outlierrn

So, after 10 years with Medhost, we're finally going to Firstnet at my hospital. We've had Cerner power chart on the floor for awhile, but I've never really gotten the hang of it, so I come to you for your: Tips Tricks and Shortcuts Thanks in advanc...

One new question that's come up is how people enter surgical history? In Medhost, it's bundled in the triage history group that includes allergies, current meds, and medical history, but it seems to be buried in the bedside nurses assessment in Firs...

Ah thanks for this (and everyone else), I'll have to talk to my informatics nurse and see about this.

It was not my intention to be rude or condescending.

I had a 44 y/o guy come in full CPR in progress. We never got him back, but the story we got from the family was that he had started a new job about a week ago, and c/o of vague shoulder pain since he began (left, of course). If he had presented to...

Paraphrased for simplicity: Pt. I think I have a kidney stone. Me. Describe your pain. Pt. Vague, diffuse, mild. Me. ?? Have you ever had a kidney stone before? Pt. No. Me. What makes you think you have one now? Pt. I have a diagnosed staph infection...

It's usually institution specific, since, with the exception of what's covered by yout ACLS card, the medical staff has to sign off on any standing orders done by RNs. Where I work I can do accuchecks, 12 lead ekg, initiate o2, ua/ucg, and plain film...

Rather than saying think on your feet I would say reprioritize on your feet. You were going to clean that pt up before admitting then? Well not now, there's a multiple casualty inbound. Your pt was a stable abd complaint? Not now, the wife tells you...

I've worked PICU, general peds floor, and peds ER, sometimes with other guys sometimes not. If that's something you're interested in there is no reason not to for try it. Now I work in general ER, but it's a rare week when a parent doesn't compliment...

10 years in, never looked back. Some days suck, but's that's true of every job I ever had.

I agree that C is the correct answer. It's poorly worded so as not to lead you to the right answer. Look at it this way; what's the worse case scenario? Compartment syndrome. If so then A actively harms you pt, B&D delay care for no gain, tha...

When I worked peds ER we had lots of kids with ortho pain come in. We often gave subQ morphine, got the films, decided if they needed an IV and proceeded with definitive care. Now I work adult ER and find the docs resistent to this; usually I hear ...

I never use dimensional analysis. dose des/dose on hand X vol on hand can be used for everything I've come across in ER and ICU

Lots of variation obviously, I've pushed brevitol and propofol before, and for some strange reason out facility doesn't require wasting ketamine, brevitol yes, go figure.

Back in one of my other lives I observed that you could ask two farmers about the best way to cultivate tomatos, get two diametrically opposed answers, get reasonable, rational explanations for each, and damned if you could tell them apart come harve...

I given it a number of times for procedural sedation (we don't call it conscious anymore, go figure). Usu for peds, IM or IV, sometimes with an atropine chaser. I'm an ASRN in California with plenty of experience in ER. We don't consider it a big ...

Lets see, Pressure on the bleeders is fine, be careful about making injuries worse. Can't remember the last time I saw a pair of MAST trouser let alone used them. You're right about the abbreviations. I can't believe no one, myself included, mentione...

Good question, Allow me to suggest calling the ER nurse if they're still on to see if this happened there. I take questions from floor nurses all the time. Sometimes the ER doc wrote holding orders that we can clarify, sometimes I tell them they ha...

hypovolemic shock is a question of degrees, B/P and C/O are maintained in compensated shock by tachycardia and peripheral vasoconstriction, when these mechanisms fail, B/P and C/O fall as uncompesated shock begins, a very slippery slope, best avoided...

you boast about starting an IV on a pt that hasn't had a pulse for 20 min.

Although it varies from place to place, the exact meaning varies most importantly from CASE to CASE. Understand that ALL of your pts are going to die, allowing them to pass easily is not killing them. Facilitating a comfortable, peacefull experienc...

In my ER we have a dedicated peds crash cart, each drawer is a different color and corresponds to a color on the Braslow tape. Within each drawer are the supplies that are right size for that pt. We have several cheat sheets, peds micro blood tubes...

well, if you took opiates and benzos away I'm not sure I would stay in the business, so I'd be a hypocrit to oppose it. Besides, I have NEVER, EVER seen anybody in the ER because of marijuana.

Depends on where you work. When I was in PICU I liked it, it was very helpful in keeping 30 doses per shift organized. OTOH, in the ER it would suck, things are changing too rapidly, Larry

you absolutely did the right thing for the pt, virtually everybody is grumpy at 3 in the morning. But I would have asked my charge nurse to come in and confirm my obsevations to the on call doc who came in. Better to convince him now in case the pt...