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Discussion

ER and defibrillators, what the deal?

Hi, I'm a student nurse entering into the third year of my BSN. I've watched NBC's ER for quite sometime and can't help but notice that almost everyone who comes to the emergency room has to be defibrillated at least five times. From migraines to an actual cardiac arrest, it seems as if there are few things that several hundred joules of direct current to your chest cavity won't solve. Medication error? Grab the paddles. Feeling faint? Threehundred...charging...clear! So my question to all you ER nurses is how often do you have to use (and is an RN allowed to use) this drama enhancing, yet universally life-saving device? Another question I have (and perhaps the real reason for this post is) how do you like working in the ER? I like a faster-than-average work pace, and am thinking of ER work. Thank You!

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  • Experts

In TV land, drama is good! I don't work ER now, but that's where I started. University trauma center equals fast-paced excitement and lot's of good experience and my first burn-out.

I started in ER as a new grad on night shift. I loved it, but you can get burned out very easily. As far as defibs go, I probably used them maybe 10 times in 3 years. It depends on the cardiac rhythm. I suggested reading the ACLS manual if you are interested. Most of the time in the ER you usually see the "citizens" and the coughs/colds/non emergency or the HTN CHF pateints. A lot of patients are real train wrecks! If you re interested in ER, make sure to do a preceptorship, or even work as an aide until graduation. It is definitely not for everyone. I am now in grad school for family nurse practioner. LOoking froward to the weekends and holidays off :)

dkv

  • Experts

Have worked level one trauma center for almost 8 years now - love it. As to defibrillating people - not very often. However, nurses do do it.

TV needs to be dramatic I suppose, but you are right. It does not reflect reality.

its called tv

I'd say I've had to shock maybe 15- 20 patients in the past 3 years in the ER. We finally got the hands free defib where you just attach the pads and push the button- but you won't see that used on TV because it takes away from the drama! Once you've had ACLS and you watch these shows, you'll notice that they shock even when it isn't indicated, i.e. "ooh he's a flat line - shock him!" or there's an episode where a man is laying outside in the pouring rain in a puddle of water and they shock him- not a good idea either. Gotta go with what gets the ratings....

Edited to add: one more thing that bugs me about defibs on TV- in real life I've never seen an MD (excluding synch cardioversions) shock a patient, EVER. It's always the nurse....but in TV Land, you rarely, if ever, see a nurse doing it, it's always the doctor.

  • Experts
there's an episode where a man is laying outside in the pouring rain in a puddle of water and they shock him- not a good idea either. Gotta go with what gets the ratings....

:rotfl::rotfl::rotfl:shock7.gif

The most experience the ER gets is responding to the codes on the floors. In the ICU, we code and especially the CCU, we defib quite a bit, at least one of six shifts, and then it seems ALL night long... when you're breaking out the procainamide... you know you're in for the long haul.! But in NY any ACLS nurse can cardiovert and defibrillate, if under ACLS circumstances

ER also gets quite a few codes in progress from EMS- they just usually don't make it out of the ER into the unit. We do anywhere from 5-15 codes a month just from EMS, and then there are those who code once they've been there. I agree that the units run more codes, but we do get our fair share.

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