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.

we had a similar situation with a doc. he was a specialist, who was very influential, and made it clear he was to be the ONLY specialist in this particular field who took er call. well the politics of THAT worked for 20+ years, until we absolutely needed him for a very sick pt. turned out she had nec fasc, and needed emergent surgery. he refused to come in. our docs called everybody else under the sun, none of the other docs would see her as she really needed this other dude. there was a group with the same special as said "doctor" but they did not have OR priveldge at our hospital but a nearby sister hospital, and they agreed to get the OR ready at the other hospital, but we had to transfer her. she died the next day. he lost his privelges, not only at our hospital, but at all the hospitals within this system. eventually these "influential" doctors let their egos do the talking and get themselves in trouble. hang in there. the tides DO change.

many years ago i worked a neuro science/surgical unit. we had 4 rooms all with cameras that were for our seizure pts. they were on 24/hr eeg monitoring. they also had a button they would hit if they had an aura, or the monitor would go off if it sensed a spike in the eeg. if we were in the room and noticed a seizure we would then "task" them for the cameras. this would enable the neurologist to pinpoint exactly where the seizure was coming from in the brain,thus ruling IN epilepsy. it also was a way to rule out epilepsy. trust me i have seen some pretty fake looking "real" seizures and some pretty real looking "fake" seizures. I have taken care of people dx for years with pseudo seizures and then after 24 monitoring were dx with partial complex epilepsy. however,75% or our pts were diagnosed with pseudo aka non epileptic seizures. those people were then referred to neuro psych. most of them were put back on neuroleptics. I really hate the term pseudo seizure. it implies that the person is consciously faking it. i prefer the term non epileptic. many of the people diagnosed with this do not realize that they are doing it. with that being said, there are those that are doing it for other reasons. such as serious psych issues. with that being said, there are ways to tell a true generalized tonic clonic vs "faked" 1)they always drop their sats and usually turn an icky shade of grey/blue/purple 2) there is usually some sort of post ictal state 3) they may become incontinent, or have tonic related injuries, i.e. tongue bleeding or muscle soreness after. 4) their lab chemistries, and even abg are totally out of whack the only way, inmho to truly diagnose epilepsy vs non epilepsy is the 24 hour monitoring. doctors cannot predict when and if one is going to have a seizure, even if it is sleep deprived, unless while getting the eeg, they say or do something to imply that they are having one. at this point they will be able to see disturbances on the eeg. hope this helps

i have something to say about this. i am an er nurse at a level 1 trauma center in my city. i am a nurse at work and work only. i dont wear my scrubs when off. i dont stop for accidents when off, especially when i see the big trucks with the blue and red swirly lights. and i certainly do not tell strangers i am nurse when i am off. after 17 yrs in this "business" i have learned not to take my work home with me. been through burn out a couple of times. the question is, am i a saint because of my profession. the answer, HELL TO THE NO. I enjoy going out with my friends and having a few cocktails every now and then. if people think because you are a nurse and should be held to a higher standard, they are sadly mistaken. we are human too. am i suppose to say, i want a different banker because i saw him out last night and he really got lit. nope, i guarantee nobody does that. i gotta tell you, with the economy the way it is, i want my financial advisor to be stone cold sober all the time. i dont want him investing my money in madoff schemes. imagine this, you are out to dinner with whomever, and you notice at the next table a couple who are drinking and being loud. you think to yourself, wow i hope they are taking a cab home. the next day, you walk in the room, and your patient is the dude from the night before. he is complaining of upper abd pain and vomiting, he says to you "it is my pancreas pain" do you ask somebody else to be his nurse or better yet, come back an hour later with his iv fluids and dilauded. you know, make him wait a bit longer cause he did this to himself. NO you dont, you quickly get iv access fluids and pain meds. get him better, treat and street, or admit. then you send him on his way with substance abuse resource material upon discharge, knowing he will promptly throw away. my point being, none of us should take ourselves so seriously that we lose sight of WHO we are. not WHAT we do.

ok, had one this am at 0650 "sour trout and shest" huh?????? went in the room with iv and labs ready to go thinking she was a puker. NOPE not even close. her complaint-sore throat and cough. have not a clue what "shest" was sposed to be.

you really need to check with the facility that is running the labs. i work at one place blood etohs are off a red top, another that it is off the purple. one place i work tall purples are t&s's another it is a pink. if you ask the lab they will more than likely have a chart for you. hope this helps

we have a strange float policy, it correlates with bonus shifts. we get so much extra money if we sign up for extra shifts,/hours it averages out to 10 dollars extra per hour. $40 for 4hrs $60 for 6hrs and $120 for 12 hrs. we get that money regardless if we are needed. if we sign up for a bonus shift and get put on call and get called in, no matter how many hrs we are there we get time and a half for that many hrs we work. same with if we are scheduled and get put on call. ok, if we work our bonus shift, that counts as a float day. if the icu does not need us and tele, or bmt needs us, (those are the only places we float to) and there are no travelers on, we are asked if we would float. if we say no, then we lose the bonus money. it rarely happens. the other thing, travelers ALWAYS float first. regardless whether it is their turn or not. when only reg. staff is on, and we are overstaffed enough to have at least one person on call. we take turns floating. they wont float us if we do not have one or two admit spots. rarely do we actually float, but it does happen. I am actually looking forward to floating. it will give me a chance to meet other people in the hospital.

wow, i am going to have to try the laser pointer as well. we use the old bulky carpenter levels. i did my internship in a different icu, they had the transducers that were attached to the pts arms. do those of you who use those, have any problems with them.? how about cost?

lmao, i just got my flu shot and boy oh boy, i am really debating which hurts worse, tetorifice or flu. lol

most of our rooms are private. however, we have 4 rooms (two on each side of the nurses station) that are divided by a curtain. when all hell is flying, sometimes we have 4 pts in those rooms, however most of the time it is one. i love those rooms for pts on cvvh, iabp, 16 thousand pumps, vent, cco monitoring, ..... so basically we convert our semiprivate rooms to one huge icu room for the sicker than snot pts.

we have a special probe for the forehead. those seem to be the best for our pickers, and wiggle worms. we have the disposable ones for the fingers. and depending on hgb, or if they are a vasculopath, they simply dont work. cant get a pleth with an accurate reading. try the forehead, see if it works for you. good luck.