errn1968

This is a very important thread for ER nurses to read. I have dealt with countless fetal demise patients in the ER (at least one per week) and I can't remember us making too much of an effort to offer support to those that have come in with problems, been sent to ultrasound, only to be told they were having a miscarriage. I worked in L&D while in nursing school as a tech and am familiar with the Resolve through Sharing program (which my hospital offers). I did extend this program to one miscarriage patient that delivered at 25 weeks in the ER and brought the baby to our L&D department for photos and to initiate the "Resolve through Sharing" support. As an ER nurse however, I think I only new of this program because I worked on L&D earlier. Many ER nurses may not even know there are grief programs for patients who have had a tubal pregnancy or miscarriage. I guess one problem is that pregnancy problems at less than 20 weeks often go to the ER and not L&D where this information is available. Please pass this on to your ER nurses and maybe allnurses.com could post some of this in the ER forum, because it really is something ER nurses should extend to their OB patients. I am going to make sure I make an effort to inquire with the patient about their support system. One problem is that if the pregnancy is too early, there really is nothing to give the patient, but it may be a good idea to just tell them, "this is a difficult experience and it is important to share your feelings with your family, friends and OB doctor over the next days and weeks. If you have any problems, please call your doctor's office or L&D unit and ask about programs that can help" and maybe give them the number and name of your hospital's program or "Resolve Through Sharing" (which I believe is a national support group), on their ER discharge sheet.

Every LP kit I have ever seen has the lidocaine in it. At our peds Er, we use EMLA cream first for 30 minutes, then they use lido. We don't usually consciously sedate for the procedure. I they have trouble they have scheduled it under fleuro. But I have seen that a good dose of the lidocaine usually does the trick.

Oh, I have a great technique. You won't believe this but give the IM in a stretch mark on the butt. I swear, it works every time and I you don't have to dart it in, just smoothly go right on a stretch mark. Something is different with the nerve endings there and the skin is so much easier to get through. This tip came from my mom who was a nurse long before all of us... she is 65 now and It truly truly works...almost every butt I have seen has at least a couple of stretch marks, even the skinny people. Kids are a different story, I think speed is the key because it's gonna hurt. But please try the stretch mark technique and tell all of your co-workers it is a great kept secret.

don't know if you still need info, but in peds, the resp treatments usually start with a duoneb of alb/at but then add other things like decadron as traumarn said. Xopinex is another new resp tx med that is showing better toleration for continuous treatments, it doesn't increase the heart rate. As for your lopressor question, the stacked dose of 5mg q5min is pretty much a standard in our ER, especially for patients heading straight for the cath lab. It reduces preload and hopefully lessens the stress on the heart. As for the po dose after the 3 iv, I suppose that is just because they are using the iv as a loading dose and then are going to keep them on the po doses. I would n't think it would do much immediate good except with the intention of keeping them on the po doses regularly. Just ask one of your cardiologists. But I would bet that is the answer.

We use Ketamine for our ortho reductions, complicated lacs as well, but our docs who have to be certified in Ketamine administration only give it. We always give it with a combination of Robinal (to decrease oral secretions and dry them up) and Versed (to decrease emergence problems) and then give the ketamine. The RN gives the first two, But the MDs have to push the Ketamine and stay for the entire procedure. Ketamine admin is outside the scope of practice for an RN. Also, we wait a 6 hr npo period before they will give this mixture and absolutely... airway, suction, full monitor on and at the bedside. The ER MD will sometimes redose the Ketamine during the procedure if the patient is complaining of pain up to 3 doses. But the Robinal and Versed are the one time initial dose.

That is the consesus I'm getting, Thanks. Hope your week is going well. What hrs do you work. I work 36/week. 1pm to 1am.

Thanks, I will look at the kit labels tomorrow night. Regardless I will use a soft 5 or 8 feeding tube on the boys. And as I suspected, I will run the abx over 20, 30 min to 1 hr. I need to double check a lot of what these nurses say is ok, many of them are new grads in the last 2 yrs and may not have all their facts correct, although the one who pushes the abx have been there 10 yrs. Like I said, I had a gut feeling that several things these nurses say is ok, I wouldn't do to an adult, so they can't be ok in kids. Morale: look it up in Harriet Lane or the drug book. Thanks a bunch.

Thank you, I will take your advice and it is what I was inclined to do...gotta trust my instincts. Do you put iv abx on kids? ie: claforan 250mg over 5 minutes diluted about 10cc ns. Some of the nurses here do that for many abx and I think they all need to go over at least 15 to 30 min.

ok, that's a really goog one, gotta tell my er buds. As we er rns all know about 1/3 of our visits are for goofy stuff. Gotta love the dialysis, pulmonary edema patient who needs his Viagra refilled after we have spent thousands of $ diuresing him because he missed his dialysis. Wonder where he was" Using up Viagra? I wonder if it dialyzes out? No wonder he needs refills all the time. Same guy got his own nursing policy at our hospital, no joke, because he came to the ER too much. I also like the other names people have for ailments "vomiking" for vomit. Gotta think of some more.

Thanks, I am just learning how to reply here. I will take your advice and use the flexi feeding tube. The rigid on is what i've used on adults as well and it just didn't feel right with the kid. I need to go with my knowledge and instinct, I'm just trying to do things the way they do them but I guess I did know better. Thanks. Let me know what you learn tonight.

Thanks for respond. I did let him take a breath but felt such resistance. Do you think its ok to use thos 8fr ?semi rigid? caths or should you use a flex feeding tube. Can you perf through to the colon? or is this not possible. The screaming didn't bother me, I just didn't know how much force you could use when you hit resistance a couple of times

Joined this site for help with my change from Adult ER to Peds ER at an all peds hospital. I need someone to ask "dumb" questions. I am contract so I only had 4 orient days and their nurses tell me ask anything but I feel like an idiot at times. I have 3yrs adult ER and have been an RN for 8 years all adult. Now with the peds change I think these nurses think I don't know a thing, when I could run circles around them in the adult ER. Need some peds ER and PICU buddies to ask a bunch of questions. My first, can you hurt a male infant while straight cathing? They use those 8fr rigid predesigned kits and I know kids clamp down during a cath, but tonight I felt like I was going to go right through the kid into the rectum. Finally got it in when he took a deep breathe, but it took about 4 minutes...way to0 long to sit their digging around. The next kid, I used a 5fr soft feeding tube and it went right in...any suggestions. And please, I have other "silly" questions like this about buretrols and mixing your own meds. Oh and what is an CRP blood test for? They do this alot. .