ER Questions

With ABG's you don't apply a tourniquet. When applying a tourniquet you are occluding that vein, it's the total opposite for an ABG :-) You should be able to palpate the radial or brachial artery and go on in :-)

Our Protocol for a STEMI is 2 large bore IV's, Nitro gtt, Heparin gtt, we have been automatically giving 600 of Plavix--they are currently reviewing this. We must get them to the cath lab in under 50 mintues from the onset of symptoms if possible.

Our ABG's and lacate is all that goes on ice.

Not an ED nurse, but in the ICU we also put Ammonia on ice-anybody else?

yes, ammonia as well

Ammonia, lactate and ABG's on ice. As for STEMI's they come in the ER get EKG, 2 if not 3 Large bore IV sites with lab draw from the site, 4 baby ASA, 600 mg Plavix, 5000 unit Heparin bolus, 5mg lopressor times 3 according to SBP >100 and pulse >60, usually get the nitro and heparin drip up unless patient being flown since our hospital has no cath lab.

STEMI gets 2-3 IV's at least 18-20g. EKG, Chest X-ray, ASA (81mg x4 if not taken at home), Nitro x3 (if not already done), Lopressor 5mg x3 (for SBP >100 P >60).

We don't have a cath lab so at this point it's up to the recieving facility and the cardio that sees the EKG.

We've done Retavase, Heparin bolus/gtt, Plavix, Nitro gtt.

They like our STEMI to be in cath lab w/in 50 mins. Not possible if we have to send the pt via ground EMS. Most get flown unless for some reason they can't fly.

I was just curious when doing ABGs, do you apply a tourniquet on?

What is your protocol when you have a STEMI? 2 IV sites, Nitro drip, etc.?

Which tubes and orders go "on ice"? (e.g. lactate, what else is there?) And what are the red tube and green tubes do?

Thanks. Any advice is appreciated.

def. no tourniquet for ABG's.

Lactate doesn't go on ice at our hospital, ABG's and ammonia do tho

And our protocol for a stemi is to give "clot busters" we use TNK,unless contraindicated, then start on Nitro drip/heparin gtt.

STEMI's get as much done as the cath team lets us. We have had them literally take them off the EMS stretchers so about all we are able to do is and EKG and get them quick registered. The medics have typically started a line, given ASA, NTG and maybe drawn the rainbow.

At night or if the cath team is moving a little slower- we might get a Nitro gtt started, Morphine IV, Lopressor, Heparin bolus and drip if time, Plavix is 50/50 often they want to give that themselves.

As far as what goes on ice we put the above tubes on ice, out ABG's go straight to the lab, so unless they are not going to be run in 15 mins they don't get put on ice. Oh and RT here draws the ABG's as well.

Rj

2 16-18g PIVs, 10 of Morphine, nitropaste to chest wall, metoprolol IV, ASA, and off to the cath lab. Currently our time from door to lab is a goal of 40 minutes and we've averaged around 30 minutes. We have a huge medical and surgical cardiac program. Only ABG and Ammonia goes on ice.

As far as your tubes....it depends on your lab.

Light Green-->Usually chemistries

Dark Green-->Troponin (can also be used for chemistries if you don't have a light green handy)

Red-->Ionized Calcium