murphyle BSN, RN

Emergency, Critical Care (CEN, CCRN)

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About murphyle

murphyle has 4 years experience as a BSN, RN and specializes in Emergency, Critical Care (CEN, CCRN).


Second-degree RN, veteran of Emergency and CVICU.

Latest Activity

  1. murphyle

    What is your ER like.....need advice?

    370/day in a 39-bed shop?! That's not just efficiency, that's magic. You must have amazingly fast inpatient admissions, or be seeing a lot of fast-track traffic, to make that work. How do you keep up that kind of throughput?
  2. murphyle

    What is your ER like.....need advice?

    45-bed adult acute care/10-bed adult minor care/10-bed pediatric acute care, seeing 280-330 patients/day: An acute care team, of which we run four, consists of one physician (plus or minus a resident or a PA/NP), three RNs, one tech, one secretary an...
  3. murphyle

    Warmed lidocaine

    Anecdotal evidence suggests that warming lidocaine decreases burning and stinging associated with local infiltration. I have not seen any papers proving this one way or another. We typically do not warm our lido beforehand, except in the context of ...
  4. murphyle

    ED techs to start IVs?

    IV starts are a "delegatable task" in our shop, and many of our EC techs are frankly brilliant at it. Indeed, we typically assign our orienting nurses to work with an experienced tech for half a shift or so to develop their IV competencies. We do res...
  5. murphyle

    Ebola... What'cha Gonna Do When It Comes to You

    We do have a quite robust plan for viral hemorrhagic fevers in place in my department, covering identification at Triage, a chain of notification, rooming requirements and visitor policies. If anything, it might err on the side of overkill (it calls ...
  6. murphyle

    OB ultrasound...foley or no?

    We've been waging this battle in my shop for the last 4.5 years that I've been in practice, and likely for a lot longer before that. Our physicians have repeatedly stated that they no longer agree with routine Foleys for pelvic ultrasound, we certain...
  7. murphyle

    ER Workflow

    45-bed department, midsize community hospital: An acute care team consists of one MD, three RNs, one tech and one secretary for up to 15 patients. ECGs are done by dedicated staff from Heart & Vascular Services (one always stationed at Triage, th...
  8. murphyle

    how to deal with management?

    So let me make sure I understand this: you got into it with a charge nurse, then made an error and didn't document it, for which you've already had a verbal counseling and are being threatened with Warning A, and now you're slacking at work, complain...
  9. murphyle

    Documentation in the ICU

    Head-to-toe assessment, LDA (Line/Drain/Airway) documentation, SIRS screen, Braden and safety assessment are all done q shift, plus any changes. Strips (at a minimum two ECG leads and your alarm limits, as well as anything else with a waveform - art ...
  10. murphyle

    Are swans going "out of style?"

    You do? Interesting. Policy here is that any Swanned patient has to stay on SBR, due to concerns about accidental migration of the catheter (either RV whip or PA occlusion).
  11. murphyle

    Are swans going "out of style?"

    I'm in a cardiovascular surgical ICU, so every post-op heart comes back with a Swan. We have rather a love/hate relationship with them; they're great for accurate hemodynamics, but as long as the Swan stays in, the patient has to stay in bed, which m...
  12. murphyle

    ER transitioning to ICU

    Feline, your resume looks an awful lot like mine! I am also a 3-year emergency veteran, who just transferred to CV-SICU a few weeks ago. The only differences were that I came from a Level II center, and already had my CEN and CCRN when I applied. :-)...
  13. murphyle

    What's in your pocket - ER Style

    Reply to Airwayguru: Neither. I wear Aviator Scrubs - Classic shirt, ER pants. They're comfy, last forever, and are the source of one of my two department nicknames, "Pockets."
  14. murphyle

    What's in your pocket - ER Style

    For me, this question should read "What's in your pockets", plural, as I'm quite well known for the plethora of them on my scrubs. That said, on to the tally... Left sleeve #1 and 2: Pen and penlight. Left chest: Surgical site marker, misc personals...
  15. murphyle

    Best one sentence handoff report

    "303's EtOH is only 378 this time, which for them is practically stone cold sober." "Your Resus coverage is the med student, the resident and (slow-moving attending). I'll light a candle for you." "He's had three liters bolus, six units of PRBCs, fou...