Got to use my neuro skills in real life!

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My husband plays hockey, and last night I was at his game when one of his teammates had a hard fall onto the ice. There were only a few of us in the stands watching, and I heard one of the players going to the opposing team's side asking if anyone was an EMT or a doctor. No one seemed to have any idea what to do and no one had medical training, so I jumped up and walked toward the ice.

My husband saw me walk up, and motioned for me to come on the ice. The ref wouldn't let me on the ice, but the player was able to get up by himself and come sit on the bench. I took his helmet off and did a neuro check on him and asked him what hurt. He never loss consciousness and his neuro check was fine, but was feeling dizzy, so I told his girlfriend to take him to the hospital down the street to get checked out.

It was kind of amazing how calm I was and how my learning in class became instinctive when the player sat down. It really felt good to be an asset and know what to do in those types of situations. Though, I keep replaying the situation again in my mind and wondering if I should have asked more questions or done things a little differently, but I know I did the priority items correctly.

I'm now re-considering this whole trauma nursing thing. :)

Specializes in Hospice.

OP what you have failed to realize is that these nurses and EMTs were only trying to help you and protect you. Nurses have to develop a tough skin, but not so tough that nothing can penetrate it.

Even after working in the medical field for so long, I am still learning things, and I don't ever want to stop learning. The nurses that responded to your post were not being hateful or deceitful, they were offering you some advice in a situation that they probably have experienced first hand.

My grandmother had a saying, "A hard head makes a soft ass."

Learning a lot from this blog. So... for the experienced EMTs etc. out there... what is the criteria for removing a helmet? It appears from the writers story, the injured person got up himself, and must have skated off the ice before any assessment was made. Therefore C-Spine precautions were already not-in-effect. Also, in a football game, for instance, I rarely, or maybe have never seen anyone put a player in a C-collar and take them away to the hospital. And... it seems concussions are not uncommon in this sport (I don't watch football much, so I could be wrong)... Anyhow, I know people are specially trained to assess them, but how is it different? I've watched a lot of boxing and seen many hit the floor hard after a knockout, and the neuro exam to determine if a player can continue appears short and sweet, done by a doctor. The boxer may go to the wrong corner, legs may be weak, may actually lose consciousness, but still they go on... I really have learned a lot from this blog, so wondering if anyone has more in-depth info as to onsite in the field care/assessment.

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
Unless Good Samaritan laws apply, which most states have, no?

Good Samaritan laws only go so far...and no.... not all states have them. There are states that actually state that if you are qualified to render help you are considered negligent to not offer that help, however that does NOT mean you are relieved of all liability. I believe schools should cover these things, however may school have canceled their legal aspect of nursing classes...sad really.

Good Samaritan laws cover only so far. They cover what another practitioner would do. A good Samaritan in legal terms refers to someone who renders aid in an emergency to an injured person on a voluntary basis. Usually, if a volunteer comes to the aid of an injured or ill person who is a stranger, the person giving the aid owes the stranger a duty of being reasonably careful.

A person is not obligated by law to do first aid in most states, not unless it's part of a job description. However, some states will consider it an act of negligence though, if a person doesn't at least call for help. Generally, where an unconscious victim cannot respond, a good samaritan can help them on the grounds of implied consent. However, if the victim is conscious and can respond, a person should ask their permission to help them first.

Samaritans

Some states offer immunity to good samaritans, but sometimes negligence could result in a claim of negligent care if the injuries or illness were made worse by the volunteer's negligence. You must act within your scope of practice, according to the states nurse practice act, and as another "reasonable and prudent" nurse would act.

"Any person who in good faith renders emergency care, without renumeration or expectation of renumeration, at the scene of an accident or emergency to the victim of the accident or emergency shall not be liable for any civil damages resulting from the persons acts or omission, except for such damages as may result from the persons gross negligence or wanton acts or omissions."
Laws vary greatly from state to state and it behooves one to know what applies to your state. Yes you may save someone's life by puling them from a burning car but if they end up paralyzed you can be sued for not using proper cervical spine precautions...it stinks but those are the cold real facts. There are risks in everything you do...as my Grandma used to say "The road to hell is paved with good intentions".

Good Samaritan law

Specializes in CEN, CFRN, PHRN, RCIS, EMT-P.
Changed you mind eh? Probably should have stuck to your original decision.[/quote']

You can cover your ears and yell loudly but that will not help you learn and grow in your professional career. Your profile listed one of your interests is 'Unrequested advice' lol!!! Well at least you were being honest as I never asked you for any. You are a nursing student correct? Well, just try to remember that learning never stops, even after graduation. Remember, keep an open mind, it will help you in the future.

Specializes in ICU.

