ER Consolidation

[Regent138]

Hello,

I'm a 4th year student and I will be doing my final placement in the Emergency Department next term. I am really excited for this placement, and want to study up on some information and prepare myself over the christmas break before I head into next year. I would really appreciate suggestions from anyone about things to know before I begin!

[turnforthenurse, MSN, NP]

What kind of ER will you be working in? Is it a designated trauma center? Will you also be seeing pediatric patients? ERs have different patient populations and therefore will see different things. The ER I work in is not a designated trauma facility so we almost never get that kind of stuff, but drugs seem to be a big thing here along with your other typical ER stuff:

- MI

- CVA

- Shortness of breath

- Abdominal pain/N/V/D

- Pain (such as back pain)

- lady partsl bleed (typically if they are >20 weeks they go straight to OB unless there is compromise in ABC's but it depends on your hospital's policy)

- Sprains/strains/broken bones

- Fever/Sepsis

- Overdose

- Falls

There's a book called Fast Facts For The ER Nurse that really helped me when I was a new ER nurse. It's short and to the point and pretty much tells you what types of tests/labs to anticipate for whatever the patient is presenting with. So for example, for chest pain you'll anticipate at least a 12-lead EKG, troponin, CBC, CMP, IV/O2/monitor, chest x-ray, aspirin & nitro (morphine is reserved for CP not relieved by nitro). For abdominal pain, anticipate at least IV/monitor (especially in women and elderly - remember your atypical signs of chest pain!), UA/pregnancy test, CBC, CMP, pt NPO and imaging studies depending on what the patient presents with (abdominal XR, abdominal CT, ultrasound). Then also depending on what the patient is presenting with, you could anticipate other things - serum amylase/lipase, blood cultures if febrile, guaiac stool if they are c/o rectal bleeding, IV fluids, nausea/pain meds.

Be sure to know your cardiac rhythms. You don't really need to know how to read a 12-lead EKG other than recognizing the rhythm but for the purpose of this clinical you don't need to spend time learning about axis deviation and that other stuff. If you want to get ahead of yourself, you can learn to identify different types of MI on a 12-lead: Myocardial Infarction - ECGpedia

Good luck!

[emtb2rn, BSN, RN, EMT-B]

You will see the er nurses do assessments quite a bit differently from what you been learning in school and practicing in clinical. Not shortcuts but rather very focused.

And in that vein (no pun intended), don't correct a nurse with "but that's not how they taught us", especially in front of a pt. Hold questions until you're alone with the nurse.

Review BLS. You will be doing CPR.

And most important, soak up knowledge and have fun.