msjellybean

msjellybean

Emergency

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About msjellybean

msjellybean has 4 years experience and specializes in Emergency.


Latest Activity

  1. I never, ever went to ER when I was a kid

    I was in the ER several times as a kid. I was 3-4 and being stupid in day care and split my chin open, needed sutures. When I was 5, I fell off a slide and had a humeral neck fracture. In my teen years, I went a few times - after a car accident (par...
  2. Critical Alarms, who answers?

    In my ED, we have two nurses stations. One larger, more central area that shows all the monitors and a smaller area that only shows the monitors in the rooms close to that station. It seems to be an unwritten rule that everyone is responsible for loo...
  3. Guns and Wepons

    Access to our ED is badge controlled. Visitors get an ED visitor sticker, which allows them access through the locked doors. Mental health patients and combative patients are stripped only to a gown and their belongings secured in a staff only area. ...
  4. Portal cath

    As always, refer to your P&P. In my facility, if a patient has a port, it is expected that you will access it and use it. Unless the doc suspects it as an infection source. In which case, we generally will access it long enough to draw quantitat...
  5. tPA

    This is tPA for CVA. We do use it PEs and DVTs, but I'm not sure what the standards are because we don't do that in the ED. All of that is started in IR and then sent to the ICU. VS and neuro checks, q15 minutes during infusion and 1 hour post infusi...
  6. Radiation danger, repeated CTs by frequent flyers

    We have an alcoholic frequent flyer, who typically presents drunk after a fall of some kind. She has had 8 brain CTs so far this year. I hate to think about how much radiation her brain has received over the last few years. Unfortunately my ED got a ...
  7. How does your ED treat chest pain?

    Forgot to add we also give 325 ASA if no contraindication/allergy
  8. How does your ED treat chest pain?

    We're supposed to initiate the CP order set with in 3 minutes of presentation to registration. From presentation to registration we have 7 minutes to get the EKG complete. Our standing orders include: place on monitor with q30 minute vitals, CXR, 12 ...
  9. What's in your pocket - ER Style

    Depending on what scrubs I'm wearing, the location tends to vary a bit. But... in my left top pocket I have my phone, gum, and carmex. Top right pocket is a couple pens, dry erase marker, & a sharpie. My trauma shears go in one of the cargo pocke...
  10. Cnas and sheath caths

    This is facility specific. My hospital allows our techs do d/c PIVs, provided they show us the catheter before disposing of it. Since that rarely ever happens, most RNs d/c their own lines.
  11. When Hospitalists Attack

    Reminds me of an incident I had a few weeks ago while sending a patient upstairs. College age girl with SOB x5 days. Chest CT reveals multiple PEs... described by the radiologist as "significant" clot burden. As I'm waiting for her bed to be ready, I...
  12. What is the lowest HGB you have seen?

    Pt came in via EMS for a fall. A&O x4, no SOB or cardiac complaints. BP stable. Lab calls with a critical hemoglobin of 2.4. A recollect is automatically ordered, based on that level. After the phlebotomist drew her, he showed us the tubes. Looke...
  13. Holding admitted patients in the ED

    I don't mind taking holds, so long as they aren't ICU patients. And my reasoning is this: while they're held in our department, they are to receive the same care standards as if they were actually on the floor. Except I can still have up to 3-4 mor...
  14. ER nurses bringing pts to the floor soiled

    I'm an ED nurse now, but worked on the floor for 3.5 years, frequently with a 6:1 ratio and one tech. If the IV site became problematic, I'd would start a new line and move on with my day. I don't understand why it's such a big issue for so many peo...
  15. New and 'fun' things

    Anecdote from when I was a floor nurse... had a rapid response code on a patient and by the time EKG got there, she was already to the ICU. They ended up performing the EKG on her roommate (oops!). But here's the kicker - found new ST elevation.