A question for all you ER nurses....

[TigerGalLE]

I'm just wondering how nurses chart during a crisis situation. When there is a trauma, who keeps up with what is done and not done? And who documents? Is there one person assigned to keep notes of everything that goes on? It just seems like it would be impossible to keep track of everything.

Oh and FYI I'm a medsurg nurse that has been watching too much Trauma: Life in the ER....

Please help me subdue my curiosity!

[E.R. Rookie]

The primary nurse charts. Primary meaning whatever nurse is assigned to that room. You would be amazed at how quickly all the tests can be done with 5 people in the room. We call a priority one and all available nurses and techs are to go to that room. After 5-10 min the primary nurse is left with the patient but with all blood drawn, lines, foley, ekg, and whatever else.

[E.R. Rookie]

I have a question too. What do you document in a code situation? What needs to go in that chart? I ask because what if I'm thrown to the wolves during clinicals.

Everything you see! There is a flow sheet that is very easy to follow in my ER where you just make check marks by the drug. I chart like a maniac. Chart on the defense!

[JessicaSN]

In my ER there is a designated person who is the "scribe" on every shift. It is written on a dry erase board that also shows who has what rooms.

I am scribe a lot because I apparently do a good job (so I've been told). We have trauma paper work and separate code paper work. Once you do a trauma or a code a few times you get the hang of it. The scribe in my ER is also kind of the "leader" and can tell people to be quiet if it's getting too loud, ask the doctor for clarification if something isn't understood (so you want Morphine 4 mg, is that correct?), and also should be on the ball if the doctor asks a question (How long ago was the last Epi given?). The scribe in a trauma has to pay attention to what all staff are doing the entire time - it can be pretty stressful!

[PostOpPrincess, BSN, RN]

I use the 2 inch tape method. Always works.

[taz628, BSN, RN]

while my hospital has gone completely electronic for charting, traumas (and codes) are different stories. we're a level 1 trauma center (like the ones on TV) so we get our fair share of traumas. We always have a primary nurse (or TRN1) and their main responsibility is chart on our trauma flowsheet. It's a bit confusing to get to used to where everything is on the paper, but once you finally (!) memorize it, it's super easy to use. If staffing permits, we assign a TRN2 or circulating nurse to the trauma bay, otherwise that nurse is temporarily pulled from another assigned area. That job entails mostly staying at the head of the bed - getting the monitor on, checking all IV sites, placing additional IVs, administering meds (which the TRN1 may prepare if there is time, charting is priority!), and grabbing equipment for the docs. After the trauma is settled and back from CT (which is adjoined to our trauma bay, xray has a portable boom system in our bay as well) the TRN2 goes back to the previous assignment or floats the department while the TRN1 stays with the pt until transfer out of the ED to an inpatient unit. It's fast, it's fun, but it can be messy. I pride myself on uber neat handwriting - but that all disappears when I'm TRN1. :) Oh - and our TRN1 always travels with the pt to CT or MRI with the pt remaining monitored. We're fortunate to rarely need to send the trauma pt very far for tests. If they go to the OR emergently... hopefully you're up to date on Q5min VS and have your brief nurses note written so you can hand off the paper work with pt. :)