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7feetunder 3,831 Views

Joined: Aug 9, '12; Posts: 54 (22% Liked) ; Likes: 39

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  • Mar 19 '15


    I used to sit on bags for the transfers to a trauma center via ambulance, it warmed the fluids, and created pressure. You can also use a blood pressure cuff around the bag for pressure delivery also.

    I use a red paper over my LED maglite to make veins stick out in bad sticks, it will fade arteries, and darken viens. (OH TURN THE FLOURESCENT LIGHT OFF!

    Baby powder in your socks helps your feet not feel so claustrophobic over the 12 hour shift.

    In patient's with uncontrolled vomiting, get them to yawn, I read this in a Neurology Book, it can reset the pathway in the brain that PAIN NAUSEA AND TEMPERATURE TRAVEL ON.

    Run water if your patient has trouble urinating.

    The Vagus Nerve Trigger can stop Hiccups.

    In a picture, if only one eye is red, that could be a sign of a tumor.

    Squeezing the skin between the THUMB and POINTER FINGER helps migraines tremendously. (PINCH, HOLD, AND MASSAGE)

    Chewing gum will make you read and chart faster.

    A 5 minute Rigourous Scalp Massage can release as many endorphins as MORPHINE 5mg!!!!!!!!!!!!

    If assessing for a stroke, shine the light in one eye, USE A DIVIDER TO KEEP LIGHT OUT OF THE OTHER, it should STILL RESPOND.

    Blowing up a baloon helps prevent ATELECTASIS, (BEWARE OF LATEX ALLERGY, and POLICY/PROCEDURE)

    When you become aware of your breathing, and conscious takes over subconscious, YOUR spO2 generally falls by 2-5%

    An aspirin 325mg crushed and put in a car batteries water supply will give you a charge to start.
    (SAVED MY TAIL IN ALASKA)!!!!!!!!!

    Where shoes that make a noise so if your Psych, or Psych Emergency Room Pts are doing something stupid, they will hear you coming and behave. I KNEW A NURSE THAT WORE HIGH HEELS FOR THIS PURPOSE!!!!!!!!

    A condom and a 18 gauge IV catheter placed in the last intercostal space for a collapsed lung in the field.

    Those prepackaged fingernail polish removers are great for permanent marks on skin, temp tattoos, and even blood stains on your scrubs.

    When doing a accu-check, get the pt. to make 5 fists first, also helps decrease pain from stick.


  • Mar 19 '15

    Quote from MrsNJTransplant
    Not a nurse yet, but I'm an ER Tech and I have seen a doc use the bp cuff in replace of a tourniquet when the pt was a hard stick.
    Yep, this works. You pump up the BP cuff until the radial pulse goes away, and leave it right there. I learned that from a guy who was a total ace with IVs.

  • Mar 19 '15

    This is so wrong on so many levels. ICU patients must be seen by a physician in the ER or in the ICU upon arrival. It sounds like you work in a small hospital that is a primary stroke center. The ER must try to stabilize the patient and EMTALA requires disposition to the appropriate level of care. That means sending the head bleed to a comprehensive stroke center. There is no such thing as a JCAHO or CMS core measure for ER throughput. There are core measure for Stroke that you should read and that will be helpful to your cause.

    Without admission orders or a physician present, you, the nurse, are left to your own devices to determine the care of that patient.
    So if I understand the situation correctly, the ICU manager is asking the nurses to practice beyond the scope of a nursing license. Forward that email to your home email address.

    When the obtunded pt with a brain bleed herniates and becomes an organ donor or even a coroner's case, the ER staff will say "that's all new, he was fine, that all happened upstairs." Do they do the NIHSS or any kind of stroke code protocol? Find that policy and hold them to it.
    The two cases mentioned were sentinel events and should have been reported to risk management with a root cause analysis investigation for each one. Unless you have a neurosurgeon and it sounds like you don't.

    Find the policy for ICU admissions and admission orders as well as any stroke protocols. That is what the ER must follow. I think that you should call your malpractice carrier for advice on this matter. Personally I would be looking for other employment rather than follow such an idiotic directive in a community hospital. You need to enlist support from the medical staff, specifically the intensivists and neurologists who can and should oppose this ludicrous directive.

  • Nov 8 '12

    Most nurses have down time, along with a generous helping of insane-crazy time, during the shift. It's the nature of the job. I don't see the difference between browsing the Internet or reading a magazine or chatting quietly.

  • Nov 8 '12

    My biggest pet peeve is the constant complaining about the wait in ER. Hello, this is the ER. Whatever made you think it would be a quick in and out? Let me push that STEMI out of the way so you and abdominal pain can get right in. Do me a favor first, and throw that cheeseburger and chips away. It's hard to believe you've been vomiting all day when you are chowing down on a burger in triage. If you have to wait, its good news, you aren't dying!

    My second biggest pet peeve is the people who go on and on to yes or no questions. Question: Are you allergic to any medication?" Answer: "Well, one time I was at my neighbors and bla bla bla.... it is a yes or no question! Yes or No

  • Nov 8 '12

    I'm sure you've all expeienced this one . . . "My pain is a 10/10 (while texting) and I need 8 mg Dilaudid and some phenergan and benadryl . . . IV push only, not pills." I love it when they think they can place a medication order. Nothing yells more loudly "Narc seeker" than this.

