As a new RN to the Emergency Room you are probably wondering about frequently administered medication in the Emergency Room. In this article not only will you learn about the go to ER medications, but you will also learn about some medication administration safety tips to help you succeed in the chaotic environment.
Members are discussing various medications commonly used in emergency and critical care settings, sharing their experiences and opinions on the effectiveness and usage of these drugs. Some members are suggesting alternative teaching methods for learning about medications, such as focusing on individual drugs in detail rather than presenting a long list at once. There is also a discussion about the use of generic versus brand names for medications and the importance of continuous learning in the healthcare field.
Are you a brand new nurse that just obtained the first job in the Emergency Room? Or an experienced nurse that has decided to master a new specialty? Well, whichever boat you might be in, here is a head start for you. Below is a list of medications that I promise you will be using time and time again while working in the Emergency Room. This looks like it might be an extensive list, but as time goes on, you will know the entire list inside and out.
Some of the medications are listed as the brand name and some of the medications are listed as the generic name. It is imperative that you are comfortable with both. Yes, I did do this on purpose, to not include both within this article. I am a teacher at heart, and I could not write this article without some homework involved!
Also, know what your hospital's policy is for the administration of all of the medications listed above. What might be normal practice at one facility, could get you a write up at another. Along with that, as always, never forget the medication administrations safety rules we all were taught in nursing school.
Oh yeah, and how could I forget the life-saving enemas! Saline and Mineral Oil.
Lastly, I will leave you with another tip for all new Emergency Room Nurses. Go through all of the body systems and learn what the emergencies are for those systems. Master those and you will feel comfort in knowing that when you are drowning, you have ruled out all of the time-sensitive emergencies for your patients. Once this has occurred, go down that list again and prioritize your patients from there. The Emergency Room is a no joke place to work, very fast paced and stressful. Mastering this list will help take away some of the stress and improve your overall flow. Give the department some time though, when it gets difficult don't quit. It can be very overwhelming at first, but I promise it will get better.
Extra Medication Safety Tip
Set your medication pumps up for success, not failure. When programming your pump to administer a high alert medication, set the rate to match the volume to be infused. This will prevent the entire bag/bottle of medication being accidentally administered to the patient due to your programming error. If this safety measure is not in place, it could lead to a catastrophic and life-threatening event for your patient. Imagine if an entire bag of Cardizem was administered, or the whole bag of Insulin or the whole bottle of Nitroglycerin?! Yikes! It only takes an extra second and when the hour is up: go back to set the pump again, reassess your patient, ensure that they are improving and not getting any worse, and continue on with the rest of your patients that need your services.
Our ED does still use it. But it's our older docs that order it. It is linked to fatalities related to mesenteric ischemia. From what I understand, the pathophys has not been established but there is enough research out there that many docs don't write for it - especially in hyperkalemia without EKG changes
Specializes in Emergency, Case Management, Informatics.
While I appreciate the effort that it took to list everything in the Pixys, I don't know if it's the best teaching method to tell someone, "Hey, here's a list of 67 more things you need to learn about".
I would be more interested if this were turned into a series, with each post giving the basics of one medication, along with tips/tricks/off-label uses.
While I appreciate the effort that it took to list everything in the Pixys, I don't know if it's the best teaching method to tell someone, "Hey, here's a list of 67 more things you need to learn about".
I would be more interested if this were turned into a series, with each post giving the basics of one medication, along with tips/tricks/off-label uses.
Seems more in that vein. I haven't looked at both to reconcile the differences, but the much more organized list is to my way of thinking much easier to grasp, especially for new to the ED nurses.
I like your idea of posts on each med, or category of meds to delve into more detail, good idea!
We use still use Kayexalate in our facility as part of the hyperkalemia treatment. It's given along with Calcium gluconate, IV Insulin and an amp of D50. Some of the providers also order an amp of sodium bicarb along with the cocktail-depending on the labs. Has your facility stopped using Kayexalate? What is the typical treatment for hyperkalemia at your facility?
Thanks!
Kayexalate has been removed from commonly referenced hyperkalemia treatment recommendations. There's no evidence it works as intended, the only thing it's been proven to do is cause bowel necrosis.
For excretion of excess potassium in a patient with adequate kidney function, a potassium wasting diuretic is recommended with fluid replacement as needed. For intracellular sequestration of excess potassium, insulin with glucose as needed is recommended as well as inhaled beta agonists (ie albuterol) is recommended.
Kayexalate has been removed from commonly referenced hyperkalemia treatment recommendations. There's no evidence it works as intended, the only thing it's been proven to do is cause bowel necrosis.
For excretion of excess potassium in a patient with adequate kidney function, a potassium wasting diuretic is recommended with fluid replacement as needed. For intracellular sequestration of excess potassium, insulin with glucose as needed is recommended as well as inhaled beta agonists (ie albuterol) is recommended.
I always see Kayexelate ordered with our initially hyperkalemic DKA patients on an insulin drip. I always hold it which we know what happens...ugh
Good list, thanks for taking the time to write this.
I'd have to add vasopressin as it's probably in the top 25 of medications that I give in the ED, although I do tend to be the one to get sepsis patients since I also work in the ICU.
As for the kayexalate, are there still facilities that are using this?
Hmm I thought first line agent for sepsis was norepi/Levo. Our ED/ICU docs always go for it first and it is in our EBP sepsis protocol. Vasopressin is added on later if we get halfway to maxing levo with no improvement.
Most of the sepsis patients we get from the ED aren't there long enough to be started on vaso. Fluid trial and levo then they try to dump them on us as fast as they can.
Hmm I thought first line agent for sepsis was norepi/Levo. Our ED/ICU docs always go for it first and it is in our EBP sepsis protocol. Vasopressin is added on later if we get halfway to maxing levo with no improvement.
Most of the sepsis patients we get from the ED aren't there long enough to be started on vaso. Fluid trial and levo then they try to dump them on us as fast as they can.
Levo is the primary pressor for sepsis, I mentioned the vaso only because levo was already on the list. At a couple places where I've worked the vaso is started fairly soon after the levo, we started it as the next step after 0.03 mcg/kg/min at one place and after 0.05 at another. Vaso shouldn't be the only pressor used, but it's worth adding it to levo fairly early on since septic patients tend to have a relative ADH deficiency, so you're getting more than just vasoconstrictive effect by adding the vaso. If I'm having to start the levo in the ED, that usually means that very aggressive fluid bolusing wasn't sufficient. And since septic patients tend to have a profound capillary leak, that fluid bolus won't stay intravascular for long, so if I'm having to start levo while most of the fluid bolus is still intravascular then starting vaso is usually unavoidable.
Well...maybe not *master*....never gave protamine a single time in the ER let alone those I may have given once...know what general category they're in? Sure. In the day and age of internet searches, that's plenty.
foragreatergood
55 Posts
Our ED does still use it. But it's our older docs that order it. It is linked to fatalities related to mesenteric ischemia. From what I understand, the pathophys has not been established but there is enough research out there that many docs don't write for it - especially in hyperkalemia without EKG changes