NativeSundance

TNCC is strictly for ER nurses and is not open to paramedics, doctors, PA's or any other non nursing personnel. It is a course designed by ENA and your certificate is issued through them. It is much different than ACLS, PALS, NRP, NALS, BLS or any of those types of certifications. ENPC is the (sort of) pediatric version of TNCC. I enjoyed the course and have found it useful in my every day job. We get plenty of trauma in my ER and the TNCC fundamentals are put into practice constantly. If you work in an ER, TNCC will be valuable to you.

I am SO glad to find this still lurking on the pages of AllNurses!! I have been looking for it in my old files for weeks to no avail when I remembered posting it here so long ago! Way To Go AllNurses for having such an extensive file storage vault! Now, if I could only find the one about 10 insane medical practices of yesteryear...

Our ER has seen far fewer cases than normal of RSV this year....BUT...the ones we have seen were very bad cases with intubation common. Not sure what is going on with the bugs, but this year when they strike, they strike HARD and FAST.

Would LOVE to hear from someone who has taken this exam. I know it's early on, but hundreds have taken it already. Anxious to hear opinions of it and what was used as study resources.

Have any of you signed up for this new exam yet? If so, what study resources did you use? Has anyone actually taken the exam? Can't remember when in January they were offering the first one. I plan to take it mid summer or so...after they have road tested it for a few months! Looking for study resources. Ours is not specifically a peds ER, but we sure get plenty of kids. I think this certification would be beneficial. My hospital, of course, will not recognize this certification any more than they do my CEN, but I still think it is worth it for ME. I won't be working at this hospital forever...

We have hourly "comfort rounds" and also walking rounds at shift change. They are Nazi's about it too. No excuse...like I had another pt circling the drain...was busy tubing in another room, doing bilat chest tubes... etc, etc. If I have time, fine. When I don't then so be it. Meeting unrealistic patient expectations is a hopeless adventure. My hospital expects us to have the patient experience a "5 star hotel" type er visit. No kidding...that was literally in the memo. Just no way to please all the folks all the time. It is an ER, not a hotel. Yes, we have blood, vomit, stool, spit, screaming, cursing, and so forth going on at all times. Bet that doesn't happen in a 5 star hotel.

i'm so glad someone caught the message there! yep, the problem was indeed the "kvo" part of the order. not a good plan for hhnk patients! stupid doctor couldn't manage to tell the difference between dka and hhnk.

We also were required to watch the fish video during orientation and encouraged to find ways to have fun at work. The reality is, however, that we are to crank out the healthcare at breakneck speed juggling impossible assignments under ridiculous circumstances. There is no room for "fun". We're just trying desperately to hang on to our license for one more day. We are expected to provide service as if they are at a 5 star hotel. No kidding, we had a mandatory inservice telling us so. Of course, they will provide no tools or additional personnel to acheive this goal and God help you if someone actually COMPLAINS about their service. We also recently received a memo stating that laughter cannot be tolerated in the workplace as it sends the wrong message to the patients...as if we don't care that they are sick or suffering. How dare we enjoy even a moment of our shift when their dilaudid might just be delayed for 3.5 seconds. :smackingf

This was clearly HHNK, not DKA. Many of our doctors don't know the difference. They'll call HHNK something crazy like DKA although the s/s are markedly different. One of the only thing they have in common is an elevated BS. HHNK folks need fluids, fluids, fluids and then fluids. And then they need more fluids. They are often many liters behind in fluids. For our doctors that can manage to tell the difference, we start with ns and move to 1/2 ns to get the cells hydrated. HHNK is lethal if not managed quickly and efficiently. Much worse in the short term than DKA. Potassium level is very important to DKA patients, but not as much with HHNK patients who are NOT acidotic. Insulin gtts take a back seat to fluids for HHNK patients. They will get one eventually, but it is more important to get the fluids going and get the cells rehydrated. The fluids alone will help drop the BS. And an ER diagnosis of "new onset DM" for a HHNK patient is ridiculous. :chuckle

One of my personal favorites is an order for KVO fluids on a patient with a BS of 984 and clearly HHNK. Dx: "new onset DM". Sigh...

Our ED requires: BCLS, ACLS, PALS, TNCC. Prefers the addition of NRP, ENPC,and CEN. BCLS, ACLS and PALS should be mandatory in ANY emergency department that serves the general population. Some ER's have seperate adult and peds treatment areas so those may have different requirements (for example, no PALS in adult areas or PALS and NRP in pediatric areas). Also, most trauma centers will likely have TNCC as a requirement. CEN is a plus for you as an RN in ANY emergency department. Even if your hospital does not officially "recognize" the credential, the knowledge you gain from studying for and obtaining your CEN will be beneficial to you, your department, and especially your patients. Also: I don't know if there are STATE regulations for credentialling in the ER's. I think it is hospital specific depending on what they want to pay for and the population/level of care that they provide. Some hospitals may have minimal requirements because they have to pay for the course and your time to take the "required" classes.

