thelema13 5,875 Views
Joined Jun 13, '11 - from 'Florida'.
thelema13 is a ED RN, CHARGE NURSE.
He has '3' year(s) of experience and specializes in 'ED'.
Posts: 287 (49% Liked)
Central FL, charge nurse in ED with 5 years experience. BSN, CEN. $28 base with 20% night diff, no diff for weekends. No bump in pay for BSN or CEN. I'm told compression raises due in April... but I'm not holding my breath.
Nonunion, not for profit hospital.
Mortgage is $650/mo with taxes and insurance included for 3/2 1800 sq ft house. Utilities 300/mo.
Most of our docs stick with 1-2 litres as a bolus, and I have given 8 litres before. Our cardio and infectious disease docs agree, give more fluid and place BIPAP if you are causing HF or respiratory distress.
Has anyone else noticed once you start abx, the pressure goes in the toilet and you end up playing catch-up until you get them in the ICU? Read a study somewhere sometime that stated there is a massive release of endotoxins once abx are initiated, and extreme hypotension ensues. Does anyone's facility have pressor guidelines without CVP monitoring capabilities?
10 mEq K+/hr (you can ask the doc for a vial of Neut, which takes the burn out completely, its 5 mL added to 10 mEq, you are adding 5mL of sodium bicarb to raise the pH of the K+ bag).
We are switching to a 'pull til full' model in a few weeks. We have done this before with bad results, mainly because our ED hires new grads and most of the charge nurses remain stagnant in their chair. Pull til full only works if you have great flow control, that is, supervisors willing to give beds ASAP, doctors willing to sit down for 15 minutes and dispo as many as possible, etc. Our ED was remodeled and now holds 32 beds plus hallways, and the managers got us a mid-level and are proposing 2 charge nurses, taking away the triage nurse, having a full time float nurse, yada yada.
Our mid-levels are not allowed to see peds under 1 year old, and they have to be a level 4 or 5. They are underutilized to say the least.
The ED works as it is, and it is my mantra that 'if its not broken, dont try to fix it.'
Someone in corporate that has their Master's degree that has never held a nursing job is trying to implement change and test a hypothesis. No other way to put 6+ years of school to work!
Sounds like if you do not have a charge, why not designate a team leader? 3 nurses for 7 beds is awesome, you guys have enough manpower but how is patient flow? Do you have a medic or tech? And I think a room assignment would be awesome, split the room 3/3/1 and whoever has the 1 trauma room will be the float/charge. Walkie talkies for staff for easier communication?
20g for CT's, but some techs will use 22g. CTA's are 20g AC or higher, preferable R AC. Per policy.
We use a manual BP cuff and inflate to 30-60 points above the systolic value.
Have any of the above posters tried high doses of high quality probiotics? Like 500 billion+ a day as a maintenance regimen?
How 'bout some Zofran ODT and a sandwich?
If the patient is truly recovering from their addiction, you should not give opiates because they are an addict, and the patient should state that as well, having known first-hand. You will just substitute one addiction for another. Give tylenol and have them follow up with PCP. There are plenty of non-narcotic pain remedies out there. In the ED, we have to deal and address with the emergency and we look for evidence to support our diagnosis, and too often the physicians give opiates because they work fast and make the patient happy (re: Press Ganey). Toradol and phenergen work well together, if your hospital still uses inapsine, talk to the docs about it. It's great for migraines/ super whiny pain seekers. Very closely related to haldol, and actually I just read an article about ED physicians using haldol/toradol/NS bolus for pain control.
I once admitted a woman with a dx of morbid obesity.
My advice would be to RUN AWAY from HCA facilities. They have terrible management and treat their nurses like dog doo-doo. I worked for an HCA facility in South Florida, the ED was a joke (the rumor was most of the ED staff used cocaine and CCC's to stay awake all night) and when I was upstairs in PCU and ICU, they were consistently short staffed, never had a unit clerk for PCU or ICU (ICU charge would handle that responsibility, as well as being the tele tech for the entire hospital). They had really wierd staffing rubrics, such as if your department had 11 patients, you were allowed 2 RN's, but if you got 12 pts you were allowed the courtesy of a tech.
Just from personal experience, I would never work for an HCA facility unless they doubled my annual salary, because you do the work of 2 or more RN's. Med-surg nurses routinely ran with a 10-patient assignment, PCU had 6 patients, ICU had 3 (routinely).
The one with the elastic band from a NRB mask?? Lmao I was thinking they should've tried it while I was reading the story!!
Wait...I'm confused. Was this like a Prince-Albert style piercing with too small of a ring, or was it just a thick metal ring placed around the circumference while flaccid that could not be removed due to the erection?
Nice case study, thanks! Did you try aspirating blood from the penis? Was urology unable to come to the ER?
51 year old male with a very large metal cock ring that was purchased a few sizes too small. He put it on and had a solid erection for 4+ hours PTA. No other medical history.
This is what we did:
1: Ice packs
2: Ice bath for penis and testicles
3: Copious surgi-gel and digital manipulation
4: IV neosynephrine, 10mg in 500cc NS wide open, did not affect BP more than 10 points systolic but had little effect on diminishing his erection.
5: Patient urinated x3, minimal size reduction
6: IVP toradol, morphine, etomidate, versed and brought out the ring cutter, then the ring cutter broke.... the ring was surgical stainless steel 8mm thick
7: A whole lot more surgi-gel and I sent a nurse home to grab his Dremel.
8: Used the Dremel on and off for 1.5 hours, allowing time to allow the metal ring to cool (iced surgi-gel helped here) We used tongue depressors as a barrier/guard in between the penis and ring.
9: Ring pried open with some monstrosity tool from the OR.
10: Patient took a cold shower for 30 minutes, then ended up going home with a urology consult, percocet and a lesson well learned....
He had the ring on and a solid erection for approximately 7 hours. He was a retired firefighter/EMT and was cracking jokes left and right. It was a very sensitive, delicate, dangerous situation.
What did you just learn???????? Buy a rubber ring, and invest in a Dremel for your ED!
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