Emergency Room Rotation - HELP!

kasperas, BSN, RN · Jan 4, 2011

You will probably be doing a whole lot of observing - legally they can't have you doing anything you aren't licensed to do yet or haven't been educated on first in a classroom. It is really important that if they ask if you want to do something you have never done before you tell them you would love to, but need to be walked through it because you have never done it before. Also, not a whole lot of surgeries happen in the ED, but if they ask if you want to go to the OR to watch it is worth the experience. Have fun!

netglow, ASN, RN · Jan 4, 2011

IDK about assisting in the OR :rolleyes: I was invited by surgeons to be tableside scrubbed in several surgeries including CABG/Valve but I did not touch nothin!!!!!! But, I was allowed to bring my patient up to ICU after that one with the anesthesiologist, and then I got to work on this patient with my assigned preceptor in the ICU (which was nursing stuff not surgeon stuff... hint). This was in my 4th semester preceptorship.

As a nursing student in the ER, I got stuff for people when they called out, I got to observe, take vitals, help hookup to monitors, run strips, etc. And, do CPR. I guess I'd say, know when and how you can help and know when you cannot and should get the heck out of the way. It's probably quite similar for an EMT.

VICEDRN, BSN, RN · Jan 4, 2011

I would say pay close attention to the interaction between EMS and providers at the hospital. You will likely observe the following:

pts often given conflicting reports regarding history to EMS and to RN and MD. note the "tricks" people use to combat this problem. For example, interviewing pts regarding hx can yield information re medications. (Another: I write down their vital ranges so I can compare to my own) It behooves you to learn from this.

Note also how EMS report can and cannot give an accurate presentation of the patient's condition upon arrival.

note what types of things will prevent the patient from going to fast track or triage. (back boards, ivs, etc)

note how long it takes to obtain diagnostic scans, labs and advanced interventions like central lines. I used to be in EMS and my brother is an EMT I. It still amazes me how much I *thought* the hospital could do for the patients when really the best interventions can be done pre hospital. (AIRWAY AIRWAY AIRWAY)

note how EMS and hospital providers focus on similar and different interventions. note which one you philosophically agree with.

since this will be your first exposure to the emergency room, note which patients walked in and which came by EMS. Note how care is prioritized by RNs, MDs and resp therapist. Try to figure out what is causing the forever shifting priorities.

attempt an IV if permitted. (watch a few first). Provide extra set of hands whenever present. ER people are not shy. You will be asked to help or told to move. don't take it personally.

and finally, have fun!

ImThatGuy, BSN, RN · Jan 4, 2011

patient assessment, vitals, watch how EMS transfers their patients to the ER staff, you might get to do some bandaging, set up oxygen adjuncts....

watch whatever you can watch in the ER...IVs, injections, suturings, I&Ds, splinting, bandaging, codes and traumas if you get them....

I remember my 24 hours in the ER when I was an EMT student ten years ago. Fun times. Basically, I'd walk in, announce my presence, look over the charts that were there, look at the computer screen to see what was in the waiting room, and then go talk to patients, do the assessments, and whatever a nurse or doctor might let me do. I tried to glue myself to the doctors, and they didn't mind. I was young and eager then. I'd be less enthusiastic now quite honestly, but I had fun back then.

ts52 · Jan 4, 2011

Do Not Panic

I've managed an ED for a number of years and we have EMT students all the time--you may only practice the skills you have already learned and should be (I hope) providing some type of documentation to the ED staff as to what skills you may perform, such as vitals, medication administration, IV starts, etc. You must always be supervised when providing patient care.

You did not mention if you are doing a basic class, IV tech or intermediate, etc. so I can't give you specifics--

However--be on time, neatly dressed, wearing your name badge. Identify yourself to the charge nurse when you arrive and explain the purpose for your presence. Be interested--students who want to shadow the nurses and physicians get a lot more experiences than those who sit like a bump on a log. Bring a pen, scratch paper, stethoscope, bandage scissors, etc--whatever tools you have been using in your class and lab.

