Cohiba 3,777 Views
Joined: May 12, '11;
Posts: 188 (51% Liked)
; Likes: 455
Nasty sammiches and Dilaudid
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...
Towel = OK. Pouring water over said towel = not OK...
Yep, all nurses, every...single...one... will get MRSA and C. Diff so run now while you can...
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.
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...
My favorite thing about being a (male) nurse? Every other Friday...
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.
Never pass up a chance to:
2) Sit down
3) Drink water
3.5) Pee (see what I did there? )
Sorry, I just don't feel like doing your homework...
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...
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)
I'd be a carpenter...
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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