CEN35

call the urology group and get an acute urinary retention tray down there............ ever see it done? EWWWWWWWWWWWWWWWWWWW!!!!!!!!!!!!!!!!!!! Not me looks painful as He**

I started in ER out of school. The first 3-4 months seemed overwhelming. After that the learning curve dropped a little bit at a time over the next two years. After 2 years I was completely comfortable. I stayed there 7 years, then went to PACU. However, I also work ER at a different hospital still. It's up to you. Not every unit or floor is for every person, only you know that.

Most ridiculous ever.............. Dilauded 4 mg IVP Fentanyl 100mcg IVP Demerol 50mg/Phenergan25mg Im Demerol 50mg IVP Morphine 14 MG IVP ALL in 1 hr and 10 minutes. 28 yrs old wide awake complaining we are not helping his pain and denies drug use........... hmmmmmmmmmmmm................

I work 2 jobs right now. ER and PACU - In the ER most docs I have met are always hesitant to give much more than 50-100 of Demerol much less anything else. I can tell you that, one patient will passout after 4mg of MSO4 IV, and the next may take 8MG of IV dilauded, or even (seen it) 235mg of IV MSO4 over 1 1/2 hours. Everybody is different. However, I would give much more than 75 mg demerol, 1mg Dilauded, 8 mg MSO4 (roughly) without a monitor. Ecspecially when it is right there to be used. :)

I can tell you from working in pacu, with adults it is horrendous to keep the patients tame afterwards. However, our peds ER uses it also. They come as suckers that the patient can suck on. They love using it, it works great for kids. Rick

once a year paycheck here: $325 before taxes

We do in PACU at times. Also I float to the pain center. They use it all the time for spinal blocks. Propophol is dose based, and wears off quickly. I believe you can only use it here, if the pt is intubated or anesthesia is present.

Not sure? Seen quite a few. The only thing I can say, is it seems like as time goes on and you see more, it isn't as bothersome. Although, every now and then there are certain situations that can tear you up. The only thing that gets me every time is when its a kid.

None - went in right out of school, stayed 7 years and went to pacu.

Ours was doc dependant. 90% Compazine. If they are allergic to compazine (allegedly), Demerol vistaril. After CT Toradol. Always the variance of triptans and sometimes DHT.

Quanik - I didn't say you were downing the use of propophol. On your quote "Maybe age, weight, fluid status, circ time, biotransformation, metabloism and a few hundred other factors might play a role." That all goes back to amount given. If the patient responds appropriately (i.e. neuro checks, etc) with propophol, then it is still CS. As far as my quote: "lets face it who doesn't know how to use a nasal or oral airway or bag somone" - My point being, I have seen people get to that point after just 1mg of versed. So the person there better be able to know how to do these things, not to mention anything else neccessary that may occur. Maybe my initial wording was not correct. The CRNA thing was directed at, SONNY who said: "Maybe the wave of the future is to train RN's to give these drugs previously only given by anesthesia providers......" __________________________________________________________ Spidermonkey - One thing I have to wonder about your posted incident. If the doc is yelling to give more and more, and the person was not comfortable with it, they should not have. A common side effect of fentanyl when given to quickly is muscle rigidity, most common the chest wall. Fortunately, I have anesthesia available within 90 seconds. That's all Im saying, didnt mean to stir the pot. Have a nice new years all!

