Latest Comments by Cohiba

Cohiba 2,988 Views

Joined May 12, '11 - from 'Down on the corner, out in the street'. He has 'some' year(s) of experience and specializes in 'Nasty sammiches and Dilaudid'. Posts: 188 (51% Liked) Likes: 446

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    For background, I'm a RN in the ED of a level 1 trauma center (CEN/CCRN/TCRN plus some other stuff that doesn't make it on my signature block) but have a question that none of our docs can answer and there isn't a cardiologist in the department right now whose brain I can pick. Given that, I'm wondering if a patient has a pacemaker, in the absence of ANY INFORMATION AT ALL beyond a 12-lead EKG (i.e. a demented/unconscious/very ill-informed patient with no ID or a wallet with a pacemaker info card) is there any way to tell what chambers are sensed and what chambers are paced? I'd think that if there was a P-wave followed by a pacer spike than a QRS one could assume the pacer is atrial-sensed/ventricular paced or if there was a pacer spike/P-wave then pacer spike/QRS then the pacemaker is dual-sensed/dual-paced, etc. though if I'm wrong on that, I'm open to learning how I'm wrong...

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    ktwlpn, kalycat, LadyFree28, and 11 others like this.

    Towel = OK. Pouring water over said towel = not OK...

  • 38

    Yep, all nurses, every...single...one... will get MRSA and C. Diff so run now while you can...

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    There are a lot of people available to answer questions in the ED of your local hospital(s), not on an Internet forum that doesn't vet members/verify credentials.

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    If there was an app that could direct the user towards the nearest source of coffee or beverage alcohol, I'd be ALL OVER it...

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    My favorite thing about being a (male) nurse? Every other Friday...

  • 1
    WKShadowRN likes this.

    I'm going a sliiiightly different route and voting for multifocal atrial tachycardia since the P-waves I see aren't consistent between QRS complexes.

  • 0

    Never pass up a chance to:

    1) Eat
    2) Sit down
    3) Drink water
    3.5) Pee (see what I did there? )

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  • 3
    SarahMaria, elkpark, and 203bravo like this.

    Sorry, I just don't feel like doing your homework...

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    A couple nights ago I was talking with a friend who's one of the instructors in the local college's EMS education program and they said it would be nice if I was to speak in class as a guest about EMS from an ED nurse's perspective and what they could do to prep their patient for handoff/transfer to definitive care. That seemed like a fine idea so I'm starting to think of points to discuss, even before the exact format of my presentation is still up in the air, i.e. Q/A, prepared lecture with PP slides, free-form discussion, etc...

    Here are a couple of my ideas so far but I'd welcome other suggestions:

    * Calling report--please do it, even a simple "heads up--we're inbound emergent with a STEMI" since nobody likes the surprise amberlamps (misspelling very much on purpose), especially if they're bringing someone who's actually sick

    * Focusing their report--VS, relevant demographics (age/gender/race), and history as it relates to their current condition, not a complete health history that doesn't directly or even indirectly relate to why they called the ambulance this time

    * Take care of themselves physically, ie eat right, stay in shape, etc--too many times I've seen 350 lb+ EMS personnel wheezing a pt into my ED and I've gotten concerned that they're going to code before the patient does

    * IV access--if the patient needs fluid resuscitation or might need blood/large volumes of fluid, see if they can go with a large bore catheter (18/16/14) vs bringing in a septic patient with a 24 ga that for our purposes isn't very useful and might be occupying the pt's one good peripheral vein into which we might have been able to get a larger catheter, albeit in better working conditions.

    * Take ownership of their patients--even if they're "just" transferring a patient, get vitals, do their own assessment (however abbreviated), and be prepared to give report when they arrive at the receiving facility. Seeing a senior Attending surgeon verbally destroy an EMS crew who, literally, said "I don't know--they just said to bring him here" when they delivered a trauma transfer and were asked for report was one of the more glorious moments of my career--schadenfreude doesn't even come close...

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    H/H: 0.98/3.9 (alive but looking like death)

    BAL: 0.8xx (alive--Indian off the reservation and he probably lives at 0.5xx)

  • 3

    I'd be a carpenter...

  • 4

    Get drunk, sleep until whenever you wake up vs being tied to an alarm clock, turn 5 y/o again (eg have sugary and nutrition-free cereal for breakfast, then go to McD's for lunch), climb a tree, take a long afternoon nap in a hammock under the trees in a breeze, and generally enjoy yourself. There will be time enough for work once you're in school so enjoy the summer off when you have it.


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