TraumaLPN

Thanks susi Q for pointing out my spelling mistakes. I have never heard of diprovan being used for regular CS or it being given IV push either. Ketamine works great with kids and I love to use it. I had one doc that believed in CS for every minor injury in a kid but he would never dose enough ketamine to fully sedate them. He wanted to prevent the child from being "traumatized". So the meant the 1cm-1 stitch tiny lac camped out in a room for several hours and we generally had to hold them down anyway. Oh not to mention the trauma of getting an IM injection too! Geez! This same doc was not liked by any nursing staff. He believed in pelvics too, on every female regardless of conception age, from 12-13 to 99!

Bottom line rectal and oral temps are the most accurate. And personally I feel it boils down to how good your nursing skills are. If you will accept a 99.9 scan temp on a 3 yr. old that has a HR of 160 and ignore that there is probley a fever going on ,you will ignore an 80/40 BP in an adult pt. Vital signs are an important tool to determine what is going on with a pt. and temp is an important vital sign. This happened just the other day.....one of our new nurses came and got me because her nursing home pt. had a HR of 138, was cool to touch and scan temp was 98.2. She was concerned that something cardiac was going on. I did a rectal temp and it was 102.7. That HR and the temp both returned to normal with some tylenol. The pt. was uroseptic.

HAHAHAHAHA!!!!!!! L&D come to the ER to moniter a pt? Our L&D nurses will refuse a pt. if they are 19 weeks and 6 days! It is a constant struggle at our ED.

Most of our psych pts. come in with PD or SO or EMS so it is up to the nurse to make sure they have no weapons or keys or cell phone. It is ultimately the primary nurses responsibility to ensure that she/he is safe, the pt. is safe, ED staff is safe and all ED pts. are safe. Over the past 17 years I have seen some wild **** pulled by psych pts. Even though I treat them with respect I don't trust them for one minute. I have found that if you put them in a gown and take all their belongings they are much more cooperative also. They also calm down faster and stay calm if they know you have the advantage. I also have found if you are truthful and honest from the start and don't keep anything from them they are much more calm and cooperative. I've seen nurses keep information from pts. like "you are being 1013ed to a mental hospital" and when it's time to go the wild rompas starts. THAT is what gets people hurt!

Also sounds like "a human purse."

Texas LVN, She closer to 700 lbs.

My rule of thumb is rectal temps on all pediactric and geriatric pts. who can't PROPERLY hold a themometer in their mouth. We have the temperal scan themometers but I have found them to be very inaccurate. ie. 80 yr old c/o cough with a scan temp of 97.7 but a HR of 114, an oral/rectal temp shows a temp of 102.4, or a 3 yr. with a 99.9 scan temp with a HR of 156 and hot to the touch with a rectal repeat temp of 104.6. One of my biggest pet peaves are triage nurses that use the scan and it reads under 100.0 but the pt. is tachycardic. So I get to do a rectal temp and medicate the pt. for fever when it should have been done at triage. Elderly pts. will fool you, they will be cool to the touch but can still be running a 103.0 temp. Also if you see a scan temp on a kid of 99.8 and the heart rate is 150 you will always find that the pt. has a high fever when you do a rectal temp. So watch your pulse rate.

Our Ed policy is anything under 20 wks. stays in the ED, Over 20 wks. with c/o abd or back pain or elevated BP goes to L&D and of course trauma is evaluated first in ED. Recently L&D have decided that all pts' with ruptured membranes needs to be taked to L&D on a stretcher, and of course it was made policy. Most of them only urinated on theirselves but they get a stretcher ride!

My "true" psych pts. and my suicidal pts. ALL go into a gown and I take ALL of their belongings; cell, phone, car keys, wallet, ect....I have never had a pt elope in 17 years. It is our hospital policy to place all psych pts. in a gown and take their belongings. I've seen other nurses not do that and they end up with pts. running. One psych pt. that eloped came back via EMS because he went down the road and jumped in front of a car. When you take their belongings it makes it safer for ER staff and other pts. as well. They also don't fight so hard against the "psych work up process."

