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Discussion

Emergency critical thinking

During emergencies on my floor I always feel like the one who is running for needed supplies but I can never in the moment be the one calling out orders. Even if it's my patient, I kind of freeze and just listen to what everyone else needs. I feel like I need some help with my critical thinking during emergency situations, I've been an RN for 2 1/2 years so not super new nurse, I just kind of feel embarrassed about how I react compared to some other coworkers who know what they need and know what to do.

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    • Featured Replies

    If you have a patient thats very ill reheorifice in your mind what might go wrong. Check to see that you have the equipment or that you know where it is if you need it. Gradually you'll be the one with new ideas, don't be worried if you arent right now. Being level headed and contributing is pretty valuable too. You'll notice sometimes the ones shouting out orders aren't the people that actually get things done.

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    • Expert

    Hello,

    As a new grad in the ER and an RN now over 14 yrs, 10 of those ER,  here are my recommendations:

    1. Every single patient you have, run through the worst case scenario differential diagnoses for their complaints. E.g. lower abd pain has an endless differential but worse case scenario,  volvulus, SBO, Abd perf, etc.

    2. If you take care of trauma patients,  educate yourself on differentials here as well. E.g. blunt force trauma MVC would be pulmonary contusion,  cardiac contusion, sternal fx, rib fx, hemo/pneumo, aortic rupture, etc.

    3. Get a critical care app that runs through code scenarios to practice

    4. Always carry your ACLS algorithm cards on your person until you know them by heart. Also, if you haven't taken ACLS, do that first ?

    5. Make sure your rooms are prepared for the worst at the start of your shift. For instance, ensure you have ambu bag (age appropriate size), 02, age appropriate ekg leads, working defib, know where and what's in your code cart ( and HOW to use), exp dates, how to open code drugs quickly and accurately,  etc etc.

    6. Before an emergency memorize your primary and secondary assessments so that in the emergency you can mentally run through every crit care aspect of the situation,  (hemorrhage? Airway (clear, protected?), breathing (even, adequate, 02?), circulation (2 patent IVs, pulses?), etc. 

     

    7. Know and memorize your critical care drugs, doses, drip rates

     

    Hope this helps you. We are rooting for you 

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    • Author

    Very helpful, thank you ❤️

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