Latest Comments by Lev <3

Latest Comments by Lev <3

Lev <3, BSN, RN 41,657 Views

Joined Jun 3, '11 - from 'Another planet'. Lev <3 is a ED Registered Nurse. She has 'A few' year(s) of experience and specializes in 'Emergency - CEN, upstairs, troll bashing'. Posts: 2,564 (52% Liked) Likes: 4,726

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  • 1
    nursej22 likes this.

    Type 1 Diabetes Mellitus: Practice Essentials, Background, Pathophysiology

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  • 2

    Yeah the patients BP is 127/72 but the BP med is keeping it that way!

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    I can only think of 1 instance of a really bloody CPR. This was a teenage trauma case and the patient got bilateral chest tubes during the code and he was bleeding out of the ETT. There was blood everywhere - on the walls and on the floor.

    Aside from gastric secretions coming up the esophagus at times during CPR, there isn't usually that much to worry about.

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    My hospital is trying to improve its sepsis numbers and I've been asked to be involved on the ED end of things. We do really well with the STEMI and stroke patients so they are trying to make a "code sepsis" of sorts. I've been looking at a triage alert with provider notification and RN initiation of orders as well as up triaging patients to an ESI 1 for suspected sepsis and at least a 3 for SIRS without a noticeable source of infection. What is being done at your facility?

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    Perhaps ask if you can work continue to part time but now as a case manager while gaining per diem hospital experience until you feel comfortable with the hospital. If they want you, they may agree to this. It sounds like this is a new position being created for you?...

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    HA! I had a nightmare like that too!

  • 4

    Quote from amiss5572
    coming in early unclocked to look up patients, etc.
    This is probably what she was referring to when she said to "never say that."

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    I work with the adult population in the ED. (It may be different for kids). We do not jump to epi initially even if someone had a previous anaphylactic reaction. It depends on their symptoms. The medications we use for allergic reaction include IV solumedrol, benadryl, and pepcid and of course IM epi. I have given the above IV medications (not epi) to an asthmatic who was wheezing after being exposed to a nut she was allergic too with a good outcome. We do not always jump to epi. It depends on when they were exposed and what their symptoms are.

    Again, I work with adults, so with kids and outside the hospital setting without a physician present, jumping to epi may be the right thing to do.

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    The patient is dehydrated so there is no reason to restrict fluids

    A creatinine of 2.7 does not indicate dialysis.

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    LadyFree, so happy to hear you are doing well!

    Re: the metoclopramide aka reglan - I have seen people react with extreme agitation/anxiety to reglan which is also corrected with benadryl however, I have found that this happens mostly because the medication was given too fast. I have gotten into the habit of mixing reglan in a 100ml bag of normal saline and letting it drip wide open. The patient will get the medicine within a couple minutes but will usually not have a reaction. I have done this with people who had the anxiety reaction in the past and they were fine when it was given slowly over a couple minutes.

    What did I learn this week?

    That I will be precepting (for the first time) an experienced nurse transferring from med-surg. Any pointers... because I have only had nursing students and a practicum student (when I worked med-surg), and paramedic students (in the ED), not an actual nurse.

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    Great tips, thanks.

    *I think this article should be revived*

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    Wear a suit and bring along scrubs. If the unit has a particular color bring that color.

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    Yes it happens and yes it is not safe but this is reality of the overpopulated ER and over-utilization of emergency services.

    Patients are triaged, IVs are started, and labs sent, EKGs done and patients are sent back to the waiting room of 50+ people to wait (it happens). If a patient is ordered IV fluids in triage they are sat down in one of the triage rooms with other patients (an area visible to the triage nurse) and given their IV fluids or IV antibiotics and then sent back to the waiting room to wait some more. Patients who need vital signs monitoring may be sat in triage with a pulse ox on til a room opens up. The fall risks and psychs sit in triage.

    It can get very dangerous out there. However, we do go out to the waiting room aka "the jungle" to get patients back and a quick scan of the waiting room for the previously unnoticed sick patient is always in order.

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    Osteoclast, ~Shrek~, fawnmarie, and 1 other like this.

    Wait till he is well off orientation and stable in his new career i.e. 1 year on the job and then quit your job and go back to school to do whatever you want. You want challenge? Find an NP program. Now it's your turn!