Hypothetical situation, thoughts?

[ladysyrah]

Hi, so I am going through a lecture about trauma and I began wondering what nurses are allowed to do in emergency situations in "the field" or life outside the hospital? If your assessments of a person says they have a tension pneumothorax, their trachea is already shifted and etc, and you can tell time is running out, do you have the ability to create a hole into the person's lungs to save them? What if they are aware and nod in acceptance of receiving that care knowing it is outside the "usual" scope of a nurse but may possibly be their only chance of survival? What would you do? What is allowed? How far would you go to help someone live if you know that immediate action is required? What is the legal course of action?

[HermioneG, BSN, RN]

Attempting to educate someone on the internet with detailed references to surgical procedures is pretty good use of sarcasm.

Well, at least I can now be at ease knowing that if the OP ever comes across me and I'm in dire need of a needle decompression, they will hopefully remember to use the mid-hemithorax as opposed to mid-clavicular line for the needle decompression site to help mitigate the risk of iatrogenic bleeding and my subsequent death :)

Kidding. I barely even understand what I just said

But thats the point, isn't it? Its complicated.

The point of referencing the detailed surgical procedures is to show exactly how risky and complicated it is. Its not just "poking a hole in the lung" its something that is serious, and should be done only by people with the right training (ie, definitely not me, and probably not the OP). This is also one of the many reasons why we have a scope of practice.

Perhaps people who think its as simple as poking a hole in a person's lung need a good dose of detailed surgical info to hopefully wake them up, and help them understand how badly it could turn out if done improperly. People who underestimate stuff like this scare me, because you can really hurt someone. And its not just about this one particular off the wall scenario, its everything about providing medical care in general. If you're not trained in it or don't know how, then just don't do it! Stay in your scope (not you, dear Mavrick. I'm just piggy backing on what you're saying and throwing my opinion out to everyone in a general sense :) )

[Mavrick, BSN, RN]

Well, at least I can now be at ease knowing that if the OP ever comes across me and I'm in dire need of a needle decompression, they will hopefully remember to use the mid-hemithorax as opposed to mid-clavicular line for the needle decompression site to help mitigate the risk of iatrogenic bleeding and my subsequent death :)

Kidding. I barely even understand what I just said

But thats the point, isn't it? Its complicated.

The point of referencing the detailed surgical procedures is to show exactly how risky and complicated it is. Its not just "poking a hole in the lung" its something that is serious, and should be done only by people with the right training (ie, definitely not me, and probably not the OP). This is also one of the many reasons why we have a scope of practice.

Perhaps people who think its as simple as poking a hole in a person's lung need a good dose of detailed surgical info to hopefully wake them up, and help them understand how badly it could turn out if done improperly. People who underestimate stuff like this scare me, because you can really hurt someone. And its not just about this one particular off the wall scenario, its everything about providing medical care in general. If you're not trained in it or don't know how, then just don't do it! Stay in your scope (not you, dear Mavrick. I'm just piggy backing on what you're saying and throwing my opinion out to everyone in a general sense :) )

Glad we got that cleared up. Now can I get back to remodeling my kitchen I have 28 minutes to finish this project.

[Ambersmom, BSN, RN]

Basically, in order to be protected under good samaritan laws you have to do what another nurse with the same training and experience would do. Most nurses are not trained in chest decompression and cric's, therefore if you where to perform one you would be stepping outside your SOC and would be liable for any ill effects as well as possibly facing punishment from the BON and legal authorities for practicing medicine without a license. Everyone wants to be a hero, but the best course of action is to keep the patient calm, utilize first aid and wait for the people who are trained in advanced procedures to arrive. Doing a chest decompression is not quite as cut and dried as just "making a hole in the patients chest", and there ard often other underlying injuries that ard more dangerous than the obvious one, just mho.

[bgxyrnf, MSN, RN]

If your assessments of a person says they have a tension pneumothorax, their trachea is already shifted and etc, and you can tell time is running out, do you have the ability to create a hole into the person's lungs to save them?

Creating a hole in their lungs isn't going to save them, it's going to kill them.

This is precisely why you are covered *only* for things which you are trained and competent.

[bgxyrnf, MSN, RN]

There is absolutely no way in hades I would do an invasive procedure without training.

There's no way in hades that I would do an invasive procedure without a medical director's protocol authorizing me to. Otherwise, I'm practicing medicine without a license.

[bgxyrnf, MSN, RN]

Good Samaritan Laws only protect you if you do things that are within the scope of your practice. If I were to render basic first aid, start an IV (look, there's a sterile IV start kit sitting in those bushes!), and do CPR, I'd be covered.

You probably wouldn't be covered for starting an IV outside of a physician's order... and you *certainly* wouldn't be covered for administering anything through it, including that sealed bag of NS laying in the bushes with that start kit.

[Meriwhen, ASN, BSN, MSN, RN]

You probably wouldn't be covered for starting an IV outside of a physician's order... and you *certainly* wouldn't be covered for administering anything through it, including that sealed bag of NS laying in the bushes with that start kit.

I did say "start". I never said I'd give anything :) And considering first responders start IVs in the field all the time, I probably wouldn't be held liable for just starting one.

Though if I'm ever in an emergency situation in the field, I'd want to be by that bush. Maybe there is a crash cart and MD hidden behind that bush too?

[amoLucia]

How many of you remember the old show "ER" when "Nurse Hathaway" was being held hostage in a drug store and "saved" a shooting victim by not only traching him with a pen but relieving a pneumothorax with a tampon applicator? Last time I watched that hot mess.

Like when Fr Mulcahy on M*A*S*H used a pen barrel.

[Lulu Belle, RN, EMT-B]

If you are interested in what you can do in the field that might actually be lifesaving and within your scope, I recommend taking a course called Tactical Emergency Casualty Care. It's a little pricey (I got my volly ambulance service to pay for it), but very informative. It's adapted from the military version of the course called Tactical Combat Casualty Care.

While it addresses some interventions which are outside your nursing scope, it also reinforces what others here have said: a) most of those interventions are last ditch efforts even for Medics who are trained to do them, and b) controlling major bleeding is really your #1 concern, people bleed out fast.

[NurseSpeedy, ADN, LPN, RN]

Call 911, assist with BLS, apply pressure BUT PLEASE, PLEASE, leave the scalpel (or any sharp object) at home, Work, or wherever you may have found it! The chances of making it worse is far greater than saving the patient in this situation...and there's a reason it's way above our pay grade-so much could go wrong and you don't have the supplies or personnel to fix it when it does.

[alex1214]

The best course of action would be to follow the state's Good Samaritan act

[CrunchRN, ADN, RN]

Absolutely no.