traumarns

"Setting yourself up for a huge liability issue! I hear the word "SUE" really come into play here!!!!!!! Like others have mentioned, the results of a fall, or other injury can be easily seen witht he naked eye, or much more minute. For instance, today we had a very seasoned ER doc tell a pt that the CT brain looked ok after a fall, however, after we received the official radiologist read result, a subarachnoid bleed was noted! So NO, we will not de-board someone before an MD sees them. We will board someone who needs to be without a doc becuase that is part of our responsibility." what the heck does sah have to do with spinal immob?? and back boards?????? so lets just say the dude had a compression fx of lumbar- would you keep him on a board???? or better yet put him back on one? cant stay on one forever- cant go to the floor on one-

i loved the question "are you a clean person" i answered, "yes, that is why i hire somebody to come to my home once a week and clean up after me" some of the questions i just giggled through, by the end of the process, my interviewer was giggling too. dont be nervous about it, the questions are pretty harmless its not a "test" per se.

our techs who are paramedics or emts with acls, or equivalent go with tele pts anywhere on the monitor. a nurse and tech go to the icu. any intubated sedated pt gets a nurse and a tech.

i love my pre-ictal pts, dont like my incarceritis pts and the all time fav tdfd (too drunk for detox)

seen the "heebie jeebies" with comp, phenergan, reglan and low dose inapsine. if somebody has a rx with one of those and has never had the others, i always get order for benadryl, or just zofran. (can give pretty high doses of zofran) when all else fails we give ativan or valium. when that doesnt work, they buy a bed upstairs and let the admit docs figure it out. love HIGH dose inapsine, specially for our out of control intoxicated peeps, no heebie jeebies, just night night.

our trauma protocol-level 1, must be taken off the backboard within 15 mins of arrival. there are situations when the pt cant come off board wihin that time, ie- 6 alerts and 1 activation all rolling in at the same time. we MUST document when they come off the board, that is to maintain our trauma designation. (when the trauma surveyors come in we can get dinging for it) we DONT take them off unless the doc is in the room, to palpate back. it takes a couple of minutes to remind the doc-"hey this guy is still on the board" we dont take off c-collars. the doc does that. my fav is when the pt chews his collar off- thats always fun. our ems are mostly using scoops. the back board does nothing to maintain spine precautions, all it does is cause skin breakdown. remember you are a pt advocate-get em off the board as quickly as poss. if somebody has cord compression, use a slide board for transfers. like other people have said, always check your policies.

somebody on levophed should have had a central line. was this in the er, when you dont have time to start the drip while waiting for the doc to put one in. or was this pt in the icu already? if in the icu she SHOULD have had a central line. in the ed, we go where we can, while the docs are putting in a cordis, cut down, central, anything. did anybody try an EJ?

we dont cut the arm bands off. a vast percentage of our pts live outside and need a ride to a shelter. many of the rtd drivers will allow these people to ride for free IF they have an armband on proving they were in the er.

we only get ems calls from private companies, trauma alerts/activations. and cardiac/resp arrest. other than that, they just show up. the charge takes a very quick report, and decides triage or bed. the crew then gives the full report (hopefully) to the nurse caring for the pt. it works for us.

.And with the floor leavers -- call the doc and request an order for a dose of narcan after any "unexplained absence" from the floor. You give them narcan, and tell them they'll get it anytime they leave the floor, and presto, they are ready to go home. narcan aint gonna help if hes tweeken from meth or crack. if hes high from opiates you are absolutely correct, he is not gonna be a happy camper. i would get a utox and have security search him and his belongings each and every time. if drugs found in his possession , call the po po. dude aint gonna like the pretty shiny bracelets they put on his wrists and legs.. plus he wont get to call his mama for help, or get visitors to bring him his "stuff." he will want out pretty quickly i bet your hospital has a policy re elopements- ours is if they leave campus and then reappear, they are no longer pts on the floor. they get a trip to the er. if the er docs cant find anything to admit for, they get to go BUH BYE!

just a suggestion. why dont you ask pharmacy to stock your pyxis with 4mg morphine. we stock with 2,4, and 10's it makes it so much easier, and dont have to find somebody to waist with.

1. If the pt is on the gurney naked except for a gown and SHOES- leave the shoes on!!!! there is a reason WHY the shoes are still on. (if you take them off, do NOT leave the room without putting them back on.) 2. if you see a nurse running around dripping in sweat with her hands full DO NOT pick that time to ask the nurse to put tao on the lac YOU just sutured. do it yourself. 3. get all discharge paperwork READY, including getting prescriptions signed, BEFORE writing dc on the board. the charge nurse gets a lttile peeved when there are 40 people in the wr and the er is on divert and there is a pt in the room for 30 mins waiting for prescriptions. 4. clean up after yourself.

took care of young dude who ate a 100 mcg fent patch. did the math it is about 7000 mcg of fent in one sitting. he was found down in his own vomit many hrs later. extremely high dose narcan barely made a dent. he is LUCKY to be alive, although he now has major brain damage. i hear this is the latest trend with the prescription drug addicts. if your friend is really doing this, she is lucky she has not od'd yet. that is a ridiculous amount of fent to ingest.

love t-system hate meditech dont scan meds in the er. worked at a place that used e-mar on the floors and icu none of us wanted it in the er. especially because the hospitals policy had something to do with pharmacy entering all the meds in to the computer- would be a HUGE delay in that er setting. floated to the icu several times and had to use e-mar. told my er manager if we ever went to that system i would quit. it still has not been implemented. THANK GOD

I LOVE LOVE LOVE this policy. What would make it absolutely perfect if they would add If you are awake alert oriented x 3 and cannot provide confirmable identification NO NARCS cant tell you how many time i saw pt A on monday night at one hospital, and the same darn pt at another hospital for the same darn complaint on tuesday, only this time using a different name. not to really change the subject have any of you noticed how the fliers all come in together and when the er is SWAMPED and the only way to get them out is to treat and street. when the nurses and the docs dont have the time nor the energy to argue. just give em what they want and get em out. do they call each other? do they stake out the er waiting rooms to see who is the busiest? how do they do it. there should be a study.