One2gofst · Jan 4, 2011

I would say pay close attention to the interaction between EMS and providers at the hospital. You will likely observe the following:
pts often given conflicting reports regarding history to EMS and to RN and MD. note the "tricks" people use to combat this problem. For example, interviewing pts regarding hx can yield information re medications. (Another: I write down their vital ranges so I can compare to my own) It behooves you to learn from this.
Note also how EMS report can and cannot give an accurate presentation of the patient's condition upon arrival.
note what types of things will prevent the patient from going to fast track or triage. (back boards, ivs, etc)
note how long it takes to obtain diagnostic scans, labs and advanced interventions like central lines. I used to be in EMS and my brother is an EMT I. It still amazes me how much I *thought* the hospital could do for the patients when really the best interventions can be done pre hospital. (AIRWAY AIRWAY AIRWAY)
note how EMS and hospital providers focus on similar and different interventions. note which one you philosophically agree with.
since this will be your first exposure to the emergency room, note which patients walked in and which came by EMS. Note how care is prioritized by RNs, MDs and resp therapist. Try to figure out what is causing the forever shifting priorities.
attempt an IV if permitted. (watch a few first). Provide extra set of hands whenever present. ER people are not shy. You will be asked to help or told to move. don't take it personally.
and finally, have fun!

EMTS CAN NOT RUN AN IV!!! Starting one could be a good way to stop your career in healthcare right there.

That said, I got to do CPR on a patient when I was doing my ER clinicals, along with a lot of other stuff. Best advice I can do is constantly volunteer. The ER staff will appreciate it a lot and you will get much more out of the experience. On the flip side, if you don't volunteer, they aren't going to ask you and you won't learn a thing.

Have fun!

VICEDRN, BSN, RN · Jan 4, 2011

EMTS CAN NOT RUN AN IV!!! Starting one could be a good way to stop your career in healthcare right there.
That said, I got to do CPR on a patient when I was doing my ER clinicals, along with a lot of other stuff. Best advice I can do is constantly volunteer. The ER staff will appreciate it a lot and you will get much more out of the experience. On the flip side, if you don't volunteer, they aren't going to ask you and you won't learn a thing.
Have fun!

In your state or in mine or in the OPs? In my state, EMTs not only run IVs, they administer medications and give breathing txs and fluids. In fact, most "code drugs" are given before the CPR in progress patient arrives.

In the ER that I work in, we expect EMS to use their judgment and establish an access in appropriate patients.

Sad that I basically said in my post that me and my brother are/were EMTs but you want to tell me what the job is in every state!

ImThatGuy, BSN, RN · Jan 4, 2011

EMTS CAN NOT RUN AN IV!!! Starting one could be a good way to stop your career in healthcare right there.

EMT-Paramedics do IVs.

EMT-Intermediates do IVs.

I don't see how starting one would stop his career in healthcare right there. If he's in EMT-Basic school then he won't do IVs. He knows his limitations. Don't wig out, lol.

VICEDRN, BSN, RN · Jan 4, 2011

EMT-Paramedics do IVs.
EMT-Intermediates do IVs.
I don't see how starting one would stop his career in healthcare right there. If he's in EMT-Basic school then he won't do IVs. He knows his limitations. Don't wig out, lol.

Not to mention that I said start an access not "run" one, whatever "running" an iv line is. (Honestly never heard that expression used.)

Gosh, even said my brother is EMT-I...:)

Guest717236 · Jan 4, 2011

At a cardiac arrest, the first procedure is to check your own pulse.

(from The House of God by Samuel Shem)

Just stopping in to wish you good luck in the ER rotation!

ts52 · Jan 4, 2011

EMTS CAN NOT RUN AN IV!!! Starting one could be a good way to stop your career in healthcare right there.
I'm sure you're just trying to avoid an issue for the student, but please be careful in statements like this that are not accurate.
As the OP noted, EMT IV techs, I's and Paramedics (and their student counterparts) can start IVs with the appropriate supervision --this student should be well aware of what skills they have practiced and are expected to perform during their clinical time.