ER Preceptorship

[perkygyrl81]

Hi

I'm starting a preceptorship in the ER and feel that im not thinking very well on my feet in the early hours of the morning. Can anyone recommend some resources for emergency assessment and intervention. For example at pt comes in with abdominal pain what do we need to rule out first and what medication and interventions would follow.

Thanks,

[emtb2rn, BSN, RN, EMT-B]

Tbis is the kind of thing you need to talk to your preceptor about. How does your facility handle abd pain, chest pain, mi, cva, od, trauma, psych? What are your standing orders? Line, lab, monitor?

It's critical that you know what is expected of you at your facility.

Good luck, have fun.

[Anna Flaxis, BSN, RN]

This is what your preceptor is for. Your facility should have written patient care guidelines somewhere as well. Ask your preceptor about that; maybe you could study those in your downtime.

[EMcGrady]

Take a deep breath, I did my preceptorship in the ED, ICU, and IMCU You won't know everything and it's better to learn than to go in thinking you need to know everything. You will hopefully have a wonderful mentor and a ot of time to review what you have learned.

[MesaRN]

The reason for your preceptorship is to help you understand how complex the question you just asked really is. Your preceptor is there to help you figure out the questions to ask and focused assessment needed based on the answers to those questions.

An example is that we had a 70 yr old female who was having dinner with her friends, she had an onset of ABD/ epigastric pain. Pretty healthy otherwise other than HTN. An hour after registration to the ER she unzipped her arota and died within two min. While there is not much a nurse could have done assessment, my point is that there is no 1-2-3 step by step in the ER, or things we must automatically rule out first (there are a few examples such as CP, but the majority of patients require more assessment and questions before starting r/o. r ABD pain alone can range from viral syndrome, to appendicitis, to SBO, to ecoptic preg, to a bad gallbag, to AAA, and on and on.

Do not be eager to break away from your preceptor, use every minute they give you despite that it may seem to get boring and routine. Its those moments when your preceptor points out something from there experience that you very heard of before that make the difference. Like the 58 yr who had a onset of "something stuck in my throat", after a few pointed questions the first thing my preceptor did was get an EKG, sure enough STEMI, only symptom was choking.

Try to never get complacent, the worst nurse I have seen or those who always say "its just another ABD pain" before ever seeing the pt. Treat each one individual, that one biased judgement can make you miss something important!

[bartender514, ADN, BSN]

coffee, coffee and more coffee....