Emergency situations: what do I do???

cmo421 · Oct 3, 2007

A B C's

Airway_ give O2,always,no hesitation if pt is in distress.

Breathing- High fowlers,listen to them,call for assistance as u r doing these. Get a doc ASAP. If pt is awake,try and calm them by being calm, more anxious the pt is,more O2 needed.

Circulation- If they stop breathing or HR drops/stops, follow policy,iniciate code,get help!

Preemienurse23 · Oct 3, 2007

ALWAYS follow your ABC's. If you lose your airway, or you can't maintain it, nothing else matters. You can place O2 on a pt if they are in distress, when you call the Dr, they are probably going to ask if they are one some or order it. Never leave your pt unless you absolutely have to, get someone in there with you as fast as you can. Yelling usually does great! (I had one of my infants extubate and yelling brought 2 more nurses immediately!) And try not to panic, try to remain calm, you will think better, and it helps keep your pt calm.

And speaking from the point of a new nurse, NEVER think you know it all or can handle it all by yourself. Even the experienced nurses call for help in these situations. Right now, I still rely on my experienced nurses to help me, but they may not always be right on hand. Luckily I have had only emergency, and my first thought (after the pt) was to get help in there!

CRNAorBust · Oct 3, 2007

HiThere!

I know exactly how you're feeling. i had the same issues when i first started. In fact I'm still dealing with them. It's not always easy to know when you're patient is in trouble. But here's some tips I've picked up so far.

NEVER leave your patient once you feel they're in trouble. Ring the call buzzer and tell the secretary to get another nurse or the charge nurse in there with you. And then always make sure to take vital signs to see how bad the patient is really doing. If they are complaining they can't breathe, yes you can put them on O2 but be sure to monitor their O2 sats till they stop feeling scared and are able to breathe better on their own. You can also ask another nurse to pull out a Neb treatment for the patient if they are allowed to have that. If the O2 sats are going down instead of being stable again get a neb tx but make sure another nurse is in the room to monitor the patient. And if the patient is not feeling better and or the O2 sats are still not up there call RRT (Rapid Response Team). This will also get a doctor on the floor in a hurry. Tell everyone what went down (try to remember TIMES) and if the patient happens to get worse from there you have experienced people there to help. And then YOU can go call the doctor and or the RRT person will tell you that maybe this patient needs to be in a critical unit.

In the case of a patient whose mental status has changed this can be a little bit trickier. Why is the patient there? Do they have liver problems? Encephalopathy? That would change their mental status.....Call the doctor! Are they diabetic? Check the finger stick! Do this FIRST! if its low and the patient doesn't have an order for D50 ampules, go into the pyxis and pull it out by selecting Override! BUT check to make sure the patient has an IV. If they don't then THIS becomes the priority and get help from another nurse, either the manager or the charge. two people need to try for a line so whoever gets it first can put the d50 in. I had a patient who had BS of 29 and they were fading fast. Had several people trying for a line and RRT had already been called. If its lower than 50 and the patient is very symptomatic call RRT right away. Push the D50 slowly because it can blow an IV easily. And you don't need a complete line put in and have it looking pretty either. Just get that hub in and push the D50.

Next case. What if your patient isn't responding to you. If they're history says they're cardiac, get vitals ASAP, if they they are on finger sticks, get one ASAP. If the vitals show low BP call RRT WHILE you are staying with the patient. Keep taking vitals and call for another nurse. You'll need someone to get you a couple of liter bags of NS in case someone wants to put in a bolus 500cc of fluids.

Always be able to tell someone if the patient is DNR/DNI, and what happened to make you call.

Hope some of this helps. IT takes a while to get your legs about this stuff. I have had problems myself in the beginning. Being 50 as a new nurse seems to have given me a bias as to when to call for help. So I have had issues with this and I'm still trying to deal with them. Hang in there if this get to hairy try different departments that use RRT less than say a med surg floor does. I am moving to Hospice myself at this point to try and minimize my exposure to such situations.

All the best....

Daria5363 · Oct 3, 2007

May I just say.... THANK YOU!!

You have no idea how much that just helped me!

ABCs are the most basic and fundamental parts of healthcare and I honestly (and shamefully) would've totally forgotten all about them by panicking in this situation. My frame of mind up until now has been NCLEX strategies (ABCs, Maslow, Erikson, etc) that I completely forgot about applying that to real life! If I saw an answer about ABCs on a test I would pick it, but I'm so in multiple choice/NCLEX mode, that I would've had no idea what to do in real life!!

:idea: I guess that just says a lot about how students get so absorbed in NCLEX, that once they pass, they have no idea how to translate what is on paper to real life.

Oh, and I'm printing these responses out an memorizing them. I don't EVER want to forget this!!

jjjoy, LPN · Oct 3, 2007

I agree that such emergency basics should be explicitly taught in nursing school. I know they weren't in mine. I guess they figured we'd all taken the required CPR for health professionals course and that was enough.

