Learning thread (ER medicine)

zenman · Jul 6, 2004

Posted by nightngale1998: Zen: increased anxiety between 3-5PM; could that be from the increased Catecholamenes?

Nope, 3-5pm is the time that ki is the strongest in the Bladder meridian. One of the psychological aspects of this meridian is anxiety/fear.

nightingale, RN · Jul 6, 2004

Heh Zen: That's not fair! That is not a Nursing Question It is good to know though! I have long been an advocate of Acupuncture and Holistic Medicine so thanks for reminding me of the Eastern Influences in Health Care.

RNCENCCRNNREMTP · Jul 6, 2004

This is the same concept as using the Ottawa ankle rules to determine the necesity for ankle films. Speaking of the Ottowa ankle rules, what are they, specifically?

Ottawa Ankle Rules

Unable to bear weight immediately and in ED.

Tender on lateral malleolar tip or posterior aspect of lateral malleolus.

Tender on medial malleolar tip or posterior aspect of medial malleolus.

Answer yes to any = x-ray.

Ottawa Foot Rules

Unable to bear wieght imediately and in ED

Tender over navicular bone

Tender at 5th metatarsal base

Answer yes to any = x-ray

Ottawa Knee Rules

Unable to bear weight immediately and in the ED

Age 55 years +

Isolated patellar tenderness

Fibular head tenderness

Inability to flex > 90 degrees

Answer yes to anyy = x-ray

RNCENCCRNNREMTP · Jul 6, 2004

Here is a stumper for you.

What are the NEXUS criteria for avoiding c-spine x-rays?

RNCENCCRNNREMTP · Jul 6, 2004

bump...
isn't anyone going to take a stab at this one?

Hmmm, specifically strep throat or just sore throat. Mono can cause sore throat and abdominal pain mimicing appy.

Dixiedi · Jul 6, 2004

Speaking of strep throat........how come nurses are not educating their patients to toss the toothbrush? I thought the nurse was to educate their patient. I have had a lady to come to the ER 5+ times for strep throat and when I was discharging her, I advised her to toss the toothbrush and go to the dollar store and buy the pack that has a few in a box for a dollar. I told her that after she used one toothbrush that day that she needed to toss it in the trash and the next day use a new one. Then after a few days she can get a more suitable toothbrush that she would like. She told me that no one has ever told her that. Well, I haven't seen her and it has been several weeks. Maybe I am a bit extreme with using a different toothbrush for a few days but strep throat is not a comfortable feeling and there are risks involved. I am a new ER nurse and I have found out that no one in my ER educates about tossing the toothbrush. So far, my advise has been very successful. No one that has followed my advised has had to return for reoccurring strep throat.

My plan was to just read this thread to learn from it. But I have a suggestion for you. Why don't you post this one out in General Nursing Discussions.

For years we have told pts to put their tooth brush in Listerine to soak (as opposed to replacing it) but I recently saw something someplace claiming Listerine doesn't do much for that elusive 1% of germs.

I don't just want to take your post and move it around, but thought you might do it. May make great conversation to know how other nurses have helped their pts prevent recurrence.

Brian, ASN, RN · Jul 6, 2004

What a great idea for a thread, thanks Chris! FYI: I just added (ER medicine) to the title, to help people realize what the thread is about at a glance. I think that this thread might start a trend in all the specialty forums, at least I hope it does, because it's a great way to share knowledge with one another! I just learned a lot! Keep up the questions :)

I think I'll post an announcement in all the specialty forums to encourage nurses to start threads in their specialty forum.

ERHack · Jul 6, 2004

Ive got one.

What do you say to the irate mother who has brought her child into the ED at 2 oclock in the morning for a c/o that he has had for 2 weeks, and who is now lecturing you on how it is unacceptable to have to wait for 3 hours to be seen? My answer- "well Im sorry ma'am, but this is not Burger King, and unfortunately, we do not do things 'your way right away' here in the ER. Unfortunately, the gentleman who needed a tube put down his throat so that he could keep on breathing took precedent over the cough that your son has had for the past 2 weeks. And yes, youre right, we should have more people working here, but unfortunately, (and I dont know why) there arent too many people who are eager to be standing here in my position trying to explain why the wait is so long".

Yes, i said this to her among other things, and yes, I was bad, and yes, i should try to be more empathetic, and yes, i had a tone with her all the while, but hey, you know you've said worse (me too) and it felt good dammit!

sorry if this really isnt related to the original post, but it is kinda an ER question, isnt it? I think it might fit under psych-social area, no? :rolleyes:

thanatos · Jul 6, 2004

Hmmm, specifically strep throat or just sore throat. Mono can cause sore throat and abdominal pain mimicing appy.

I've only seen this w/ strep, but you're right...it can occur any sore throat, including mono. what is the mechanism?

thanatos · Jul 6, 2004

Here is a stumper for you.
What are the NEXUS criteria for avoiding c-spine x-rays?

1) normal LOC

2) no ETOH on board

3) no focal neurological deficits

4) no point tenderness to posterior c-spine

5) no distracting injuries

btw...you did stump me, I had to look it up

jaimealmostRN · Jul 7, 2004

I'm going to take a guess about the previous strept infection and appy s/s. In a child who has had a previous undx. group A beta-hemolytic strept infection 10-20 days prior to the onset of symptoms it could be poststrept. glomerulonephritis which includes abd. pain as one of it's symptoms.

what an awesome thread...keep um coming!

Sarah, RNBScN · Jul 7, 2004

This is great...I will have to wake up and think of some questions to post. I am going to get my coffee and will be back.

Sarah