  • Nov 8 '12

    Yesterday my patient asked me if I could "just give her a couple amoxillin pills, I don't have money for the prescription". Meanwhile both she and both the middle school aged children she brought with her were all texting away on iPhones, and her Coach bag sat right next to her. I had to bite my tongue, hard. Also, yesterday, as I was trying to discharge my patient who came in for a nosebleed- and was explaining to her the meaning of EVERY SINGLE ONE of her lab values- which were, mind you, more perfect than mine would have been- she asked me to call the dr back in the room because she forgot to mention something to him. What was that important piece of info? Oh- that she was beginning to notice that her hair was beginning to fall out. I did not, surprisingly, fetch the dr for her. This woman was close to 300 pounds and I could not help thinking, if you are that concerned about your health perhaps we could start with weight management. I love the ED but sometimes it leaves me speechless!!

  • Nov 5 '12

    I have never known of anyone to fail it. You will be fine Good luck

  • Nov 5 '12

    YOU CAN DO IT!!!!!!!!!

  • Nov 4 '12

    Go in there with your knowledge and try not to think of what others have said, esp if they didnt do well.... lol
    Believe in yourself!!!!!

  • Oct 30 '12

    Practice makes perfect, and you are sure to get more then enough practice in the ER. You will get proficient because you will have the constant exposure to the skill. Although, I would question the move since you don't like bedside nursing. You are still doing bedside nursing in the ER.

  • Oct 30 '12

    It's not that bad, honestly! I took it while in nsg school and passed easily w/o really studying for it beforehand.

  • Oct 28 '12

    Quote from 7feetunder
    thanx.we've been taught so..and the using of non-PVC bags if more than 2 hours is new to me.Thanx a lot.I've seen Amiodarone 150mg diluted in 50cc N.Saline over 0.9% and run over 10 minutes during my clinical.Being curious,I asked more than 5 staffs workin in ED and they give me the same answer.Can be diluted in N.saline.I just wont believe it.
    It absolutely can be diluted with NS. That is how to administer your IVP dose in a code.

    Maintenance doses need to be mixed in D5w.

    The question is whether the initial loading dose of 150 mg can be mixed in 100 ml ns, as it often is.

    According to Davis: No.

    * Direct IV:

    Diluent: Administer undiluted. May also be diluted in 20-30 mL of D5W or 0.9% NaCl.
    Concentration: 50 mg/mL.
    * Rate:
    Administer IV push.
    * Intermittent Infusion:

    Diluent: Dilute 150 mg of amiodarone in 100 mL of D5W. Infusion stable for 2 hr in PVC bag, or use pre-mixed bags.
    Concentration: 1.5 mg/mL.
    * Rate:
    Infuse over 10 min. Do not administer IV push.
    * Continuous Infusion:

    Diluent: Dilute 900 mg (18 mL) of amiodarone in 500 mL of D5W. Infusion stable for 24 hr in glass or polyolefin bottle.
    Concentration: 1.8 mg/mL. Concentration may range from 1-6 mg/mL (concentrations >2 mg/mL must be administered via central venous catheter).

    Despite that, I believe it is a fairly common practice.

    Let's say you are working a code, and getting drugs ready. Patient is a 10 kg baby. In anticipation of needing Amiodarone, you draw up 50 mg in 30 ml ns, and have at the ready for 10 minutes. 1.66mg/ml. (while this is not how I would draw it up, it would be within the guidelines.)

    In the next bed, is a more stable guy getting a maintenance gtt, starting with a loading dose. 150 mg in 100 ml ns. 1.5mg/ml.

    Similar concentrations for similar duration. The baby gets Amiodarone diluted with normal saline.

    It is not always clear why a manufacturer makes certain recommendations. Lovenox in love handles for example: " Alternate injection sites daily between the left and right anterolateral and left and right posterolateral abdominal wall."

    This makes no logical sense. Why not anterior abdomen? When I asked a Lovenox rep about this, I was told that since the initial studies were done using the sides, that was the recommendation. Absolutely no pharmacologic reason to do it.

  • Oct 28 '12

    You can have these incompatibilities in general

    1 Physical ..this is when you could see physical changes such as in a precipitate or turbidity in the solution...and color change..things of that nature

    2 Chemical You may not see anything but the drug may not work at all or as may inactivate the therapeutic effect that is desired and even create a different agrnt that may be toxic. (think back to chemistry)

    3 Therapeutic This is when unfavorable or undesirable reactions occur in the patient b/c as a result of incompatible medications being administered. This can include any routes

    The following medications have a known hx of incomaptabilit issues to name a few: Dilantin,Valium,Electrolyte additives(ie calcium) Flagyl,the antifungals such as amphotericin ,TPN and PPN solutions,propofol,and other fat based drugs

  • Oct 8 '12

    Your story gave me chills. I will challenge myself.
    Thank you