ED practicum

Learn the signs of a drug abuser lol. Seriously only about 5-10% of the patients that come through the ER are emergencies. Things to study up on are S/S of MI and acute cardiac symptoms, also abdominal pain and the possible triggers for it. For example Apendix, Abdominal Aortic Anyerism (misspelled sorry), Ischemic Bowel, Colitis, gallbladdar problems, pancreatitis. The two things that get patients admitted the most are abdominal pain and chest pain. Many of these problems are nothing to sneeze at, a triple A can rupture and the patient die before they know what's happening. You will see some kidney stones as well. CVAs are also a good thing to study on. Hope these help!

P.S. Things I have seen come into the ER that you don't need to study on. Sneezing (sneezed 3 times and called the ambulance), physical (figured he hadn't seen the doc in a year and it was time to come into the ER), sun tan, meth mouth, taking the wife's trazadone to go to sleep after being up for a week on meth... made him feel funny, and a few other things lol.

I did my practicum in the ED, seek out as much learning opportunites as you can. I was able to follow a STEMI into the cath lab and observe, got to participate with a concious sedation.

I told all the nurses in the area, not just my preceptor that I wanted to practice my IV skills, so they all would come get me to start their IVs, and if they had anything interesting then they would pull me in to see

One thing that my preceptor told me, was in practicum you are there to learn to be a nurse to learn the skills, when you are hired you will learn the job (as in the paperwork)

Jammin pretty much covered the basics, but since you are seeing peds as well you will encounter various types of fever babies. 95 percent will be simple viral syndromes. A few parents will bring their kid in during a blizzard because he "felt out" at home. You will also learn that no parent in the world owns a thermometer, I'm not sure how the thermometer companies stay in business. The thing you do want to brush up on is septic kids, so you can identify that 5 percent. FIB (fever in baby) under 12 weeks is a red flag for a septic kid.

You also want to screen kids with lower belly pain for appendices. You can do this with the classic rebound tenderness, but another good non-text book clinical test is to simply ask the kid to jump up and down. Kids with an acute abdomen won't jump. You also want to keep meningitis in mind for a kid who only complains of fever, headache and neck pain.

You will also likely see a lot of asthma in kids. You should listen to the lungs of every person you triage. Most of the time you will be giving nebulizer treatments to these kids so this will give you a good chance to learn how to set them up. Also, remember that respiratory is the leading cause of cardiac arrest in children. So you want to do a good breathing assessment on kids. You need to brush up on signs of RSV and pneumonia. You should pull up the shirt of every baby to look at how they are breathing and look at their nose to make sure they are not in distress.

Lately, please, please learn pediatric vital signs and their values. If you work in a mixed ER, you really need to know this and unfortunately many nurses who work in mixed ED's and dread they days they are put in peds don't pay much attention to these differences and it makes that nurse and the hospital look really, really bad.

thx so much for all the helpful advice. I'm very thankful.

Be an ACLS kingpin and know how to throw a good right cross.

thx so much for all the helpful pieces of advice I have received so far. I'm very thankful.

I've asked my instructor about what to do for the first day of ED practicum but I received very vague answers. I've emailed and asked my preceptor a lot of questions and she appears to be a very nice lady. I don't want to annoy her too much by keeping spam-emailing her.

I'm a little worried however in terms of what to prepare for the 1st day of ED practicum. Do you here have any ideas? I'm planning to bring with me my stethoscope, penlight, a small bag, an objective sheet, anything else to add? How should I present myself to my preceptor?

thx so much ^__^

When I did mine I also had bandage scissors, tape, my cheat sheet of normal lab values, different colored pens, and a big bottle of water! Stay hydrated!

Just go ready for anything and follow directions! I loved the ED, it really felt like the RNs were in charge.

Don't forget trauma shears, very useful. I also carry my ipod which has epocrates drug reference. Just be ready to be flexible and expect to be overwhelmed. Good luck!

A good preceptor will not expect too much from you...first shift should really be about observing how the ED works. So my personal advice would be to stay out of the way the first day and ask questions only when it's appropriate (do not interrupt pt care). Most important thing you can bring the first day is comfortable shoes :-)

Skills

Whether you have done a lot of IV starts or none at all, don't worry!! Learning is what the rotation is for! I just want you to be familiar with the procedures so you know how to measure the NG tube before we place it. Don't be nervous about skills, there will be ample opportunities to practice in a safe environment. Review these skills:

IV starts

Venipucture

NG tube placement

OG tube placement (with a ventilated patient)

EKG lead placement

3 lead (red, white, black)

12 lead placement

Foley catheter placement

Straight catheter placement

ABG collection

Medications:

Remember, just a few important points about each. Why would it be used it in the ER?:

Morphine

Ativan (lorazepam)

Epinephrine

Haldol (haloperidol)

Benadryl (diphenhydramine)

Solumedral

Metoprolol (Lopressor)

Nitroglycerine

Versed (midazolam)

Albuterol

Magnesium (what type of dysrhythmia is it used to treat?)

Zofran (ondonstrone)

Phenergan (promethazine)

Cardizem (diltizem)

Dilaudid (hydromorphone)

Compazine

Protonix

Xanax (alprazolam)

Valium (diazepam)

Pepcid

Lidocaine

Amiadorone

Adenosine

Atropine

Dopamine

Propofal (diprivan)

Normal Saline

Dexamethasone (decadron)

Heparin

Lovenox

Vicodin

Percocet

Tordal (ketoralac)

Ancef

Rocephin (ceftriaxone)

Activate Charcoal

Cardiac:

Common signs of an MI

Remember MONA??

What is Troponin? What does it mean if it’s elevated?

Be familiar with the following rhythms:

Atrial fibrillation

What does supraventricular tachycardia (SVT) mean?

Normal Sinus Rhythm

Ventricular Tachycardia

Ventricular Fibrillation

Sinus Tachycardia

Cardiovascular:

What is shock?

What are the four (major) types of shock?

What is anaphylaxis?

Renal:

How do the kidneys regulate BP? (no long patho, just the big picture in 10 words or less)

Common signs of a kidney stone

Hepatic:

How does the liver effect clotting (in 10 words or less!)

GI/ Abdomen:

Common signs of appendicitis

Common signs of cholecystitis

Endocrine:

What is DKA? What are the common sign and symptoms?

Neuro:

Common signs of a stroke

Differences in treatment of hematic stroke vs ischemic stroke

Common signs of herniation

What is involved in a nuero assessment?

What is a Glasgow Coma Score?

Respiratory:

Common signs of pneumonia

Common signs upper respiratory tract infection

Croup, RSV, bronchitis, pharyngitis (we see a LOT of these!)

wow, thx so much for all the helpful and thoughtful advice. I'm so thankful. :)