We had quite a debate about the administration of blood products the other night at work which became unusually heated. So I put the question out to all of you... How fast do you run your prbc's? What type of tubing do you use? What size of angiocath do you run it through? This subject in particular was hotly debated. Stable patient in over 3-4, unstable as fast as you can. Special blood tubing that has it's on filter and so you can run ns with it. At least a 20 is recommended but can run safely 22 how fast do you run your ffp? What type of tubing do you use and through what size angiocath? Do you use a pump? Ffp can ran as fast as you want, still use blood tubing. Pump is optional, same size angio as above How fast do you run your platelets? What type of tubing do you use and through what size angiocath? Do you use a pump? This subject was also hotly debated. Platelets can just be run in as fast as they will go often just by gravity. Still use blood tubing Do you feel there is any difference in cell integrity when running your (trauma-emergent) blood in using a pressure bag as opposed to using a rapid infuser/warmer? As long as the vein is good, no problems It will be interesting to see what some of your opinions might be!!

I took and passed CEN last September. The test is challenging and has a high fail rate, but is IS worth the effort! I bought Laura Vonfrolio's DVD's and also MedEd. I can honestly say that Dr. Laura's DVD's were very entertaining and interesting, but they are OUTDATED! Many things have changed in our happy world of nursing since those DVD's were made. Nonetheless, I did brush up on things I hadn't thought much about lately and it was helpful in my overall practice and probably helpful on the exam. The MedEd CEN review was EXCELLENT and CURRENT. It has the most recent CEN changes and the speaker was informed and engaging. I bought the new CD ROM version and still use it to review things from time to time. They have a pass guarantee with a purchase of the program. Using this program, I got a score of 139 out of 150 questions. Missed 11 of them. 25 questions on the exam are trial questions and there is no way to distinguish them from the rest of the questions so you really have to give every question your best effort. 175 questions and 180 minutes to take the exam. Roughly 1 minute per question. I also bought the newest version of the ENA Core Curriculum and leafed through it, but didn't embrace it totally. Bought the ENA CEN Review, which was a little dated, and used that heavily. Also went online to the ENA site and took their practice tests (175 questions each, I think) that were included in the cost of the review book. You get 3 tries with each of those two tests. All of it was just review and practice. Worked out well enough for me in the end though! My hospital does not recognize CEN certification so for me it was a matter of doing it for the personal satisfaction of acheiving this goal. There was no pay raise involved nor was the cost of the review programs a covered expense. I spent roughly $1000.00 in study resources and exam fees to reach this goal and I do not regret it. Good luck to all of you who are studying for this exam!!!

Drat...it didn't show the pictures. They are hilarious and worth your time to go look at!

