TaraER-RN

We have two types, moderate sedation (which is usually versed and fentanyl), and deep sedation (which we can use etomidate, ketamine, propofol-pushes only, no gtt, and brevital). We have VERY strict guidelines and monitoring requirements. They are done in our code rooms, we monitor all VS including CO2, etc. The ketamine can only be used on kids up to age 12, and I have seen the docs typically giving a small dose of versed with the ketamine to help with the hallucinations and nightmares that can sometimes come with it...I have had absolutely no problems with any of the meds (knock on wood)...I actually prefer the deep sedation drugs, because like others have said, we get the procedure done quick, and the recovery time is so much faster!

We use Dilaudid so much now, I don't think our hospital will ever run out of Morphine! Lol

OK...I am super confused, I was looking at the website for this drug but can't figre out what it is....It looks like you let fluids basically infilitrate SQ instead of going intravenous, and this drug helps your body absorb it?? I can understand the rationale for then using it for an infiltrated line, but I see one poster above saying you use it for infusions? How does this work? Thanks!

We have the same situation as the original poster...our security isn't "allowed" to touch a patient...they are basically there as a visual cue, with no weapons of any sort on them. Most of them are smaller than me, and I hear they are the lowest paid position in the hospital! We, as the nurses, are the ones taking down patients...luckily I have a lot of guys on my shift so they help take care of that. But when we have had violence in our dept, all we can do is call the police...we pray nothing bad happens as we are not locked down (they say we can't be because we are the one of the main fire exits for the hospital), no metal detectors etc. How do those hospitals who have police, metal detectors etc get those things in place?

I have been an ER nurse now for almost 7 years...all of it being in the ER (I started as a new grad there). I have trained multiple new grads into our department, and truthfully in my experience it has been easier to train a new grad than a person who transfered from another area of nursing. New grads you seem to be able to mold, whereas those that come from other areas sometimes are stuck with old habits that are detrimental in the ER. That being said, that is just my experience. I know that it depends on the person...if you are energetic, feel you can multi-task/prioritize and have a good memory than the ED is for you and you should hopefully not have any problem...but if you need to build your skills and can't multi-task easily then you may want to build your skills/medication knowledge etc in another area. It really does all depend on the person...good luck!

The last couple Xmas' we got a nice fleece sweatshirt with the hospital logo on it, and then the next year we got fleece sleeveless vests with the logo (and the girls do tend to where them to work a lot--the boys not as much). I heard that this year our managers are getting us scrub tops. We also are getting a dinner/party at a hotel...not too bad (at least for those of us who don't have to work that night. I think those that are working will get a dinner catered in). Our managers treat us pretty well I think...

In our ER for new grads or for those coming from non ER backgrounds we do 40 shifts with a preceptor on the floor, plus 6 weeks (one day a week each) of a regional training class and an our facility specific class to didaticley review things.

wow...I'm really shocked to see all this...I have given phenergan probably a thousand times as an ER nurse (its our most commonly used anti-nausea drug)...I always give it diluted in the highest port, and luckily it has always been ok...I might start doing the whole piggyback thing...I will discuss it with my managers...

Hi everyone...we have been having to do med recon's in our ER for about the last 4-5 months. It has been getting easier...all we (as nurses) are responsible for is printing their med recon sheet (since I work for an HMO the patient's meds will print out as long they get them filled at one of our pharmacies), and then we are to go through the list with the pt and just list "taking or not taking" we don't have to put the last dose, how much etc...and we are suppose to list any herbals or OTC's. At that point prior to going home the ER doc or admission doc (if they went up to floor) are suppose to reconcile it and the pt gets a new sheet on discharge telling them what new meds they have, what to cont to take, and what to d/c. But we in no way are responsible for a "doctor's rationale". I have been told that JACHO likes the way we do it....

Thanks Ken...I read that article too...its actually based around what happened to that one patient in a waiting room in Illinois who came in for CP and waited to long in the waiting room and ended up having a cardiac arrest....one of the reasons that we are going to ESI so that the CP patients aren't out there waiting. Is there anybody that can tell me how their flow is in triage from the time the patient enters? I need ideas to give to my manager that will be more effecient. Thanks!

Hello....I am looking for ideas from people who work in busy ER's (greater than 130 coming in daily) on how you manage your triage flow. We just started using ESI (emergency severity index) and its important to us to have a nurse be one of the first points of contact to make sure the patient is safe to take a seat, "ok to wait", for their medical screening exam and not a priority 1 or 2 that needs to be taken immediately back. We are an HMO that uses name and medical record numbers to put people into our computer to track everything including the initial triage and MSE. But I am finding our flow just doesn't seem to be working, especially when it is busy. We have only 1 triage nurse and 1 MSE nurse, so its getting pretty backed up and people are waiting longer to get their MSE (and the patients and us are not use to the longer waits---so we are having a lot of complaints!) also with our flow we have a lot of bouncing around, and the patients getting up/down a lot to see the triage nurse, then to see the MSE nurse and then to see the receptionist and then again to go to the back. SO I thought I would like to see if anyone out there uses a computer system like this and is using ESI and how you guys manage the busy patient flow....thanks in advance!

I wanted to add this one...I kinda saw it in other notes, but: No, I will not push this "narc of choice" in the closest port, as fast as I can, since that "is the only way that works for you." It is my license and I will push at the rate that is deemed by all the medical books. I am not giving it to you for the rush you will get with a fast push, I am giving it to you for your pain, and whether it is pushed fast or slow, you will get the same drug amount, and the fact that I need to give it safely is what really matters!

In our ER we try to stay at the 1:4 ratio (and then 1:1 with codes, etc)...but occassionally we have to go to 5 each...but we are not assigned rooms, we do too much bed shuffling to maintain room assignments. But you can't really control how many people come into an ER...and for whatever reason (probably $) our hospital never goes on divert for ED overload! But it tends to be manageable, we use to have 8-12 patients...and that was unsafe...so I will take 5 anyday :)

This is all very interesting to me...have been an ER nurse for 4 years now, and we give Demerol all the time! I would say in the last year or so it hasn't been used as much, but some docs will only give that med for pain control (unless there is an allergy of course). I would say we give it IM more than IV (and we definitely have some people who I think are addicted, one who gets 200mg with 50-100 mg Phenergan almost every 2-3 days for migraines!)...but I'm curious as to why some hospitals are completely taking it out of their formulary and others are not. I've never personally seen any of the really bad side effects that have been mentioned in this thread. Just drowsiness, and it not really working in some patients. Dilaudid is the one everyone asks for now. But this will make me think about it the next time an MD orders it, and ask them what they think about this research. By the way, we still stock 50mg, 75mg and 100mg vials in our narc drawer consistently!

I hate it when JHACO comes to town...as do all nurses...all it does is gets the management all over you! We just went through our survey and yes management tells you a bunch of stuff you need to know, but the truth is, they 1) will ask you things that you already know, or 2) you can always say "I don't know the answer to that question, but I know where to find it" and say that your manager and/or charge nurse is available, or the answer is in the manuals at your nurses station etc...just don't lie!!!! They'll get you for that...and just remember, they can not interupt patient care, so just stay busy!!!!!