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Discussion

ED basics, as if there was such a thing...

Hello all,

I'm a Level I (of IV) nursing student in a BSN program interested in working in an Emergency Department.

Obviously I've got a long way to go before graduation (May '13), but I was hoping some of you who already have experience working in the ED could give me a few topics that I can research on my own time to advance my learning.

I realize you see everything from bunions to brain damage, but I was specifically looking for the most common critical cases you encounter. For example, if someone presents with chest pain, you would do X, Y, and Z and I need to know about drugs A, B, and C.

What are the most common, but critical cases you see regularly, and what drugs do you administer frequently? Chest pain, trouble breathing, stroke, MI, gunshot or stabbing, other?

Thanks for your time and replies.

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    • Featured Replies

    Study ACLS to learn what to do for chest pain, and really ACLS applies to all trauma care, the focus is keeping the heart pumping and the brain oxygenated.

    You don't have to take the class or test for ACLS licensing if you don't have time for it now. Just learn what you can for your own knowledge.

    There are also several trauma certification courses, again you don't need to take the course, but you could study the books on your own.

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    CP =02,Monitor, IV, ASA, NTG Every time.

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    Oh wow. There is so much. The topics I would google are Rapid Sequence Intubation tools and meds (usually Succs. and Etomidate), Cath lab activation (2 to 3 large bore IVs, Oxygen, Ekg, Monitor strip, heparin bolus and drip, Nitro drip (unless inferior MI), Integrillin, Plavix, Aspirin. What to do in traumas (2 large IVs, warm fluids, watch c-spine...) Google TNCC for this info. Conscious sedations. Different meds for it Ketamine, Versed... Last meal, crash cart... SVT treatment. Just know ACLS protocols. Know that with allergic reactions start IV right away and prepare to give drugs like Benadryl Solumedrol and Pepcid. Your ER may use different meds. Start making notecards. It helps. Get comfortable operating your bedside monitors and defibrillators. Know how to set up CVP monitoring and Arterial lines. It all takes time to learn. I hope this at least helps you get started on what to study.

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    CP =02,Monitor, IV, ASA, NTG Every time.

    Don't forget the morphine.

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    CP =02,Monitor, IV, ASA, NTG Every time.

    If by "NTG" you mean Nitro. We were taught in EMT school yes everytime. Unless they had taken any Sexually Enhancement Drugs a prior number of hours before. Not sure if that applies to nurses or not. BUt i thought i would just say it.

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    Yeah, we want to know about the viagra, etc. Always know the bp before giving nitro. Don't give if hypotn. Are they allergic to asa? Did they already take any?

    We move fast, really fast. But never in a rush. Think before you act.

    I would suggest getting a part-time job as an er tech. You'll see everything that goes on and get a foot in the door to boot. About half of our techs are nursing students and they pick up a lot.

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    • Experts

    Just a couple of ER pointers here:

    - never conclude that someone is what we old folks called "turkeys"; not sure what they are called today; A turkey was a pt we thought was being melodramatic. Such people were screened out of the acute care ER and were sent to the Clinic instead. Some nurses would take one look at a patient and decide, before VS, before taking of a history or even hearing why the person had come to the ER, to screen them to the Clinic. Don't do that. Always, if you are the triage nurse, get VS and hear the person's reason for coming to ER before deciding his/her disposition. Some nurses who screened lazily had many pts sent back from Clinic to ER.

    - when you don't know what else to do, do VS. It will give you a moment to look at your pt, employ touch, and think of your next step.

    Common ER happenings:

    chest pain

    hypertension

    abd pain or other GI symptoms (vomiting, diarrhea, blood in stool, etc.)

    respiratory issues

    pelvic pain/urethral or lady partsl discharge

    difficulty urinating, blood in urine, urinary frequency (dysuria - this might be a good item for you to study in depth, as numerous nursing home residents develop UTI (urinary tract infection) and are sent to ER because the diagnosis wasn't made at the nursing home.)

    change in neuro status

    paralysis or paresis (weakness) of limbs, difficulty speaking

    dental problems

    trauma (motor vehicle accidents, shootings, burns, stabbings, falls, lacerations, fractures, police dog bites, & many more)

    fever, cough, sore throats, other ENT c/o

    mental health issues - psychotics who've been off of their meds;

    suicide attempts - do not stand in judgment of the suicide attempt folks - you have no idea what drove them to it or how horrible their lives might be or how you would survive if you had their problems; I've heard too many hospital workers make fun of them or c/o about having to do all this work for someone who doesn't value being alive.

    drug addicts either withdrawing, under the influence, or drug-seeking (This is a good one to study, too. It is very common, very dangerous to staff, very sad.)

    infants, children who might have been abused or who are ill/have suffered trauma (non-abusive)

    chemical exposure

    hypothermia (now that it's winter)

    women in labor

    cancer pain

    You probably know that lots and lots of people go to the ER with c/o that should really be seen in a doctor's office, or even just cared for at home. Don't hate them. Just be glad you are able to help. And be glad you don't have to use an ER for non-ER problems. No, you do not have to provide blankets, food and drink, etc. for all of their relatives.

    I'm sure there are a lot more cases that you will see, but these are the ones that came quickly to mind. Just think of the body's systems - circulatory, gastrointestinal, renal, and so on - and of the various classes you will take - Medical and Surgical Specialties, Mother and Baby, Pediatrics, etc. and you will be able to think of many health problems that you will see.

    I wish you all the best in your studies and your chosen profession. It is honorable and you will be a blessing to so many other people. Don't put yourself in danger. You want to go home safely after every shift. You won't be able to help anyone else if you don't take care of yourself first. God bless.

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    • Author

    I'm not sure what every abbreviation meant, but I've ordered my first book and my Google machine is on fire! (It will be a busy semester break.) Thanks everyone for your replies, I appreciate you taking the time!

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    CP = 12lead ECG, line and lab (iv and pull stardard labs, we call it a rainbow), O2, asa (aspirin), nitro (remember only one not the whole bottle), monitor, CXR

    Syncope = 12 lead, line and lab, Accucheck (bedside blood glucose), CT

    Abd pain = 12 lead, line and lab, UA

    DKA = 12 lead, line and lab x2, Accucheck, foley, fluids

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    Hi, try to get a job as a tech in the er even just for a couple of months, or an internship. that's the best way to get an idea first hand of what you'll need. The best prepared nurses for working in the high paced, high pressure environment of an ER are those that have worked as techs in my experience. As a new nurse, you have so much to take in and so much to remember it can be overwhelming. Just getting a taste without the responsibility can be very helpful. Good Luck with your career. Karen

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    i agree get a tech gig ifyou can. also consider trying med surg or telemetry after nsg school if you are unable to get directly into the ER. it will prepare you for the hustle and bustle.

    and chest pain is a big thing in the ER . EKG vitals are always a good start. but not all chest pain people are the same.... sometimes nitro will do much more harm than good depending on what the underlying patho physiology of the patient is. and pumping up a blood pressure with intravenous fluids can in some instances, create a whole new set of issues. but thats for the 'floor nurses ' to deal with once you get the birds relatively 'stable' and up to the floors.:coollook::D

    but thats above board for your question. just some food for thought like one poster said 'not everyone is a turkey' remember that. especially when your 90 year old grandmamma comes in at midnight because of a horrible 'toothache'

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