First Response Actions

They have not had mock codes or even taught us what to do in case of an emergency per se. I brought this up in many nursing meetings and no one seems to have the answer.

If a patient I'm caring for says they're having chest pain, I place them at rest, HOB up, get a set of VS w/sat, place them on O2, do an assessment, send for an EKG, try to determine the type of pain they're having (i.e. location, onset (and whether gradual or sudden), intensity, duration, description (what does it feel like? does it hurt worse when they take a deep breath? does it hurt with palpation?) , what precipitated the pain, does it radiate and if so, to where, have they ever experienced this type of pain before, etc.) I'll ask them if they take NTG and if this pain is similar to what they've used it for in the past. Then notify the doc. This can all be done pretty quickly. Of course the specific response is determined by the condition of the patient.

With a seizure, preventing injury, maintaining the airway, providing O2 if necessary, noting the type and duration, having someone notify the doc for orders. Again, the condition of the patient determines your specific response.

Are you working in an outpatient area of a hospital? The hospital employee education department should be involved. Have you contacted them about your concerns?

A) Call for a stat EKG and the doc, make sure the pt has a line and O2 going.

B) Lower the head of the bed and do not leave the pt! Call for help. Most seizures are self-limiting unless there is neuro trauma.

1. If a patient reports that they have chest pains, what should be my response?

2. If a patient has a seizure, what should be my initial response?

I wish to be a part of the team that does not drop the ball.

Any suggestions are greatly appreciated.

Usually I don't quote text (too many people do in these forums do... what a waste of bandwidth)... anyways...

It sounds like you are working in an outpatient clinic, but even if you were in hospital and working the ward and came across any of the situations my advice would be the same.

Speak with your clinic manager and have them organise a first aid course for your staff...

Scope of practice really means nothing (IV's etc.) if you don't manage the ABC's. Everybody thinks that they have to get all in depth right away and care gts complicated. People tend to forget the basics when they are worrying about the details that might be able to wait.

Red Cross, Heart and Stroke, etc. all offer group first aid courses, they are inexpensive, are a great team builder and people will appreciate having the knowledge for their personal lives (rather than trying to remember protocols from work when you probably don't have the bag of tricks to work with).

I have been an ER RN for 5 years, volunteer first responder / first aider for 10 years with the Canadian Ski Patrol System (In Canada obviously), and an first aid / CPR isntructor for 8 years. It was actually my volunteer first responder training and experience that got me into Nursing.

Some times I get tempted to bust out the more advanced skills in day to day situations witht he patrol, but the basics are the most impoprtant amd will save the day everytime. If everyone in the clinic is up to date and can run a scenario as a team, things will go smoothly when it happens for real.

CPR level "C" - Healthcare provider (O2 administration, CPR (infant, child and adult), and choking (infant, child and adult) is offered through Heart and Stroke of America, Red Cross, etc. and should be the standard you work at. It covers all the issues you were describing and as a group you can be done in one fun afternoon.

I'd encourage you to conatact one of the above to organise the program (through your employer of course or get staff Education to run a similiar course). Ber proactive; Instead of taliking about it, take the steps now that can someday help out.

Sincerely,

Ian (RN - Emergency)

Ski Patroller

Superior Zone

Canadian Ski Patrol System

I find this a bit disturbing. Is there anyone else you can go to to get these answers?

If a patient I'm caring for says they're having chest pain, I place them at rest, HOB up, get a set of VS w/sat, place them on O2, do an assessment, send for an EKG, try to determine the type of pain they're having (i.e. location, onset (and whether gradual or sudden), intensity, duration, description (what does it feel like? does it hurt worse when they take a deep breath? does it hurt with palpation?) , what precipitated the pain, does it radiate and if so, to where, have they ever experienced this type of pain before, etc.) I'll ask them if they take NTG and if this pain is similar to what they've used it for in the past. Then notify the doc. This can all be done pretty quickly. Of course the specific response is determined by the condition of the patient.

With a seizure, preventing injury, maintaining the airway, providing O2 if necessary, noting the type and duration, having someone notify the doc for orders. Again, the condition of the patient determines your specific response.

Are you working in an outpatient area of a hospital? The hospital employee education department should be involved. Have you contacted them about your concerns?

Yes, it is very disturbing. I mentioned it to everyone that I could. Problem is that this hospital sponsored my education by granting me a leave of absence with pay to become an LPN, so I am under contract with them for at least three years. What is basic comfort to me is that the RNs I work with really are helpful for the most part, but we have had no time to do mock codes in our clinic. While most of the nurses I work with are great, management is in the ivory tower not really responding to basic information needed, I believe. I don't even know if I am supposed to take a verbal order or phone order. School stated that this really should be done by RNs, but we hadn't had clarity. At this time, I pass the information to the RNs, only because none of us are really clear.

Our Staff Education department basically trained us by sitting us in front of videos, doing group projects amongest ourselves and would stop in and collect our papers. Really great folks, I would say, heh? :trout:

Thank you very much for all of your responses. Amazing that I would get more from this forum than from my own job.

Yes, it is very disturbing. I mentioned it to everyone that I could. Problem is that this hospital sponsored my education by granting me a leave of absence with pay to become an LPN, so I am under contract with them for at least three years. What is basic comfort to me is that the RNs I work with really are helpful for the most part, but we have had no time to do mock codes in our clinic. While most of the nurses I work with are great, management is in the ivory tower not really responding to basic information needed, I believe. I don't even know if I am supposed to take a verbal order or phone order. School stated that this really should be done by RNs, but we hadn't had clarity. At this time, I pass the information to the RNs, only because none of us are really clear.

Our Staff Education department basically trained us by sitting us in front of videos, doing group projects amongest ourselves and would stop in and collect our papers. Really great folks, I would say, heh? :trout:

You need to compose a letter listing all these problems you've encountered, and send it to your manager. Give her adequate response time, and if he/she doesn't address the issues start going up the chain of command until you get answers.