this is posted here for your amusement. these are actual medical treatments of yesteryear! the 10 most insane medical practices in history by nathan birch have you ever been left with the impression after a thorough poking, prodding and testicular cupping at the doctor's office that perhaps they don't always know what's best? the thought is usually pushed from your mind, after all these people had to go through years of school and thousands of dollars of their parents' money to get where they are! if you can't trust them about your health, who can you trust? here's the thing though, doctors have a long storied background of not knowing what the hell they're doing. history is filled with stories of hilarious medical ineptitude, and in all likeliness, today's medical practices will be similarly snorted at 100 years down the road. in other words, if you're looking to justify your medical phobia so you can rationalize not getting that ever-growing lump on your neck checked out, you're in the right place. #10. children's soothing syrups in the 19th century, people were simply too busy churning butter, waxing their moustaches or changing in and out of 15 layers of undergarments every time they went to take a piss to be bothered with disobedient children. to aide the stressed 19th-century mother, a series of "soothing syrups," lozenges and powders were created, all which were carefully formulated to ensure they were safe for use by those most vulnerable members of the family. oh, no, wait. actually, they pumped each bottle full of as many narcotics as it could hold. for instance, each ounce of mrs. winslow's soothing syrup contained 65 mg of pure morphine. based on our experiences teething and experimenting with pure morphine, that seems like a lot. finally in 1910 the new york times decided the whole narcotic-babysitter concept was probably bad in the long run, and ran an article pointing out that these soothing syrups contained, "...morphin sulphate, chloroform, morphine hydrochloride, codeine, heroin, powdered opium, cannabis indica," and sometimes several of them in combination. you can't say the soothing syrups weren't effective, as long as you didn't mind your toddler being strung out on the midnight oil or, you know, dead. that's right, the terrible 2s weren't just a cutesy euphemism back then. kids were not only at their brattiest but also often died, in many cases after their parents tried to cure the aforementioned brattiness with narcotic concoctions that would give anyone a nose bleed. #9. the curative powers of mercury mercury is pretty neat stuff. the shiny silvery liquid has fascinated humans for millennia (there's evidence people used it as early as 1500 bc) and will undoubtedly continue to fascinate far into the future. how could something so awesome not be good for you? that was the thinking for centuries, when mercury was used to treat pretty much anything and everything. scraped your knee? just rub a little mercury on it. having some problems with regularity? forget fiber, time to get some mercury up in there! if you lived more than 100 years ago, you simply weren't considered healthy if you weren't leaking silver from at least one orifice. mercury, as we now know, is toxic as hell. symptoms of mercury poisoning include chest pains, heart and lung problems, coughing, tremors, violent muscle spasms, psychotic reactions, delirium, hallucinations, suicidal tendencies, restless spleen syndrome, testicular twisting and anal implosion. ok, we just made the last few up, but they barely looked out of place on that horror show list of symptoms did they? it's a testament to just how cool a substance mercury is that people kept trying to cure ailments with it for 1,000 years after everybody who ingested it dropped dead. "yes my lord, i'm afraid another member of your court has perished. the autopsy showed it was silver liver syndrome. not even the gallons of wicked-awesome mercury we fed him could bring him back to health." there was a silver lining, though, as it helped to fight the spread of stds. mercury was used as a cure for syphilis and to its credit, the "cure" usually resulted in one less person with syphilis in the world. it's generally believed mozart was poisoned by mercury-based syphilis cures, which contradicts the film amadeus in which he was killed by writing too much music somehow. #8. calm your cough with heroin in the late 19th century people apparently took cough suppression seriously. we're talking "i'm-going-to-take-me- some-heroin-to-calm-this-cough" level serious, here. we know victorians were sticklers for social etiquette and wheezing your head off was probably considered frightfully rude, but we can't imagine tying off and shooting some horse in the middle of a dinner party would go over terribly well, either. well you probably don't need us to tell you how addictive and destructive a drug heroin really is, but just in case ... heroin? might want to avoid that stuff. on the upside, it actually does suppress coughs, so if you do decide to become a junkie at least you'll save on buying halls. heroin, by the way, was originally developed by bayer. you know, those friendly folks behind harmless old aspirin. oh, and while we're taking on the man, we should also mention that bayer used to be called ig farben, a pharmaceutical and chemical conglomerate that allegedly sponsored experiments by nazi torturers. #7. electrical impotence cures men have been desperately searching for solutions to their malfunctioning members since grok the caveman clubbed a cavewoman, drug her to his cave only to drag her back out again a half hour later with an embarrassed look on his face and muttering excuses about how tired he is. in the late 19th century, the wonders of electricity became to be known to the common person. surely this marvelous new technology could be used to heat things up in the boudoir, right? electrified beds, elaborate testicle shocking electric belts and other strange devices were advertised as being able to return "male power" and prowess by making your member rise to electrified attention. what's fascinating is that you can find ads for more than one brand of electric genital-shock belt. that seems to indicate that the genital-shock belt industry somehow survived the negative word of mouth from the first genital-shock belt. by "word of mouth," we mean the incoherent screams of the first customer which could presumably be heard in the next town. #6. lobotomies imagine if you will. you're sitting on your psychiatrist's couch, pouring your tortured heart out about how depressed you are. he listens, jotting notes on a piece of paper and nodding intently. "i think i have the solution to your depression," he says as he produces a 10-inch-long ice pick. "i'm going to jam this into your eye socket, then put it into your brain using this mallet over here. then, i'll wiggle it around so that it shreds part of your brain. then you won't be depressed any more. just lie still." congratulations hypothetical version of yourself living in the 1940s, you've just been lobotomized! lobotomies were a popular fad for the first half of the 20th century and were floated as a "cure" for pretty much any mental issue you can name, from conditions as serious as schizophrenia to something as mild as depression or anxiety. the inventor