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OutdoorLovinRN

OutdoorLovinRN

Emergency Department
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OutdoorLovinRN has 7 years experience and specializes in Emergency Department.

OutdoorLovinRN's Latest Activity

  1. OutdoorLovinRN

    Octreotide bolus question

    Hi All, I was wondering how you would administer an ordered 100 mcg octreotide bolus for someone with SEVERELY bleeding esophageal varices? How much of what would you dilute it in and how fast would you push it or would you run the bolus on a pump? Have you seen severe bradycardia with this? Did you stop the bolus administration due to bradycardia? Do you treat the patient with a lot of nausea medicine before you adminsiter the bolus? Any information you could give would be greatly appreciated. I have looked this up in several drug books, but am still concerned about administering this drug and would like to hear from other RNs who have experience giving it. Thanks!
  2. OutdoorLovinRN

    Mass Transfusion Questions

    Hi JoPACURN, Thanks for sharing with me your knowledge about platelets. The anesthesiologist took those from me and hung them-without pressure I do believe. And, I see your point, if in the future there are not enough hands and pt is uber-critical, I probably shouldn't delay hanging blood because "4 units have infused" on the filter-especially if the blood is still infusing fine on the old filter. Fortunately, there was someone who brought the filter to me and changed it while I was checking the additional units of products with someone else. I didn't get to go back to the unit to see how the pt's vs did later and I don't have close contacts up there. Thank you so much for your insight. Everyone on here has been so great in answering my questions and sharing their experiences.
  3. OutdoorLovinRN

    Mass Transfusion Questions

    Thank you Emergency RN and Questionsforall, You really did a great job of answering my questions. One question that is still unanswered is: do I need to change the filter on the Level 1 even if it still seems to be infusing fine? Do you routinely change it after 4 units? Our pt's labwork continues to look good. It's a nice feeling to see that his coags, h and h, fibrinogen, and lytes are currently looking adequate. He got 8 units of blood, 6 of FFP, 1 unit platelets, and 1 "cell saver" which is apparently autotransfusion....I think one of the OR people must have prepared that and the anesthesiologist just shouted to me that he was hanging it. This was all between 7 AM and 0915 AM. Plus I was running fluids and the anesthesiologist had him on phenylephrine at one point-but he was off it before we took him to the unit. I checked on him a little more than an hour later and his systolic blood pressure was in the low 200s (not on any pressors). I didn't get his heart rate from the icu rn. But I'm not sure what mechanism would make post surgery bp that high? And, someone at work today also suggested the blood might have been hemolyzed to give that K of 7.1. It was done on an I-stat. Anyway, they treated him for high K and follow up lytes looked good--so maybe it was real since K didn't tank with the treatment. out of curiosity, Do RNs do I-stat at your hospitals?
  4. OutdoorLovinRN

    Mass Transfusion Questions

    Hi Need some reassurence that senior RN's advice was right-- If you're running a mass transfusion, and your lines on your level one are both primed with blood and you need to get FFP up, (and assuming your filter is still good), is it okay to spike the FFP even though your drip chamber(s) has blood in it? I wasn't sure today if I needed to change the whole Level 1 tubing set when switching from prbcs to ffp. Or if I needed to hang saline on one side and prime up into the empty blood bag (YUCK) on the other side to try to clear all the prbcs out of the drip chamber and tubing. Another nurse told me to just spike the FFP right on the tubing filled with blood, so I did. And then later, I spiked more blood on the tubing/drip chamber that now had FFP in it. Is that consistent with what you would do? I felt rather uneasy doing this since I've never heard of mixing blood products or sharing tubing for different blood products. But it WAS a mass transfusion. Also, on the Level 1, if the products keep flowing ok, then does the filter still need to be changed? Another nurse changed the filter for me because I knew 4-5 units had gone through, but it seemed to work fine--so was it unnecessary to change the filter? Also, I was actually not on my home turf....I was pulled into the OR....and the anesthesiologist had me run Normasol, which I'm not familiar with. He indicated it was okay with blood. Any thing I should know about Normasol-does it have Ca in it like LR?-anything I should be aware of in the future regarding normasol and blood? After the procedure, pt's K was 7.1-we were thinking from hemolysis. I wasn't sure if it was from my spiking different blood products on top of each other????, or---the Level 1 tubing was never moved to the central line---so most of the products were going through a 20G AC IV--doesn't seem like the best size for high pressure and mass transfusion. I'm kicking myself for not catching that. Maybe the high potassium was unrelated to the blood/blood product transfusion? Lastly, anything special about platelets for mass transfusion? The anesthesiologist hung them separate. But out of curiosity, do people put platelets on the Level 1? I had heard not to put them on the IV plum pumps. And can you spike platelets onto tubing that you've run FFP and/or PRBCs through? Pt is intubated in ICU, had splenectomy, among other things (hx pancreatitis). They got the K down. Coags, fibrinogen, platelets, h and h all seem to be okay. But I just want to get another opinion on mixing my blood products. This was a big deal for me to go to OR to do this today-but it would have been nice if my first mass transfusion had been in the ER-on my own turf with my colleagues.
  5. OutdoorLovinRN

