involvement is present.

    Please encourage your nurse manager to provide increased education on the management of STEMIs and chest pain patients, as it would seem the knowledge is lacking, or at least that is the picture you are painting.


    Annie

  • Apr 29

    Hi,

    When a patient is having an inferior MI, you should always do a right sided EKG ( V3, V4, and V5 on the right) PRIOR to giving NTG. The right ventricle is very dependent on after load and preload especially if its infarcting, thus as another poster eluded you should be giving fluids to the patient, not NTG, after you assess lung sounds of course. Also the right sided leads will not have crazy amounts of elevation, and it can be very vague because the right ventricle is a lot smaller than the left ventricle, thus the waves are smaller.

    That was rather negligent to begin patient care with NTG before he had an EKG or IV in place! Please don't ever let that happen again. Tell you clinicians to read the research, as NTG has never been proven to lessen morbidity or mortality in MIs! Morphine has been shown to INCREASE mortality. If a narcotic needs to be given, which in most cases it can help calm the patient and take the edge off, Fentanyl should be given instead of Morphine, especially if a STEMI with right side involvement is present.

    Please encourage your nurse manager to provide increased education on the management of STEMIs and chest pain patients, as it would seem the knowledge is lacking, or at least that is the picture you are painting.


    Annie

  • Apr 29

    Hi,

    I work as an IV nurse and we use arms (upper arms included) and feet, but only if absolutely necessary and with a doctor's order. I will not do a foot IV on an elderly person, someone with PVD, or a diabetic. I would NEVER put an IV in someones chest wall, especially a female because if they end up with a bad infection or infiltrate that could mean the loss of breast tissue and could be disfiguring! Not worth it when here are alternatives. We can usually find one in the arm with ultrasound. If we cannot we will consult with the physician and they can opt for some other access, either a PICC, midline, or EJ.

    In emergency I recommend an IO if there are no contraindications.

    Annie

  • Apr 29

    Hi,

    When a patient is having an inferior MI, you should always do a right sided EKG ( V3, V4, and V5 on the right) PRIOR to giving NTG. The right ventricle is very dependent on after load and preload especially if its infarcting, thus as another poster eluded you should be giving fluids to the patient, not NTG, after you assess lung sounds of course. Also the right sided leads will not have crazy amounts of elevation, and it can be very vague because the right ventricle is a lot smaller than the left ventricle, thus the waves are smaller.

    That was rather negligent to begin patient care with NTG before he had an EKG or IV in place! Please don't ever let that happen again. Tell you clinicians to read the research, as NTG has never been proven to lessen morbidity or mortality in MIs! Morphine has been shown to INCREASE mortality. If a narcotic needs to be given, which in most cases it can help calm the patient and take the edge off, Fentanyl should be given instead of Morphine, especially if a STEMI with right side involvement is present.

    Please encourage your nurse manager to provide increased education on the management of STEMIs and chest pain patients, as it would seem the knowledge is lacking, or at least that is the picture you are painting.


    Annie

  • Apr 29

    Hi,

    When a patient is having an inferior MI, you should always do a right sided EKG ( V3, V4, and V5 on the right) PRIOR to giving NTG. The right ventricle is very dependent on after load and preload especially if its infarcting, thus as another poster eluded you should be giving fluids to the patient, not NTG, after you assess lung sounds of course. Also the right sided leads will not have crazy amounts of elevation, and it can be very vague because the right ventricle is a lot smaller than the left ventricle, thus the waves are smaller.

    That was rather negligent to begin patient care with NTG before he had an EKG or IV in place! Please don't ever let that happen again. Tell you clinicians to read the research, as NTG has never been proven to lessen morbidity or mortality in MIs! Morphine has been shown to INCREASE mortality. If a narcotic needs to be given, which in most cases it can help calm the patient and take the edge off, Fentanyl should be given instead of Morphine, especially if a STEMI with right side involvement is present.

    Please encourage your nurse manager to provide increased education on the management of STEMIs and chest pain patients, as it would seem the knowledge is lacking, or at least that is the picture you are painting.


    Annie


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