If you really got offended by people pointing out what you did wrong in the thread, let me tell you - it's a lot harder to take it face to face with your preceptor raising her voice and/or physicians yelling at you when you make a mistake. Nursing is NOT sunshine and roses. I'm not trying to discourage you, I'm just saying you need to grow a thicker skin because if internet comments that you can walk away from make you this upset, I wonder how you are going to handle someone yelling in your face in person, in front of your patient and their family members, where you can watch their confidence in you drop and see six or seven people start to judge you at once. It will probably happen at least once when you are actually a nurse, and probably a lot more times than once.

You have to be able to see what you did wrong because if you work data entry and you make a typo, it's not a big deal. If you make a big enough mistake as a nurse, someone could die. You are expected to be perfect all of the time as a nurse. It's not written in your job description that you are allowed 10 med errors per year, or 10 patient falls, or 10 times that you screwed up and injured someone. It is a big deal if you even make one large mistake. There's a reason this is a high stress job. Is everyone perfect? No. Are you going to make mistakes even though you are not technically allowed to make any? Yes! The key to any mistake that you do make is to treat it like a learning experience, say thank you for teaching me to the person getting up in your face while you are trying not to cry, and internalize that information so you don't make that mistake in the future, and of course - immediately inform the patient/family/physician/charge nurse so your mistake can be corrected. You cannot take anything personally. It is a learning experience like missing a question on a test and nothing more. Try to look at it like that and it helps - I assume you don't get hugely offended every time you miss a test question, right? Look at this as a real-world test question that you just missed. Nursing is a high personal accountability job and you cannot get offended and cover up what you do, or say, well, it didn't hurt the person this time so it's okay - as you were saying with this guy. What if it was a med error, and you accidentally gave Lasix to a person it was not prescribed to once and it was okay, but the next time you gave it to a person it was not prescribed to they had an anaphylactic reaction and died? Would it have been okay to give it again without a prescription just because it worked okay for you once?

I hope you have realized your mistake from the people trying to help you in this thread, and you have since come to realize that taking constructive criticism is a VITAL skill in nursing that is oftentimes a lot more important than anything you learn in school, especially when you're new and don't know everything. Nursing is a team job a lot more than a lot of other professions. If you can't learn from your coworkers and take advice from them, this is probably not a good fit for you.

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
I'm under the impression that my state protects against everything but willful or wanton negligence, UNLESS you're a professionally employed ER health care provider. Meaning it doesn't matter what you "should" know, but what your intentions are.

Unless, of course, you respond to emergencies for a living.

Not true...you are held accountable for your actions. You can still be held accountable for your action if your "good faith" actions were negligent or outside your scope of practice. Many state have a 911 clause buried in there that 911 must be called and it is the injured persons decision responsibility to refuse but your responsibility to make the call. You still must act within your scope and within the standards of what "another reasonable practitioner" would do in that situation.

No...the laws may protect you but that doesn't mean they can't sue you and you spend a ton of money defending your actions. This is what malpractice is for...your legal fees and protection of your license. We live in a litigious society and it needs to be respected.

For example, you see someone drop dead in front of you, you perform CPR. While CPR is within your scope If you fracture a rib and the patient sufferers a punctured lung which lengthens his hospital stay and complicates their recovery. You can be held liable for fracturing their rib and puncturing their lung if it can be established that at any time you performed CPR incorrectly at any time. Will they win? Maybe not but you still will have to defend yourself. This takes time and money.

They reality is just because there are laws it will not absolve your actions.

In this case the OP is a student. If at ANY time she declared herself a nurse as she does in her name...depending on the state this is considered illegal for she is not licensed. For example in your state...unless a RN is present she may not represent herself as a nurse nor nursing student unless she is under the direct supervision of a registered/Licensed nurse.

Texas

Section 1. Subchapter D, Chapter 301, Occupations Code Section 301.1606.

(4)(d) Unless the person holds a license under this chapter or as a vocational nurse under Chapter 302, a person may not use, in connection with the person's name: (1) the title "nurse"; or (2) any other designation tending to imply that the person is licensed to provide nursing care.

Section 301.415. Use of Certain Nursing Titles

Unless the person is practicing under the delegated authority of a registered nurse or is otherwise authorized by state or federal law, a person may not use, in connection with the person's name: (1) the title" nurse aide", "nurse assistant", or" nurse technician" or (2) or any other similar title

http://nursingworld.org/MainMenuCategories/Policy-Advocacy/State/Legislative-Agenda-Reports/State-TitleNurse/Title-Nurse-Summary-Language.html

Nursing is complicated and people can be ugly AND greedy.

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
Let me get this straight. You guys hijacked my post to rain on my parade and now you're telling me I cannot take constructive criticism and I won't do well in my professional career. You guys have no idea what happened. I didn't even give you the entire story of my assessment because it was too long to read. Half of you didn't even read my original post correctly to see that the player wasn't unconscious.

This isn't about criticism or me not listening. I've had a really really hard week and hard quarter. I needed to feel good about myself and my skills and very few of you were willing to give me a thumbs up for trying. All I got was a list of things I did wrong and how I could of somehow killed the guy... who by the way, has NOTHING wrong with him after visiting the hospital.