True for all of the above. However, despite a hospital being a bussiness it needs to consider the staff and other issues. At the same time, I know they are being crunched by the insurance companies and medicare. Which at times seems to be nothing but a big game to avoid payouts. Initially you had to decide if a patient was being admitted to observation or as an inpatient. Then once everybody became in the habit of getting this down right, they change it again. Saying, you must say "admit to observation" or "admit as inpatient". This gave people time to screw up, and a reason for insurance companies not to make payment. Then they changed it to "assign to obersation" or "assign to inpatient". Once again, it took physicians months to remember this and get it right. If it's not writen exactly like this, then no pay from the insurance co. or medicare. It's their way of trying to avoid payment. The end result of patient care, is money and profits. It's really a bummer. Something needs to be fixed somehow? Otherwise I think it will get to the point where only the rich, and the congessmen/senators with their "Golden Plan(s)" will be able to get sick and not go bankrupt. If it gets like that? Hospital settings will be 10 times in worse shape. P.S.- the latest way to avoid payment and punish the health care facilities. Check this out................ Pt's with pre-op ABX ordered, inp, outpt, or ER. They must receive their ABX exactly as ordered. (i.e. in most cases 1 hour pre-op). 2 things must apply: A) - If not given exactly 1 hr pre-op. they will not pay for it, or any infection tx that may occur after surgery. The problems with this are: Delay in surgery, d/t problems with the prior case. ER never really knows when the patient will be picked up for surgery. let's face it, there is no guarentee that an ABX 1 hr pre-op guarentees no infection. So if it's given 70 minutes pre-op, or 50 minutes pre-op your screwed. B) - It has to be documented on a MAR. Outpatient stuff gets documented on their surgery center sheet, not a MAR, never has been. ER - has never used MARS, and like a surgery center would have to start using one. More good ways to avoid payout, on something that they know is near impossible to do most of the time. Including more paperwork/forms to rifle through. truly amazing.

just for the record, patient response after propophol is no different than any other drug. It is based on the amount given. In reality, you can give someone 2 mg of versed IV, and have them become unresponsive and need bagging. So that statement is a vague statement. Your answer, I have had many patients, squeeze my hand or follow a command after propophol, although some times uncordinated. Which I have seen with versed and/or narcotics also. As far as family practice guys? I couldn't answer that question. The physicians I worked with were all (except 1) board certified and trained emergency physicians. also as far as ketamine? I have only seen it used on pediatrics in the form of a sucker. Sony - that would be a CRNA.

I went to ER out of school. Despite the cries of my teachers "That's not real nursing", "You can't do that, you need experience", "they will never hire a new grad", blah, blah, blah. While when I look back, I clearly see that experience is what makes you a great nurse. Realizing after a any given situation, that incident will make you better are important also. On a 1/10 scale: 1st 6 months - learning curve is a 10. 2nd 6 months - learning curve is a 7.5 3rd 6 months - learning curve is a 4 After 2 years it's always a 2-3, you never know enough, or everything. I was hired part time 40hrs per pay (2 week period), but worked on the average of 90 hours a pay, and read in my off time, and paid attention to everything. I took my ACLS, PALS, BTLS, MICN, CEN all within 14 months. Even after everybody said wait until your in the ER for 2-3 years to take the CEN. I wanted to know all the answers to everything, all the meds and S/E's of meds, procedures, helping with procedures, and how to manage a patient on my own when the ER physician wasn't readily available. By my 3rd year, I felt I had it down pat. All of it helped immensly. Even though I'm not there now all those things have carried over to now, that give me the insight, assessment skills, and thought proccess take handle a situation. I don't regret it for a second. They were all wrong. Just remember it doesnt all come to you overnight. cya :)

Our ER is not allowed to use it, without an anesthesiologist present. So the ER docs would use versed and Demerol. Which I did not really like. To long to wear off and hit baseline. As an ER nurse I also thought propophol was a bad idea. I left ER 3 years ago to go to another department, where we use propophol fairly frequently. Also we use fentanyl about 100 times a day. Since then I have went bcak to the ER and talked to some of the physicians. Fentanyl & Versed together is an awesome choice for CS procedures. It acts fast, does an awesome job, and wears off quicker than everything but propophol. As far as propophol, I think that ttoo is a wonderful drug for CS procedures (now). It starts wearing off the minute you stop pushing it, and lets face it? It's not like people don't know how to use nasal/oral airways and ambu bags. Although if you take your time, and push it in increments it's IMO the best drug of choice for CS. But if not available or allowed, fentanyl and versed cannot be beat (and are both reversible in an emergent situation.).

