CEN's and experienced ED nurses I need your help!

[TaoMedic]

Hi everyone,

I am a Paramedic/RN and I'm working on my capstone project. What I need to know from the experienced nurses is What is the CRITICAL information you need to manage a patient in the ED when the patient can't speak for themselves?? In cases when patients are unable to communicate due either to language barriers, developmental delays, dementia, pediatric patients, trauma patients, etc what are the key pieces of medical history, medications, family history etc that you need to know? What are the Zebras you need to know, like wolff parkinsons white??

I really appreciate your time and help in this!!

[Lunah, MSN, RN]

Allergies is nice ... seems simple, but dang I hate loading up an unconscious sepsis patient with abx, for example, not knowing if there's going to be another issue from it.

[Medic2RN, BSN, RN, EMT-P]

Past medical history is nice too. You have to look for the horses before the zebras.

[dthfytr, ADN, LPN, RN, EMT-B, EMT-I]

WHY the patient is unable to communicate, in other words what their baseline is, and is their baseline differant from what I'm seeing in the ER?

[Nursing_Chic]

before I try to figure out anything diffcult I always looked out for medical alert tags/necklaces/bracelts. I even have seen young aduls wear them around their ankles! (hard to find but understandable) I like the know past medical hx. mostly to know if that is a common mental status for them to be in or is that a new symptom.

[MassED, BSN, RN]

unconscious trauma patients, for instance... not knowing anything, which is likely, especially if they're from an MVC. Likely EMS states just the accident scene, who was on scene, who survived, and might grab their wallet, but likely not, since the police will be around for that.

SO, in the very likely scenario of an unconscious patient where you have absolutely NO information you care for what you have: their hemodynamic status, vital signs, obtaining tests to determine what is the cause of their altered mentation. You look for any other trauma related injuries, even those you might not suspect, which is why trauma CT's are done. You go from head to toe in your assessment, front and back as well. Check every system, but checking those that might have an imminent threat to life - head, chest, abdomen. Obtain an EKG, send labs, insert foley, send urine. Check Glasgow coma in that secondary assessment. That's pretty much all you can do - obtaining information on the patient often comes while all of these things are in motion - either from EMS or police or visitors/family who offers up some information. The most helpful information is medical history, meds, and allergies.

[Esme12, ASN, BSN, RN]

It really depends on the situation...in a trauma.....seatbelt? LOC? windshield encroached? vehicle damage...encroach in to the compartment. extracation time....Passenger? driver?

full arrest Down time? drugs given? History? allergy?

HOw detailed are you needing? where are you going to? secondary survey? interventions?

[imanedrn]

WHY the patient is unable to communicate, in other words what their baseline is, and is their baseline differant from what I'm seeing in the ER?

I love when the oncoming nursing home sends a patient for AMS. Then the family arrives and asks why the pt's here.

"Because they're confused, right?" I ask.

Family, "No..."

Baseline is SO important!

[Larry77, RN]

How about a name and birthdate? I don't know how many times I've had crews tell me, "We just scooped him up and brought him here...there should be family coming".

If I have a name there is a good chance they're in the system and I can get something.

I think the experienced nurses want the basics because we will figure out all the details later and they usually don't change what we are going to do for the patient right now. It's the newer nurses that are asking all the irrelevant questions :-)

I think that allergies, basic medical hx, what events led to how you got the patient, and a damn NAME are the biggest things we care about.

[murphyle, BSN, RN]

I'm a big fan of the AMPLE rubric: Allergies, Meds, Past history, Last PO intake, Events leading to presentation. Simple, clear and covers just about everything I need to know in a Priority I/Resus situation. The rest I can either obtain myself on assessment or find out later from family, records lookup, etc.

Other critical factoids include patient's weight, either actual or estimated (docs can't order weight-dosed meds without it), anticoagulation status (another critical item for OR/Cath Lab), and what if any care the patient received prior to arrival.

Hope this helps!

[edmia, BSN, RN]

Ok. First of all assess the situation.

1. Life threatening? Go with your basic trauma care -- A,B,C,D,E,F, etc.

2. Routine ED visit? you have more time and can take a look at the available data on the patient either from other ED visits, next of kin, nursing home reports, medical tags the patient may be wearing, etc.

And lastly, if no information is forthcoming, you do your best to take care of the patient to the best of your ability.