Maybe instead of jumping on the "picking out what she did wrong" bandwagon, you can stop and see that I'm a person who has feelings. Just because you're online and can't see my face doesn't mean you can talk over me and pick me apart. If I wanted insight into what to do differently, I would have asked.

I'm done with this thread, and I think this forum. I came here to be lifted up and share with others in the same boat as me. So far, all you guys have done is made me feel bad for doing what I know was right. Who needs enemies, when your have fellow nurses like this.

First, you are probably not going to like what I have to say but I need to say it....I have a favourite quote that is my tag/sig line.

"Let me never fall into the vulgar mistake of dreaming that I am persecuted whenever I am contradicted".......Ralph Waldo Emerson

No one is raining on your parade. We have all said good for you, however here are things that as you go forward you need to know and remember. You are first and foremost a student. There are still SO MANY things you still need to learn and it is important that you learn them.

First KNOW your state. Know what your states expectations are and what they expect of you. This will protect you as you go forward.

Second. KNOW YOUR LIMITATIONS You are a student and you are learning you need to accept that there are those who might know slightly more than you and can see what you could have done differently and what you SHOULD do differently in the future.

OP...we can see your face, virtually speaking of course. We remember how exciting it is to have that AhHa moment when it suddenly clicks. It's exciting an wonderful... but that doesn't mean that you can't learn for this experience.

For example as a student.... did you know it can take up to 3 days for a head bleed to show up. Were you aware that just because someone didn't lose consciousness doesn't mean he didn't suffer a head bleed or a concussion and can incur permanent damage as a result of him striking his head? March 14, 2013

http://www.news-medical.net/news/20130314/Researchers-turn-concepts-about-head-injuries-in-sports-upside-down.aspx

In the British Medical Journal, concepts about head injuries in sports are now being turned upside down by a group of researchers at UmeƄ University: Impaired brain function is rather a risk factor for incurring such injuries than a result of them.

The problem of head injuries in sports like ice hockey and American football has increased markedly in the last ten years. Thus far so-called retrospective ("looking back") studies have examined individuals who have already had a mild head injury, finding impairments of the brain's cognitive function, that is, its ability to interpret and comprehend the surrounding world through memory and learning, for instance, several years after the injury.

Just because this person didn't suffer a loss of consciousness doesn't mean he didn't suffer a head injury. A loss of consciousness isn't always an indicator of the severity of injury. I am thrilled that he was treated and released form the hospital but as I said before...it can take up to 3 days for a head bleed to show even on a CT scan.

As an emergency room nurse I have seen many patients return to the ED within days for altered LOC or persistent headaches after a negative CT scan only to find they have a subdural hematoma ( subdural/venous bleed). I have seen patients that have walked into the ED after falling in their bathrooms only to discover they have cervical spine fractures that require HALO traction. In medicine...looks can be deceiving.

It would be a shame if you walked away from people who want to help you become the best nurse you can be...it is exciting to see that all your hard work is paying off and things are beginning to mkae sense. But you have much to learn.

It is in your best interest to heed the advice of those that have been at this a long time and just might know a few things that you could benefit from...just because nurses who have experience have told you how to do better in the future doesn't mean you are being attacked.

I am sorry you have had a hard semester. ((HUGS))

Specializes in Pediatrics, Emergency, Trauma.
To quote Ron Burgundy that escalated quickly.[/quote']

It sure did. :roflmao:

Specializes in Geriatrics, Telemetry, Med-Surg.
Alright, I'm done defending myself. I feel good about what I did. None of you were there and didn't see what happened and what I did. I'm going to happy despite all of your comments.

It makes you not even want to help out, doesn't it? I can say that if I witnessed a car accident, I would probably call 911, but aside from that I wouldn't want to help in fear of doing something "wrong" and being sued.

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
It makes you not even want to help out, doesn't it? I can say that if I witnessed a car accident, I would probably call 911, but aside from that I wouldn't want to help in fear of doing something "wrong" and being sued.
But see you just helped out....you called 911. There is very little anyone can do at an accident scene except keep people calm and let the EMS respond. Even I as an experienced ED and Trauma flight nurse do very little in most cases I have stopped except keep people calm and leave the people where they are until EMS arrives.
Specializes in Hematology/Oncology.
I'm under the impression that my state protects against everything but willful or wanton negligence, UNLESS you're a professionally employed ER health care provider. Meaning it doesn't matter what you "should" know, but what your intentions are.

Unless, of course, you respond to emergencies for a living.

You will learn more about this in your leadership/ethics classes if you take it.

It does not protect you for doing things outside your scope of practice. You can do assessments and what not while under supervision of a registered nurse. However, you are not licensed to do this out in the real world.

Kind of like doing CPR if you do not know how to.

I told his girlfriend to drive him because the hospital is literally down the street from the arena. The ambulances are dispatched out of a completely different city, and it would have taken longer to get an ambulance there than for her to drive him to the ER.[/
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