Last Sunday or Monday (about 12/24/05') I had the TV on after a football game. It was something like dateline? They did a quick thing about nursing and the shortages and expected outcome. They claimed that currently the shortage of nurses is about 100,000. Based on the projections by some goverment research, it's expected to hit 700,000 by 2020. They claimed that nursing schools are all full, and that most have a 1 to 3 year waiting list to get in. They interviewed a guy, who left the aerospace industry (an engineer) after 10 years to become a nurse. He claimed there is no work for him in his prior field. They then went on to say, most people view nursing as bed bathes and bedpans. Which we all know is not even remotely accurate. they then said, it's much more than that. Then the story was over without elaboration. Again the media leaves out so much info. They failed to mention, that many of the new grads coming into nursing get back out within 5 years. While the shortage continues, hospitals send people home when slow, and expect them to come running back when they are busy. At least from what I have seen, it seems everybody is prn in reality. Yet, hospitals talk about recruitment and retention. It seems many have went from the "It's about the patient" to "It's a bussiness". I think that those people who get into nursing really, don't realize what a money dumping pit a hospital can be? When it's time to make up for that, staffing or hours get cut. If a floor gets closed down for weeks, due to low census. Those nurses don't get the hours they need. Then when they need them, there not there to come back. This all happens while a hospital talks about retention. Unfortunately, I personally have not met or heard of any independently wealthy nurses, whom do this for fun. Budget cuts are expected every year (while the cost of inflation and products go up). Productivity is always expected to be high. However, some non nursing financial whiz has devised a formula that decides how this works. While other hospitals do not even have things like productivity. A lot needs to be fixed. It would be nice to ahave the media address "the rest of the story" Have a nice day!!! :spin:

Last Sunday or Monday (about 12/24/05') I had the TV on after a football game. It was something like dateline? They did a quick thing about nursing and the shortages and expected outcome. They claimed that currently the shortage of nurses is about 100,000. Based on the projections by some goverment research, it's expected to hit 700,000 by 2020. They claimed that nursing schools are all full, and that most have a 1 to 3 year waiting list to get in. They interviewed a guy, who left the aerospace industry (an engineer) after 10 years to become a nurse. He claimed there is no work for him in his prior field. They then went on to say, most people view nursing as bed bathes and bedpans. Which we all know is not even remotely accurate. they then said, it's much more than that. Then the story was over without elaboration. Again the media leaves out so much info. They failed to mention, that many of the new grads coming into nursing get back out within 5 years. While the shortage continues, hospitals send people home when slow, and expect them to come running back when they are busy. At least from what I have seen, it seems everybody is prn in reality. Yet, hospitals talk about recruitment and retention. It seems many have went from the "It's about the patient" to "It's a bussiness". I think that those people who get into nursing really, don't realize what a money dumping pit a hospital can be? When it's time to make up for that, staffing or hours get cut. If a floor gets closed down for weeks, due to low census. Those nurses don't get the hours they need. Then when they need them, there not there to come back. This all happens while a hospital talks about retention. Unfortunately, I personally have not met or heard of any independently wealthy nurses, whom do this for fun. Budget cuts are expected every year (while the cost of inflation and products go up). Productivity is always expected to be high. However, some non nursing financial whiz has devised a formula that decides how this works. While other hospitals do not even have things like productivity. A lot needs to be fixed. It would be nice to ahave the media address "the rest of the story" Have a nice day!!! :spin:

Last Sunday or Monday (about 12/24/05') I had the TV on after a football game. It was something like dateline? They did a quick thing about nursing and the shortages and expected outcome. They claimed that currently the shortage of nurses is about 100,000. Based on the projections by some goverment research, it's expected to hit 700,000 by 2020. They claimed that nursing schools are all full, and that most have a 1 to 3 year waiting list to get in. They interviewed a guy, who left the aerospace industry (an engineer) after 10 years to become a nurse. He claimed there is no work for him in his prior field. They then went on to say, most people view nursing as bed bathes and bedpans. Which we all know is not even remotely accurate. they then said, it's much more than that. Then the story was over without elaboration. Again the media leaves out so much info. They failed to mention, that many of the new grads coming into nursing get back out within 5 years. While the shortage continues, hospitals send people home when slow, and expect them to come running back when they are busy. At least from what I have seen, it seems everybody is prn in reality. Yet, hospitals talk about recruitment and retention. It seems many have went from the "It's about the patient" to "It's a bussiness". I think that those people who get into nursing really, don't realize what a money dumping pit a hospital can be? When it's time to make up for that, staffing or hours get cut. If a floor gets closed down for weeks, due to low census. Those nurses don't get the hours they need. Then when they need them, there not there to come back. This all happens while a hospital talks about retention. Unfortunately, I personally have not met or heard of any independently wealthy nurses, whom do this for fun. Budget cuts are expected every year (while the cost of inflation and products go up). Productivity is always expected to be high. However, some non nursing financial whiz has devised a formula that decides how this works. While other hospitals do not even have things like productivity. A lot needs to be fixed. It would be nice to ahave the media address "the rest of the story" Have a nice day!!! :spin:

