Latest Comments by msjellybean

Latest Comments by msjellybean

msjellybean 3,398 Views

Joined Mar 2, '07 - from 'Illinois'. msjellybean is a RN. She has '4' year(s) of experience and specializes in 'Emergency'. Posts: 284 (38% Liked) Likes: 277

Sorted By Last Comment (Past 5 Years)
  • 1
    Emergent likes this.

    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 (parents insisted, even though I didn't want to), after I had another accident wherein I fell and lacerated my inner jaw down to the bone & required the OMFS guys, and another time when I sat down on the couch and impaled my elbow with some kind of upholstery pin.

    For minor things though (earaches, sore throats, etc.), my parents were rational and just took me to my PCP.

    *knock on wood* Thankfully my accident prone-ness seems to have stopped at age 16.

  • 0

    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 looking out for the rhythms and responding to those critical alarms. I have frequently gone to rooms where critical alarms are sounding, to check on the patient. Thankfully, have never found anything worse than a slightly slower than usual bradycardia.

  • 0

    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. Multiple cameras around the department, with 4-5 panic buttons scattered throughout the department. We have a pretty large security department (considering the number of beds our hospital has), that is headquartered in the ED. I believe some of them carry tasers and pepper spray as well.

    IL just passed concealed carry, effective in January. If I recall correctly, it's now a felony to have a weapon on campus. We also have a special overhead page that indicates a weapon has been displayed somewhere on campus & we have a lockdown plan. If someone does that, security will contain the situation & notify local PD.

  • 0

    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 quantitative blood cultures and then de-access.

  • 2
    In tPA
    nrsang97 and Gabby-RN like this.

    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 infusion. There's to be an MD documented NIHSS, two hours after administration. Then after infusion, we have VS & neuro checks q30 minutes for some period of time that I can't remember... maybe 4 hours? After that, I think we transition to VS & neuro checks q60 minutes x16 hours, I believe. I'm probably off a little bit - it's been a while since I've worked with tPA.

    There's also another MD NIHSS at 23 hours post infusion.

  • 0

    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 crop of young, new docs & they seem to be firmly in the camp of CT-ing almost everyone.

  • 0

    Quote from msjellybean
    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 lead, 02, start heplock, draw CBC, CMP, coags (which we hold unless the pt takes warfarin), and an i-stat troponin. After the EKG is complete, the EKG tech or the RN takes the 12 lead to a doc (any doc, doesn't have to be the doc that signs up for the pt) to verify if STEMI or not.
    Forgot to add we also give 325 ASA if no contraindication/allergy

  • 1
    emtb2rn likes this.

    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 lead, 02, start heplock, draw CBC, CMP, coags (which we hold unless the pt takes warfarin), and an i-stat troponin. After the EKG is complete, the EKG tech or the RN takes the 12 lead to a doc (any doc, doesn't have to be the doc that signs up for the pt) to verify if STEMI or not.

  • 0

    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 pockets on my pants and then I typically have a stash of alcohol swabs in my rear pants pocket. My companion phone goes in my right pant pocket.

    I've been organizing my gear this way for 3.5 of my 4 years as a nurse and trying to switch it up at this point feels VERY weird.

  • 0

    Quote from RN2BE2016
    As far as I know, discontinuation of IV's should not be delegated to Certified Nursing Assistants.

    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.

  • 5
    T.H.R.N., RetRN77, maelstrom143, and 2 others like this.

    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 give her the heparin bolus & start the drip, as well as do a lot of teaching.

    Talk to the nurse that will be getting her and when I ask her if she as any questions, she says in this really snotty tone, "well it doesn't look like we've DONE ANYTHING for her." To which I ask her if she means have we started her heparin & bolused her? She says yes. I respond as politely as I can, that yes, in fact I had done all of that and if she had looked at the MAR, she would have seen that.

    Gah.

  • 0

    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. Looked like cherry Kool-Aid. Repeat level comes back at 2.6.

    I'm not entirely sure what her final diagnosis ended up being, because I left shortly after the second level came back.

    Crazy!

  • 0

    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 more ED patients, with varying levels of sickness. Unfortunately when patients are roomed from triage, thought isn't given to what nurses also have holds. While actually in the CCU, those nurses have two patients. I don't relish the thought of having 4-5, one of whom is ICU status.

  • 6
    Altra, cardiacfreak, nrsang97, and 3 others like this.

    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 people.

  • 2

    Quote from DeLanaHarvickWannabe
    Security guard at hospital bitten by angry patient. Doc decided to perform a PPD. (Not sure if pt history had anything to do with it - but security doesn't have annual PPDs).

    Security guard's PPD positive.

    Security guard sent for Chest Xray.

    Boom - stage IV lung CA. Not a smoker, no symptoms, middle aged healthy male.

    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.


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