We had "side rails up" "turn, cough, deep breath" "assess for pain" pounded into our heads, but what to DO right then and there if your patient suddenly is struggling to breath or some other emergent situation like that? that wasn't nearly as emphasized as other points in school.

Dixielee, BSN, RN · Oct 3, 2007

Great advice so far. I will just add....know where your emergency supplies are kept so you can get to them quickly. Know how to use an ambu bag, suction and different delivery systems for oxygen. Just those few things will get you thru a world of problems.

If the patient is really getting into trouble quickly,, don't fool around with a nasal cannula, go to a non rebreather mask, and don't forget to crank the O2 flow meter up to at least 10 liters so you can fill the resorvoir bag. If you put the mask on a pt. and do not provide enough flow, your patient will not be getting any O2, and might as well have a plastic bag over his face.

Know how to quickly set up suction if it is not already set up in your room. Set it up quickly, turn it on to high constant suction and have the tubing with a yankaur(sp?) connected in case the patients loses consciousness and vomits.

If you don't have an IV established, get one in ASAP for fluids or meds.

I know that sounds like a lot, but they are basic things that can be done in a matter of minutes IF you know where your supplies are and how to use them.

Vital signs are important, but not as important as "How does this patient look? His vital signs may be fine at that moment, but is he struggling to breathe? Has his color changed? Is he anxious or confused? Does he feel dizzy or "about to pass out"? Is his skin cool, hot, wet? Can you hear him breathe across the room? Does he have the feeling of impending doom?

If you have a patient who is looking really bad, and they say they feel like they are going to die....believe them! They probably are. But you want to intervene and stop the process.....

A quick way to check circulation is to check capillary refill. Squeeze the thumb nail and see how quickly the color returns. It should be within one to two seconds.

There are many things you may need to do in an emergency, but stick with the basics as mentioned already...ABC!

In the mean time, have someone call the doc, RT, EKG, etc. to get things moving while you are stabilizing them.

You are about to enter the scariest, but hopefully most satisfying career you can have, Good luck, and keep asking questions.

HopeItWorksDNP · Oct 3, 2007

Never, ever let someone downplay your instincts: If you think "there's something wrong with this pt" there probably is. I've managed to stop a few pts from crashing just by following my gut instinct that "something isn't right" and keeping an extra close eye on them. There will be times when you know something is wrong, but you can't pinpoint what it is. V/S will be okay, O2 sat fine...nothing you can use as proof or sign to call the doctor over. Sometimes its just a "feeling" you get about the patient right before they go bad. Follow your nurse's gut in these cases and pay close attention to this pt. You'll regret it later if you don't.

grammyr · Oct 3, 2007

I second all the above advice and have a couple of things to add:

1. Don't panic because if you do, the patient isn't going to get any better and you will be of no use to anybody.

2. Know as much as possible or have the chart handy by the time the RRT gets there. They will depend on you for the answers.

3. If all else fails, refer to #1.

Neveranurseagain, RN · Oct 4, 2007

Ask your hospital to offer a what to do in an emergency/code class. Not a ACLS class but one that offers real guidelines on what to do when hell breaks loose. I used to teach CPR/BFA classes and at the end I usually did a emergency class and covered what to do in the first few min. I was surprised at how many RN's had never turned on an 02 tank or knew how to assemble a BVM, attach 02 and bag in a SVN. (I did have one fellow paramedic I was working with that poured the Proventil solution down the ET tube-before I could stop him-then bagged the pt afterward!)

Another hospital I worked at would hide the cpr mankin somewhere and when you found him it gave S/S and you would have to call out to the staff and simulate treating him..it was good practice. But I do remember stuffing him back onto the clean linen cart one busy day for someone else to find...

Drysolong · Oct 4, 2007

Ask your hospital to offer a what to do in an emergency/code class. Not a ACLS class but one that offers real guidelines on what to do when hell breaks loose. I used to teach CPR/BFA classes and at the end I usually did a emergency class and covered what to do in the first few min. I was surprised at how many RN's had never turned on an 02 tank or knew how to assemble a BVM, attach 02 and bag in a SVN. (I did have one fellow paramedic I was working with that poured the Proventil solution down the ET tube-before I could stop him-then bagged the pt afterward!)
Another hospital I worked at would hide the cpr mankin somewhere and when you found him it gave S/S and you would have to call out to the staff and simulate treating him..it was good practice. But I do remember stuffing him back onto the clean linen cart one busy day for someone else to find...

Hi, I think I know, but would you please define BVM, SVN, & BFA?

Thanks,

Neveranurseagain, RN · Oct 4, 2007

BVM= bag valve mask, commonly known as an Ambu bag, used for pt. not breathing.

BFA= basic first aid--something some RN's don't know or have not kept current on

SVN= small volume nebulizer, also known as a breathing tx where areosoled Ventolin is inhaled into lungs--used for asthma to help open up the bronchioles and increase 02/C02 exchange.

Glad you asked, it is better to speak up and ask for clarification than to try to muddle your way through.