Info for senior students in the ED

[MesaRN]

I have been putting together an information packet for students who are doing thier senior practicum or capstone experience in the ED. I am looking for help and advise in what to put in it. The goal is to lay out expectations and give them a list of vital items to review. Not so they are masters of material, but so things like s/s of an MI or basic cardiac rhythms are reviewed and learning can be reinforced in the clinical setting.

What do you think would be good to include?

Do you have any helpful hints (ie acronyms) that you use in your practice to pass on to a nearly finished student?

Any other nearly new grad pearls to pass along?

Below is an outline of what I have so far, any feed back would be great!!! I don't need it to be exhaustive, I just want them to review vital and commonly experienced item we see in the ER everyday.

Items to Review

Skills

Whether you have done a ton of IV starts or none at all, don't worry about how well you can do any skill, that is what the rotation is for! I just want you to be familiar with the procedures so you know how to measure the NG tube before we place it. Don't be nervous about skills, there will be ample opportunities to practice in a safe environment. Review these skills:

IV starts

Venipucture

NG tube placement

OG tube placement

EKG lead placement

3 lead (red, white, black)

12 lead placement

Foley catheter placement

Straight catheter placement

ABG collection

Medications:

Remember, just a few important points about each. Why would it be used it in the ER?:

Morphine

Ativan (lorazepam)

Haldol (halpradol)

Benadryl (diphenhydramine)

Solumedral

Metoprolol (Lopressor)

Nitroglycerine

Versed (midazolam)

Albuteral

Magnesium (what type of dysrythemia is it used to treat?)

Zofran (ondonstrone)

Phenergen (promethazine)

Cardizem (diltizem)

Dilaudid (hydromorphone

Compazine

Protonix

Xanax (alprazolam)

Valium (diazapam)

Pepcid

Lidocaine

Amiadorone

Adenosine

Atropine

Dopamine

Propofal (diprivan)

Normal Saline

Dexamethazone (decadron)

Heparin

Lovenox

Vicodin

Percocet

Tordal (ketoralac)

Ancef

Rocephin (ceftriaxone)

Activate Charcoal

What drug do you use to reverse opioid overdose?

What drugs on this list are narcs?

What drug do you use to reverse benzodiazapine overdose?

What drug on this list or benzos?

Systems Review

Keep pathos short, I mean 10 words or less!!! Think about assessment!! You will be doing a lot of focused system assessments while in the ER.

Cardiac:

Common signs of an MI

Remember MONA??

Be familiar with the following rhythms:

Atrial fibrillation

What does supraventricular tachycardia (SVT) mean?

Normal Sinus Rhythm

Ventricular Tachycardia

Ventricular Fibrillation

Sinus Tachycardia

Cardiovascular:

What is shock?

What are the four types of shock?

Renal:

How do the kidneys regulate BP? (no long patho, just the big picture in 10 words or less)

Common signs of a kidney stone

Hepatic:

How does the liver effect clotting (in 10 words or less!)

GI/ Abdomen:

Common signs of appendicitis

Endocrine:

What is DKA? What are the common sign and symptoms?

Neuro:

Common signs of a stroke

Differences in treatment of hematic stroke vs ischemic stroke

Common signs of herniation

What is involved in a nuero assessment?

What is a Glascow Coma Score?

Respiratory:

Common signs of pneumonia

Common signs upper respiratory tract infection

Croup, RSV, bronchitis, pharyngitis (we see a LOT of these!)

[andyela]

i'll be visiting this thread whenever i am transferred at ED.

ti's contains a lot of help!

[murphyle, BSN, RN]

Good list so far. I'd add a few things:

Toxicities - we see tons of EtOH abuse and ASA and APAP overdoses, either intentional or secondary (i.e. pt OD'd on Vicodin and is now combined opioid and APAP toxic). They should know what the appropriate antidotes are if any, and what the CIWA scale is and how we manage AWS/DT.

Heme/coag - signs and symptoms of thromboses (DVT vs. PAT, PE). How do you test for them? How are they managed in the ED? How do you test efficacy of heparin? Of Coumadin? How do you reverse an abnormally high PTT or PT/INR?

Infectious disease - what is sepsis in 10 words or less? When would you suspect it? If your hospital has a sepsis protocol, you might want to review it.

Keep up the great work! :)

[Medic2RN, BSN, RN, EMT-P]

Great idea and guideline to have prior to the ED clinical.

I thought of a few that you could add:

~ Many patients are on dialysis, perhaps add questions about common problems associated with pre and post treatment, fistulas, etc

~ Oxygen delivery devices What are the flow rates for each, why and when would you use each one?

~ Add CHF to your list. What is the pathophysiology involved and what would you see in your assessment?

~ Infectious disease: MRSA, hepatitis, meningitis, HIV, C-diff, TB.......what are the appropriate PPE to wear for each? How are each transmitted? What s&s would you suspect if a patient possibly had an infectious disease? (how to protect yourself prior to the official Dx)

((sidenote: students are sometimes very frightened by these folks due to their lack of understanding. Perhaps involving this into your study guidelines will alleviate fears))

Excellent idea! I bet your students appreciate it!