nursemoons14

BNP is a waste of money, CHF in the ED can be done by doing simple chest xray and going on your clinical assessment. The only ED docs i see using a bnp in the emerg are ones that are very unsure of their dx's and are not confident. Its an expensive blood test that is pretty much useless. Someone has swelling in their ankles, sob on exertion crackles in lungs, hmmmm lets do a bnp just to be sure. Not really relivant to an ER setting, up for debate i guess

Oh im in no way expecting a ride in the park ahah. Things must be a little wild if they can't staff a small unit like that. Shoudl be interesting and im looking forward to it. I like a challenge

Lucky for me I'm an Emerg nurse, im going to abbotsford ER. And It sounds like they areally have a hard time staffing their ER. probably since its only n 8 bed unit with 1 trauma bay. If I can do magnet hospital ER, hopefully it shouldn't be an issue, my fear is getting pulled into med/surg. I hate that floor crap ahah

Actually I'm starting my first assignment in Abbotsford, BC in 2 weeks time. 8 week contract, it sounds almost too good to be true, I know the hospital is small but thats what I wanted, busy, and be able to do more clinically compared to a magnet hospital that I'm at now. Where did you go for Solutions and how did you find it?

I read it fast, my mind processed dilaudid ahah, thats one hell of a medication error, luckily it was on a board not in the hospital. Don't report me goldstein

Like we don't have enough problem with addicts, good idea drug company

you got problems, peg lyte smells better then lactulose.

I wrote my post after working a 12 hour night and unfortunately didn't get across what i was meaning to get across, i didn't mena we were bolusing her, she was on a pump but she didn't tell us her arm was blowing up so it kept pumping in, nevertheless we still run potassium without a pump. 20kcl with 1L. So its either put it to that or ask another nurse if i can steal her pump for her nitro drip so i can run my maintenance fluid.

hahaha, thats priceless, im sorry

Thank you, some back up

GingerSue, you forgot to add a reference from Jarvis inc. for that detailed explanation ahah, kidding. I would accuse you of copyright if you hadn't have spelled fillup as one word

I too had a very hard time differentiating between lung sounds. I would hear things nobody else would, and was the only thing i really struggled with when i started. A good way to help you would be get someone else to listen too, determine what you think you heard.. chf, usually crackly and wet sounding, sometimes you won't hear any air movement if they are totally full. Try some online sites as well, there are a few out there that have sound files that you can listen too. here's a decent site, there are more out there http://www.stethographics.com/main/physiology_ls_introduction.html

Well boss, at our hospital it is not protocol to run a ba of 1000ml nacl with 20kcl on a pump. Bolus yes, pump no, so I shall continue to do so. Its recommended, but nowhere does it say you have to. when you have a 42 bed emerg with 35 admitted pt's and most of those pt's requiring a pump, and all you need it is for maintenance IV, sorry to break it to you but its the only thing you have to use. What do you think they used before pumps?

def. no tourniquet for ABG's. Lactate doesn't go on ice at our hospital, ABG's and ammonia do tho And our protocol for a stemi is to give "clot busters" we use TNK,unless contraindicated, then start on Nitro drip/heparin gtt.

alright guys i think we all know K can cause arrythmia's I don' think 9 posts saying the same thing is really necessary.

she didn't get bolused, what i meant to say was that it was running in over say 4 hrs, and her nurse didn't check the site. that built up in the tissue over that 4 hours so there was about 700 ccs of fluid in her arm

Well there you go, and i learned from my mistake is what I was saying but thanks for pointing that out again after I stated "and never agian will i run kcl without a pump" It was my first week out of orientation and I got an order from who I thought was a resident. and again.... it was 1L NS w/ 20 kcl. And for the record yes you can run that without a pump, we get orders to bolus 1L w/20 kcl tim eand time again, dehydrated and healthy pt's with low K.

personally I think they should give us tazers for this sort of thing

I had a old lady about 4 days ago, cute lady, too nice to even bother us, we had her getting a bolus NS w 20 kcl. Her arm looked like popeye and that potassium cannot feel too good. most pumps will detect the infiltration and will not run.

I don't know how many triage RN's you have at one time, but if we were doing ECG's for everyone who came in with chest pain, you'd have 5 other chest pains waiting in the waiting room to be triaged

Wow and I thought we had it bad in our emerg. Our management does not allow beds in our "chairs " area. we rarely have beds in hallways and if we do they are taken care of by the triage nurse. We have a section that strictly has 10 beds for admitted pts but at some points we have all our 35 beds as admits or close to it and have nowhere to put anyone.

I worked in a relatively small Emerg where this was in effect but i can't imagine it at a large trauma centre. I didn't realize how unsafe it was until I came to a hospital where you actually do your assignment and help out here and there when needed. Im glad i got out of that type of care when I did, you really have to trust who your working with, which i didn't and i was a new grad

Sounds like she had a sudden change of heart ahaha. Way to stick with it

Ya I was also lucky in this situation, we denied it again and agian but when we finally broke up, we were on different lines so it worked out great

I agree with tencat, I have worked with managers like that before and consider it a good thing it didn't work out. I don't think you want to work in an environment like that anyway. If management will jump to that conclusion without really listening to your side of the story she's the manager you don't wanna work for. trust me there's a lot of them.