Last Sunday or Monday (about 12/24/05') I had the TV on after a football game. It was something like dateline? They did a quick thing about nursing and the shortages and expected outcome. They claimed that currently the shortage of nurses is about 100,000. Based on the projections by some goverment research, it's expected to hit 700,000 by 2020. They claimed that nursing schools are all full, and that most have a 1 to 3 year waiting list to get in. They interviewed a guy, who left the aerospace industry (an engineer) after 10 years to become a nurse. He claimed there is no work for him in his prior field. They then went on to say, most people view nursing as bed bathes and bedpans. Which we all know is not even remotely accurate. they then said, it's much more than that. Then the story was over without elaboration. Again the media leaves out so much info. They failed to mention, that many of the new grads coming into nursing get back out within 5 years. While the shortage continues, hospitals send people home when slow, and expect them to come running back when they are busy. At least from what I have seen, it seems everybody is prn in reality. Yet, hospitals talk about recruitment and retention. It seems many have went from the "It's about the patient" to "It's a bussiness". I think that those people who get into nursing really, don't realize what a money dumping pit a hospital can be? When it's time to make up for that, staffing or hours get cut. If a floor gets closed down for weeks, due to low census. Those nurses don't get the hours they need. Then when they need them, there not there to come back. This all happens while a hospital talks about retention. Unfortunately, I personally have not met or heard of any independently wealthy nurses, whom do this for fun. Budget cuts are expected every year (while the cost of inflation and products go up). Productivity is always expected to be high. However, some non nursing financial whiz has devised a formula that decides how this works. While other hospitals do not even have things like productivity. A lot needs to be fixed. It would be nice to ahave the media address "the rest of the story" Have a nice day!!!

ya........... $325 before taxes, paid out 3rd qtr of each year. That's it.........

This has happened at our ER a few times already. Although usually, it's the person that comes in by themself, doesnt register and does it in the waiting room.

I have pushed many different things, over and over. I almost never dilute, with the exception of ABX, Dopamine, Dobutamine, Dilantin, Levaphed, tPA, and nitro. Stuff that is meant to be on a drip or over 30 minutues or longer. The more important thing is? What can it do to the person if it is pushed? The bottom line is if you push it slow enough, it shouldn't matter? The only thing that I diluted that didn't need to be was compazine IV. basically, we has seen a lot of extrapyramidal effects (EPE) with compazine. Allegedly that comes from the rate of infusion. So I threw it up in 100cc bags for a few months, but doing that did not change the frequency of EPE.

I have seen it twice in almost 10 years between ER and pacu. It is genetic, but the individuals do rarely show signs or symptoms. For those who do, there really isn't much treatment to my knowledge. However, it is NOT a malignancy. rather just kind of a pain in the butt.

We all have those days. I have been there myself. Unfortunately, the hospitals nowdays expect all patients to be plaeased and happy with their service. All this reguardless of staffing and any other emergencies that take priority. Budget, budget, productivity, and yet they want you to run your butt off to get it done, even if it's not humanly possible. Even though off the subject, anybody can die from asthma. I know I have it my whole life, and I think most people overlook it and dont think of it as a potentially "fatal disease". It always hits everybody worse when its a kid though. Good luck and hope ou feel better, venting and getting input. me:)

I find it intersting that someone else has actually noticed this issue. As a former ER nurse, We received all types of bashing from the floors and units. It happens that some say it openly, either not knowing, or knowing an ER person is there. But I think you are right on, mostly ignorance. I will say, one person bashed us up and down all the time. A tele nurse, who 3 years later came to the er looking to get a job there. No job for her though. I don't think the staff would have been very accepting of her. Most have no idea what its like. The floor nurses in general thought when we were on diversion, it meant the hospital is full, and we were sitting around wathcing tv, eating having a party while we wait to re-open. That thought clearly verifies and clarifies ignorance is to blame. Nice thread though! Have a nice day!:) P.S. -one last note, coming out of school into the ER. My instructors told me, ER nursing is not REAL nursing.