of the lobotomy was given a nobel prize for it in 1949. doctors claimed the "ice-pick-to-the- freaking-eye" method of lobotomy would be as quick and easy as a trip to the dentist. by 1960, parents were getting them for their moody teenage children. this practice didn't hang around as long as some on our list, but still some 70,000 people were lobotomized before somebody figured out that driving a spike into the brain probably was not the answer to all of life's problems. #5. urine therapy you can tell just by the title of the entry that we're not heading anywhere good with this one. yup, throughout history there are those who believed the key to good health (and terrible body odor) was wallowing in one's own excretions. it was said to cure an endless list of ailments and promote good health if drank, was applied to the skin and yes some even used it to give themselves (turn away now weak-of-heart) a nice bracing urine enema. perhaps the best part of this is that while most of the practices listed in this article have long since been dismissed as lunacy, urine therapy lives on to today (for your own sanity don't do a google search for it). that's right, of all the crackpot theories listed here the one that endured is the one where people drink and bathe in urine! there's absolutely no evidence that urine therapy can cure a damn thing (and it comes with the added bonus of you getting to smell like the underside of a bridge or a downtown subway car). on the bright side, armed with the new knowledge we've provided you, you can now try to pass those dvds your girlfriend found in your closet off as medical instruction videos. #4. bloodletting bloodletting was one of the most enduring and popular medical practices in history, originated by the greeks and used up until the 19th century for, well, basically everything. if you were feeling under the weather back in the day there's a good chance it was because you just had too much damn blood. now, a person having too much blood may sound about as absurd as a person breathing too much air or you coming home to find too many naked supermodels in your bed. but, that's just because you don't know about the four humours. don't worry, we won't hold your ignorance against you. basically the theory was that the body was filled with four fluids (blood, phlegm, yellow bile and black bile) called humours and that any imbalance in the four was the root of all illness. apparently blood can be a bit of a space hog and thus often some had to be bled out to make room for more fun stuff like phlegm and black bile (a.k.a. diarrhea), or so the theory went. if you're wondering whether or not it works, the next time you're on your death bed with the flu, drag yourself out of bed and go downtown and give anywhere up to 4 quarts of blood; that's bloodletting for you, except you usually didn't get orange juice and a cookie after. now, there is a chance you'll feel a bit better as you take a delirious blood loss inspired trip through the clouds on a golden unicorn, but we can assure you your flu probably won't be cured. #3. hard core diet remedies while fuller figures have been popular for most of history, during the 20th century thin was in for women (which explains why it's known today as the "no fat chicks" century. well, at least by us). this need to be slim led to the creation of countless "diet pills" that promised to help you melt away those pounds and inches. while a lot of the pills actually did help with weight loss, they also often caused fevers, heart troubles, blindness, death and birth defects. they couldn't have been all bad though, as in the 1950s and '60s women who took diet pills liked them so darn much they just couldn't seem to stop taking them. of course, it might have had something to do with the fact that the diet pills of the '50s and '60s were in actuality bottles of pure crank. but hey, what's getting addicted to amphetamines when being ready for bathing suit season hangs in the balance? oh, and since we just can't resist grossing you fine readers out, there have long existed stories that in the 1920s and '30s capsules filled with dehydrated tapeworms or tapeworm eggs were sold as diet pills. there's some debate over whether these actually existed, but it seems like it could be true as various advertisements for the wormy pills have survived. #2.trepanation trepanation is a fancy word for drilling holes in your head. this is actually the oldest surgical procedure known to man as humans have been intentionally knocking holes in their skulls dating back to the time of cavemen, giving hope to anyone who's had to watch the sitcom starring the geico cavemen that all of them might die in a trepanation experiment horribly gone wrong in an upcoming episode. historically trepanation was most commonly used as treatment for seizures and migraines. surprise, surprise. having a gaping hole drilled in your skull (usually without anesthesia) did very little to help people's headaches or brain issues. trepanation was also used as an extreme form of cosmetic/experimental body modification amongst several societies such as the incans and mayans. these societies also got largely wiped out, then a few hundred years later suffered the indignity of having an insulting movie made about them, so it didn't really work out that well. oh, and yes, a few brilliant individuals still practice trepanation to this day. to give you an idea of the oh-so-solid ground today's trepanation supporters' beliefs are built on, the biggest modern proponent of trepanation is a "doctor" bart hughes. we put doctor in quotations marks because he never actually finished medical school. that's right kids, you, too, can be a college dropout and yet still go onto a career convincing people around the world to do incredibly retarded things, so reach for those stars. #1. female hysteria cures women and their mood swings, right guys? right? you know what we're saying. now, if you happen to be female don't be offended, there's no shame in admitting to the occasional bit of moodiness as according to 19th century doctors it's a symptom of a deadly serious medical condition (along with other symptoms such as nervousness, irritability and the dreaded "tendency to cause trouble"). that's right ladies, you may be a victim of female hysteria and not even know it. so, how exactly do you cure a so-called "condition" that coincidentally was diagnosed almost entirely to women who dared disobey their victorian husbands? glad you asked. the prescription for female hysteria was usually a good spot of doctor administered lady partsl massage until the woman achieved "hysterical paroxysm." yes that's right, the cure for female hysteria was a doctor's hand down your bloomers until you weren't only thinking of england but screaming its name. is it any wonder the list of symptoms for female hysteria was so long, literally any ailment could fit the diagnosis? in those sexually repressed times visiting the doctor's office must have been like a trip to disneyland for most women. doctors of the day on the other hand were apparently, i don't know, weird or something since they actually objected to women's frequent desire to be "cured" by their magic fingers. their solution to alleviate hand strain? they invented the vibrator, and thus this article comes to a happy ending.