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COERRN

COERRN

PACU/ER
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COERRN specializes in PACU/ER.

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  1. Pediatric patients are the largest population served in emergency rooms across the U.S.. In 2015, there were 30 million pediatric ER visits. Ideally, your child will never need emergency care, but if they do, here are 5 helpful tips to make your ER visit as smooth as possible. 1. Consider ALL other options FIRST. Did you know that most pediatricians and family practice clinics offer phone consultations with an on-call doctor or provider 24/7? If you're not sure if your child needs to go the ER at 2am on a Sunday morning, try giving your pediatrician's office a call. You'll likely be given instructions through a recording or an answering service that connects you with someone who can answer your pressing questions. Obviously, do not use this for life-threatening situations. This is a good resource for when you're just not sure if your child is truly having an emergency. For minor cuts, burns, sprains, and strains, a walk-in clinic (also called urgent care, prompt-care, etc.) is usually more than capable of treating a child. Consider all of these options before coming to the Emergency Room. 2. Most fevers are not harmful. One of the leading reasons for pediatric ER visits is fever. Fever is a natural body process to fight-off infection from a viral (most common in kids) or a bacterial source. Fever becomes concerning only when it is coupled with other concerning symptoms, such as inability to take fluids or extreme sleepiness. The "highness" of the fever is not an indicator of the degree of illness. Rest, fluids, and appropriate medications as recommended by your pediatrician are usually all that is needed for a child with a fever (see #1 if you have questions about safe medications and dosing). Exposing them to the stress and germs of the ER may be more harmful than helpful in a child with a febrile illness. Fever is not normal under any circumstance in infants under 3 months of age and should be addressed immediately. Save this link for a quick reference about fever in children for the next time you're worried about your little pumpkins temperature: https://kidshealth.org/en/parents/fever.html 3. Stay with your child while they are in the ER. Please plan to stay with your child for the duration of their ER stay. Staff may ask you to leave the room for some procedures and tests (such as x-ray) but otherwise, it is helpful to have a calm, loving, and present adult at the bedside. Even when it is hard to be there, it is even harder on your child. Please don't walk away when they get poked or catheterized, they need you in those scary and painful moments and so does the staff. If you can't be calm and reassuring to your child, we encourage you to find a friend or family member who can be. 4. Follow your discharge instructions. Your nurse and provider will give you a specific plan to follow once you get home. Please follow it exactly as instructed. It is especially important to follow-up with your child's pediatrician as indicated, even if they seem better. Closing this loop in your child's care leads to the best outcome for them and can prevent another trip to the emergency room. 5. Trust your gut. We acknowledge and respect that you know your child best. If your gut tells you that you need to be in the ER, we will gladly serve you and your child to the best of our abilities. We sincerely hope that your child will never need the care of the Emergency Room. However, should you find yourself there, you can rest assured that a team of dedicated, skilled, and compassionate nurses will be by your side.
  2. COERRN

