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EDRN522

EDRN522

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  1. EDRN522

    Need opinions on difficult code

    My facility gives up to 40meq/hr on cardiac monitored critical care beds. Wide complex dysrhythmia was treated with electrical therapy first per ALCS guidelines. After defibrillation rhythm was PEA, no reason to give lido or amio at that point. Humeral IOs can be infused with up to 6L/min under pressure, necessary for rapid fluid resuscitation on this pt. Pts sitting in the ECC when beds are unavailable is a nationwide issue I believe. I don't appreciate the negativity at the end. This is an anonymous forum and I am looking for outsider perspective. Thank you for your feedback.
  2. EDRN522

    Need opinions on difficult code

    Pt is a female in her 60s, presents to ecc complaining of generalized weakness, anorexia, nausea, vomiting, generalized abdominal discomfort, and weight loss x 6 months. History of hypertension and chronic back pain. Only home medication is lorcet which pt admits to taking every hour for an unknown length of time in an attempt for pain relief. Initial vital signs: temp 98.5F oral, HR 120s-140s atrial fibrillation, BP 150s/100s, RR 20, SPO2 98% on room air. On exam pt appears cachexic, jaundiced, is alert and oriented to person place and time but clearly has some confusion as demonstrated by not knowing how long she was taking the extra lorcet tabs, peripheral pulses, no cardiac murmurs noted, lungs clear bilaterally, bowel sounds normoactive in all 4 quadtants, no tenderness or obvious masses on palpation of the abdomen, +2 pitting edema to bilateral lower extremities, denies trauma. Abnormal labs: potassium 1.7 (this was rechecked on the same sample and a new sample was sent to triple check), bili 3, hemoglobin 10, creatinine 2.4, acetaminophen 5. Normal labs: wbc, ast, alt, magnesium, calcium. Pending labs: hepatitis panel, hiv. Per poison control as ast and alt are normal chronic acetaminophen overdose causing jaundice is not possible Potassium replacement is started about 1hr into pts stay: 40meq in 1L NS at 500mls/hr into each arm (1000mls/hr of this solution total), 2G magnesium sulfate given. At this point pt has 22G bil forearms and 18G R ac. Ultrasound RUQ and CT abd/pelvis ordered but are deferred due to concerns from rn and md of pt having a lethal arrhythmia outside of the ecc. 1hr after potassium replacement is started level is rechecked and found to be 2.3 (2 hours into pts stay) 3 hrs into pts stay pt was assisted onto bedpan, immediately lost consciousness for ~15 seconds, did not lose pulse but HR decreased to the 50s during this period, remained atrial fibrillation. Pt was then able to wake up and speak to staff but was clearly "in a fog", GCS 14, vitals essentially same as arrival. 3.5 hours into pts stay: md and rn at bedside, pt is acting same as 1/2 hour ago, pt has sudden decrease in loc, GCS 5, HR 50s atrial fibrillation, BP 80s/40s, pulse present. Pt is ambu bagged while being moved to trauma room. Pt lost a pulse, PEA on monitor, BLS and ACLS measures started, humeral IO, intubated (moderate amount of blood required suctioning), and femoral triple lumen placed. Along with the usual acls meds, pt recieved 80meq iv potassium bolus, 6g iv magnesium sulfate, and 120mg succinylcholine. At one point pts rhythm was vtach to torsades and was defibrillated at 200joules with conversion to PEA. Pt was declared dead after 30 minutes and a bedside ultrasound showing no cardiac activity. I'm having a hard time with this case because we never really found out what was wrong with this pt. Unsure why pt coded, undiagnosed pancreatic cancer, aggressive potassium replacement, hypokalemia, acetaminophen overdose, or other cause? Thoughts?
  3. EDRN522

    ED staffing ratios

    To everyone working in a facility where the ED has a set nurse to patient ratio, how do you make this work? Are the ratios maintained when there is a sudden influx of patients? Patients kept in the waiting room longer?
  4. EDRN522

    ARE MOST RN SCHOOLS LIKE THIS??

    At the school I went to you were automatically expelled from the program if you got less than a 75 average for any class or less than a 75 on a nursing final. Couple of people passed a nursing class, got low 70s on the final, and were expelled. My school was the strictest school in my area though.
  5. EDRN522

    Assualted by psych patient

    I was bit earlier this month by a pt in for SI, pressed charges, pt got a class d felony on release from hospital. I don't feel bad at all. If a pt is not in psychosis/AMS they have control over their own behavior and need to be punished accordingly. I personally believe that if more nurses pressed charges, we would be assaulted less because the general public would know that it is not acceptable and you will be punished. Definitely press charges!
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