common situations encountered in emergency room

BrnEyedGirl, BSN, MSN, RN, APRN · Apr 2, 2009

Wow! You're asking for a huge amount of info here! We see everything from ear aches to gun shot wounds. I might have one pt with chest pain, another with belly pain and then a Class I trauma. You chart as you go. If it's a code or a truama we have scribes that do all the writing. As for meds....that would vary depending on the pt and could include anything from tylenol to morpine or Avelox. Spend some time shadowing in the ER to see how it flows. You can't possible learn it before you get there! Best of luck to you.

vintageRXL · Apr 2, 2009

yeah i know.. thanks anyway:)

Medic09, BSN, RN, EMT-P · Apr 2, 2009

EVERYTHING is common in the ER. Every kind of patient; every kind of presentation, every sort of acuity. Anything that EMS encounters or that can come in themselves, we see it. We even get patients from elsewhere in the hospital. Chest pain during a procedure? Send them to ER. Syncope while waiting to check in for surgery? Send 'em to ER. We're the ones that sort it out, make some sense of it, and send the patients where they need to be. If fact, in Hebrew the ER is 'hadar miyun' - the Triage Dept. We're the hospital's 'handyman'; and we do it all pretty well, too! :smokin:

Some charting is on the fly, some we catch up later. Can't let it get far behind, though.

If you look at some other threads like 'what do you do in the ER' and such, you'll see plenty of responses to this.

allnurses Guide · Apr 4, 2009

Every ER has its own flavor of pain meds that are pretty common. In my ER, we hand out Lortab/Percocet like candy, or IV Dilaudid. So knowing your narcotics in general is a start.

Cardiac meds are also flavor of the month, currently ours are the old faithfuls: morphine, nitro, heparin bolus and drip, and integrilin. Support for hypotension, Dopamine. Arrhythmias: amiodarone, lidocaine.

Almost every truama with open wounds gets a gram of Ancef and a tetorifice. Pneumonia is a protocol, usually 3 grams of Unasyn. We give a lot of Rocephin as well.

But remember, there are regional differences, different groups of doctors get to using different combinations. Thoses are just what we use alot

MikeyBSN · Apr 11, 2009

Be prepared. Common situation: "I have stomach pain and I vomited 100 times. When is lunch? Can I get a sandwich before lunch?"

patrick.gines · Nov 6, 2009

is there alot of charting to be done? like charting after the admission?

Larry77, RN · Nov 7, 2009

We do our charting electronically but we use a different system than the inpatient system so we have to double chart the last vitals, I&O, IV starts, Foley, and nurse review any orders that went into the inpatient system before admit. PIA if you ask me...but if we don't at least double chart we don't chart at all...LOL

Trauma's and codes are still paper for ease and more portable (going to CT etc)...

In the ED you are paid for what is charted not what is ordered, so if you don't chart that Foley start the dept can't bill for it even if it was ordered...this is a biggy with management...if your IV gtt was charted as a push you get less money for it...this drives a lot of charting requests from my management team.

patrick.gines · Nov 7, 2009

thanks larry. The problem with the hospital that i am doing my clinical doesnt have advance technology to chart. :lol_hitti

ACRN06 · Nov 8, 2009

I recommend buying some books about ER nursing. Your questions are very broad and are the same ones I had when making the transition into the ER setting. Its good to want to be prepared, theres just no way you're gonna get all your answers on here.

Buy a book.

One of my faves is the CEN Review Manual. Even if you don't plan on taking the CEN for years and years it has a boat-load of wonderful information, and the rationales to explain WHY you do certain things.

There are lots of other ones too... I have at least 5 or so. Do some research and find one that seems to cover what you're looking for.

Cutie29 · Jun 29, 2012

ER is one of the busiest area in the hospital!all the actions,drama,etc. Are there!You need to move,think and write as fast as you can because either you like it or not,you need to finish everything in time!you may not know what will happen next,so better to be fast!charting depends on the institution you will work on with in the future!but for sure,charting is there,either FDAR,SOAPIE,etc.!For know,be the best that you can be!study hard and try to be unique!Remember,competition is very high in our profession!GB

NO50FRANNY · Jun 30, 2012

As other posters have said, you should invest in either a pocket resource or text to get the information that you need as there is far too much information to impart here. But I think that most nurses would agree there some presentations that are more common than others, the thing you need to remember is that we are in the business of ruling out life-threatening diagnoses a good deal of the time, rather than actually making a diagnosis, a substantial amount of patients go home knowing what they don't have, rather than what they do have. So, in critical cases, the idea is to rule out obvious causes (from a physicians point of view).

RESUSCITATION/CARDIAC ARREST = The four H's and the four T's. Identify correctible causes.

Hypo / hyperthermia

Hypo / hyperkalaemia

Hypoxia

Hypotension

Tension Pneumothorax

Thrombus (PE)

Toxins

Tamponade.

Common ED presentations that may evolve to the above problems.

Gastrointestinal: Abdo pain + or - vomiting / diahrroea / haematemesis / malena.

Gynaecological: PV bleeding and lower abdo pain.

Cardiovascular: Chest pain, ischaemic limbs and syncope amongst other things.

Trauma - any kind.

Neurological: ALOC, suspicious headaches, seizures, CVA.

Toxins: Usually prescription medication or illicit drugs.

Potential airway compromise (even from a boring sore throat).

Septicaemia.

Respiratory compromise- asthma, COPD etc.

Psychiatric presentations, from deliberate self-harm to florid psychosis.

Emergency medicine focuses on ruling out life-threatening illness and identifying diseases in early stages to intervene. Chest pain is the bane of my existence. Get that TNI and a reassuring ECG as soon as possible. Abdo pain, especially non-specific abdo pain, annoying and often nothing to worry about. Elderly people are always sicker than you think they are and young people compensate well when they are really sick so their numbers don't reflect it. Generally the patients who look sick, are. Most of the time we can establish fairly quickly whether to worry or not. The trick is to rule out the big stuff first, and often the look and vital signs of a patient will determine this early in the piece. ABC PAIN. In the meantime, we treat the symptoms. A pocket guide will often list off the common causes of most presenting complaints and the routine investigations necessary. The important thing to remember is that although we expend huge resources ruling out illnesses that turn out to be nothing, every once in a while, that 28 year old man who suffered epigastric pain while doing his situps after lunch, will have an aortic dissection and if we didn't do that chest xray he would be dead. Grab an ED medicine guide and start reading!