    ER to Floor...hating it

    Have you tried talking to your current boss openly about your issues? I would explain that while you have enjoyed the new perspective of floor nursing, the ER is your "home" and that you would like to notify her that you'll be actively looking to transfer to the ER. She/he may be understanding of this. As an ER nurse who worked med/surg for 4 years prior to becoming an ER nurse, I would NEVER go back to the floor. It was a great foundation and I enjoyed it at the time, but there really is something so special about the ER that I could never walk away from.
  3. Details have been changed to protect the patient and her family. The facts of this case are true. The ambulance page pierced the silence. Most nights it could barely be heard over the din of a busy ER, but tonight the snow had fallen in heavy layers and this seemed to keep people in their homes. The nurses, slouched at our stations, straightened to attention upon hearing the dispatcher's voice crack over the radio, "28-year-old female, difficulty breathing, conscious." The address was announced and everyone gave a concerned glance. The call was to a narrow, notoriously treacherous dirt road, high in the mountains on the west side of our small Colorado town. In good weather and broad daylight, it was a 30-minute response time. That night we had unforgiving snow, whipping winds, and a dark, moonless sky. The ambulance crew rounded the corner past the nurse's station, bundled in their coats, and headed out the door. Twenty-five minutes later, we heard the ambulance crew speaking with dispatch. They were hopelessly stuck in a snow drift- forcing dispatch to page another ambulance to the address. Thirty-five minutes later, it was stuck too. The woman was still having difficulty breathing, now admitting to the dispatcher that she had huffed two cans of commercial keyboard dusting spray just a few moments before her respiratory distress began. She stated her heart felt like it was racing. In our small Rocky Mountain community, we have a team of highly skilled volunteer fire and emergency medical services who had also been activated when the initial call came an hour earlier. One of these responders had managed to get his oversized pick-up truck near the cabin where the patient was waiting for help. His voice came over the radio, "Patient is pale, diaphoretic, tachypneic. Her heart rate is 140 beats per minute. She is having chest tightness." He measured her oxygen saturation at 90% on room air. She had no medical history other than occasional street drug use. As per the previous report, he confirmed that she had huffed a propellant just minutes before the start of her symptoms. He made a judgment call - this woman needed the ER right away, so he did a rather unconventional thing and hiked the woman through the thigh-high snow, bundled her into his truck, and began the unpredictable journey to the hospital. On the way, he encountered one of the stuck ambulances and was able to help them back onto the road. Over two hours had passed, but the patient was finally in the back of an ambulance and headed our way. The phone rang and the charge nurse took the ambulance report. The woman's heart rate and respiratory rate were still elevated, but supplementary oxygen had improved her condition. Her heart rate was 105 bpm and her respiratory rate 24 breaths per minute. On a simple mask at 8L, her oxygen saturation was 100%. The EMTs thought perhaps she was having a bit of a panic attack and that the delayed response had increased her anxiety, but they felt that she was relatively stable. We prepared our cardiac/respiratory room, just in case. Everyone was optimistic - this patient was young, relatively healthy, and she was already improving. This was no big deal. The patient arrived. The updated ambulance report was relatively the same. The patient was a slightly overweight Latina female with hot pink hair. Tattoos snaked her arms and calves. She was indeed pale. Smeared mascara was streaked all over her face - she'd been crying. Her initial vital signs were reassuring. Mild tachypnea was present and she was still slightly tachycardic, but otherwise she looked good. The ER doctor working that night was a gentle and highly skilled provider with over three decades of experience. He immediately evaluated the patient upon her arrival and told her he suspected a mild reaction to the inhalant she had huffed with a subsequent panic attack. Reaching for his hand with wide eyes, she said to him, "I feel so scared." He comforted her and ordered labs, an EKG, a small dose of IV Ativan, and a chest x-ray. He assured her we would do a thorough work-up and get her some medicine to help her stay calm. She nodded and appeared relieved. I left to obtain the Ativan, the charge nurse went to get the EKG machine, and a phlebotomist began to set up for labs. As I was preparing to administer the IV Ativan, the phlebotomist began to draw her blood. The patient's heart rate suddenly spiked to 110, then 120. I thought she was anxious about the needle stick, so I said to her, "Try to stay calm, take a deep breath." Eyes wide, she looked at me with pleading desperation and said something I'll never forget, "I'll never do it again. I am sorry. I am trying," she gasped. The monitor began screaming. HEART RATE 186. "SVT," I thought. Then it quickly converted to ventricular tachycardia. And before I could even blink, ventricular fibrillation. She was coding. I snapped into autopilot, a rush of adrenaline hit my body. I checked for a pulse, but it was obvious she had none. I rolled her onto a board and began compressions. The phlebotomist smacked the code blue button and our ER team streamed into the room. We ran the code for 55 minutes before the doctor announced that he was going to talk to her family, who had arrived in the waiting room 10 minutes before. We continued the code while he was gone. When he returned he informed us that the patient's mother, father, and 5-year-old son were in the waiting room. The room fell into a hush. "She has a child?" I asked. I felt totally deflated. There was no promising sign that she was going to make it. The only sound in the room was the rhythmic, mechanical thrusting of the LUCAS machine, an automated chest compression device we had placed on the patient 15 minutes after she coded, relieving the staff of the breath-taking work of chest compressions. The doctor nodded, then said, "Let's continue for another 15 minutes, and then I'll have to call time of death. Does anyone have any ideas? Anything at all?" No one in the room spoke. "Okay," he said, "another round of epi please." Fifteen minutes later, we called time of death - 0428 - almost four hours after she initially called for help. She was translucent, still, and mottled. I began post-mortem care. I cleaned her, changed her gown, wiped the mascara off her face, gently closed her lifeless eyes, and tried my best to smooth her hot pink locks, only able to guess which way she parted her hair. The doctor guided her mother and father into the room. Her mother wailed, screamed, her knees buckled. We had to hold her up so she could say goodbye to her daughter, her baby. The rest of the night is a blur of tears, tissues, crushing hugs from her mother and the reverberating question "why?" The young woman's body went to the morgue and I left for home. On my way, I saw her son, unaware of what had transpired, sitting on the lap of the grandmotherly woman who works registration. He was coloring and drinking apple juice - a picture of complete and blissful innocence. I hope someday he will know how hard we tried to save his mommy; how sorry she was for making the mistake to use drugs. But it is likely he will always wonder those things. I got in my car and the tears began. First, a hot stream down both cheeks, then a sob. I cried the whole way home. My 5-year-old daughter was awake when I walked into the house. "Mommy!" she laughed as I gave her a big squeeze. My heart was breaking, but I smiled at her. My husband rubbed my back, encouraging me to get some rest and go to bed. "No," I said, "Today, I am going to have breakfast with my baby." Author's note: You may be wondering about the more clinical aspects of this story. There are many different chemical compositions to propellant-based keyboard dusters. According to the pharmacist in the room during the code, this particular dusting compound is known to bind to cardiac muscle and deplete the body's stores of calcium. When the patient's initial labs resulted, approx. 30 minutes after she arrested, she was found to be profoundly hypocalcemic. Many efforts were made to restore her calcium levels during the code, but clearly, it was too late. I often wonder if the precious hours wasted getting the patient to the hospital would have allowed for us to correct her hypocalcemia before it led to cardiac arrest. We will never know.
  4. COERRN

    Seizures! Diastat!!

    I don't believe rescue breaths during seizure activity is the standard. You only need to do that if apnea is present after seizing has stopped. If he seizes just place him on his side and make sure he doesn't injure himself, start timing, and administer meds as prescribed. After seizing has stopped, assess airway, breathing, circulation and intervene as needed in those three areas. It is that simple. As for the bus, I would follow policy/procedure. If the child cannot receive his meds, then I suppose calling 911 would be the bus driver's only option. If I was his parent I wouldn't have him ride the bus, to be honest. Usually kids with seizure disorders don't need an ambulance called with a "standard" seizure as long as a trained adult can appropriately manage their condition. I would try to avoid all situations where the only thing the adult can do is call an ambulance. It would be expensive and unnecessary for him to have a "standard" (for him) seizure and end up with a huge ambulance bill and ER visit. In general, I think getting CPR certified is good for the bus driver. I don't think he needs to get certified for this specific kid.
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