SMS.....stupid mother syndrome TSTL.....too stupid to live Allstateitis........neck and back pain after very minor MVC's with no damage to the vehicle, arrive fully backboarded of course! CTD.....circling the drain FUBAR.....f'''ed up beyond all recognition Vit H.......Haldol Vit A.......Ativan TNTC........complaints "too numerous to count" Fluttering eye syndrome.....pretending to be unconcious Magic tylenol/motrin..........ER tylenol/motrin, that somehow manages to break the fever that the home tylenol/motrin couldn't break Magic wand.... as in "I forgot my magic wand" when seeing a pt. at 3:30 am on a saturday night who c/o any problem that they have had for numerous years but they decide now it's an emergency and it needs to be checked out. TTD....Trying to die, as in the nursing home pt. that is a DNR but sent to the ED to take their last breath, usually taken enroute on the ambulance! Human purse.....female psych pts. that insert odd objects into their lady partss ie. paper, wire, bottle caps, their hospital ID bracelet, ect.......... Crazy as a s''t house rat.......no explaination needed Acadamy award winners........Drama Queens/Kings Doing the shakey dance...having a seizure Goat herder.......pt. that stinks to high heaven from bad hygeine Turkey wrap........homemade bandages made from paper towels, toliet paper, wash cloth...etc taped with electrical tape, masking tape, etc.... Scratchers.... so-called suicide attempts made by scratching your wrists with a sharp object, usually very superficial wounds. Sponge........pts. who can handle large amounts of narcotics and constantly ask for more Medical Genius or amateur MD/nurse.......Those pts. who "know everything" but who's greatest educational accomplishment was learning how to write their name! Some I can't even post here because some folks would take offense...That's why I love ER nurses, we help our sanity by having morbid sense of humors.

In my ED we only use Diprivan to keep an intubated pt. sedated and we hang a drip that is titrated. As an LPN I hang this frequently. I have been an ER nurse for 17 yrs. now. We use fentenal, etomidate and versed, also Katemine (I love this for kids if the doc orders the right dose to sedate them!) for consious sedation. And of course we use Demerol and Phenergan, or some other narcotic to enhance the process.

The ED that I work in has NO full time security for our department. When it comes time to wrestle with a pt., we nurses have to handle it 99% of the time while we wait for the local police to get there. This is a 14 bed ER and we see about 40,000 pts. a year. We have to rely on the hospital security, usually 2 on 3-11 and 1 on 11-7. And the majority of them are between 55-65 yrs. old with pot guts and totally out of shape. If a pt. actually wanted to take their gun from them they probley could. That's why we rarely call them to help with situations that develope. Also we have several properties that are NOT on our campus that are owned by our hospital that security has to patrol several times a shift. So you never know if they are at the hospital or across town checking on these buildings! How may of you work in ED's that have security just for the ED. Also how big are your hospitals? Our hospital just won some kind of award that listed us as a "Large community hospital with more than 250 acute care beds." That's also a crock because we have whole floors in our hospital shut down because we don't have the staff to open thes beds. Even counting the closed beds I still can't come up with 250 acute care beds! We in the ER do not feel safe or protected by our facility.

This was not found in a pt. but on a pt. A very obese woman can to our Ed and while the Doc was doing his assessment he found half of a ham sandwich stuck inside one of her abdominal folds. The pt. said, "Oh thats where it was!"

I work in a 14 bed ER. Our admit pts. have orders written when they are admitted. We do the admission orders but that puts a strain on the entire ER. If we are holding an ICU pt. that is generallly a 1 on 1 pt. So that takes away a nurse that could be taking care of Er pts. I have seen us hold as many as 7-8 pts. during the night waiting on beds. That to me is dangerous business. Not only for the admit pt. but for the emergency pts. and thwe nurses as well!

I do love a good abcess! I also am facinated with blood clots! Over the past 15 years I"ve also eaten alot of things out of a clean, unused bedpan........salad, popcorn, cereal, hot chocolate, soup, etc........one trait of "a good nurse" is knowing how to improvise!:chuckle I'm here to save your butt, not kiss it!