    Code Blue Nervousness

    I remind myself when we're expecting sick patients of my ABCDEs and that we need to cover those bases and get a set of vital signs along the way. Lab and x-ray and ekg will be outside the door and will come do their thing. I try to review the equipment on slow days (setting up chest drainage devices or running fluids on the level one) Since I don't do these very often. Also, when I am trauma float, I make sure I have everything we could need in the trauma room---seems to be good karma because I seem to have a white cloud knock on wood. I do still get the adrenaline rush. Take your pulse before they come through the door is what some nurses suggest i think.
  6. OutdoorLovinRN

    CEN...study at home or in seminar?

    I got the CEN review book from ENA, copyright 2001, and took all 4 150 question tests in it and also the 2 175 question tests associated with the book that are on the computer. I used my TNCC, ENPC, and Sheehey's as reference material while targeting my studying to the practice questions (plus it was helpful to read the explanations to the questions). I also found a VERY helpful series of review lectures on cds from meded. My nursing experience (4 years, 3 in the ER) was invaluable in taking the test. Things are just more interesting when you've seen them and can recall scenarios as you're learning.
  7. OutdoorLovinRN

    Qualities of an ER nurse!

    I agree with the prior posts. You have to be able to think on your feet and take things into your own hands sometimes when the doctor just cannot be there at the bedside at that moment. I had a patient recently who went into vfib on my zoll (he was off the hardline monitor because we were preparing to transport him). We started ACLS-did a quick shock, and he regained rhythm and pulse with the shock before the doctor made it in- Since shocking someone should be done ASAP in witnessed cardiac arrest, you need to be on your toes and confident-that you know your rhthms, your equipment, how to assess responsiveness, your shock energy, and your cpr/airway management. You have to be confident in yourself and in your assessment skills. You have to be able to prioritize correctly. You have to be okay with knowing you're not always providing the most personalized BEST care to all patients. This was hard for me. Sometimes patients feel ignored when you cannot get them a cup of water when you are helping someone in respiratory distress who just came through the door--which can sometimes take a while to get them settled down-heck you might have to assist with getting them tubed. Sometimes you can't clean someone up right that second after they've soiled themselves or you can't get the pain medicine for someone that second. Or maybe you come off rough when you're trying to dress a patient quickly. You might get complaints lodged against you from these patients-which can be stressful-not being able to please everyone. -not that I get many complaints-but it happens. I guess this just depends on how well staffed your ER is. A lot of times patients understand that you have a load of patients you're balancing and if they understand that, they will be more patient waiting for you. And, about the thinking on your feet and confidence, it comes in time. I know our ER keeps new ER nurses in less acute areas for about a year to help them develop their prioritization and speed skills and become familiar with policies and procedures. This has its drawbacks, though, because then when a "less acute" patient goes south, the nurse isn't as experienced to recognize the downhill turns (we can move the patient to the higher acuity section, but this down turn has to be recognized). Good luck!
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