matthewjdouma

Thanks so much for your reply. I love learning new stuff and challenging prior conceptions. Matt

Without the leads the pads must identify the cycle and deliver shock, then continue to monitor. I'll keep you posted, thanks for your reply.

Hi Everyone, I've been through a few monitors in my career now, codemaster, LP12, Zoll and now Phillips Heartstart MRX. This is the first monitor/defib that I've ever used where our education team is telling us it can provide syncronized cardioversion without simultaneous 5-Lead monitoring. The rationale in the past was to have the 5 leads attached so the computer can properly identify the correct phase of the cardiac cycle to administer the shock to. Is anyone using this monitor, can you chime in? Phillips hasn't returned my emails. Thanks Matt

Thanks for the replies. For those who do not change triage score how do you track acuity changes when it will be hours before the patient is seen? Thanks

Thanks. That's what I think we need to start doing, moving the 4-5 up as required.

Hi everyone, A debate is ongoing with my colleagues as to whether triage scores can be altered one they have been initially applied. We're an overcrowded inner city ED, patients wait in our waiting room for many hours, when their condition change do you/should we change their score? Or when they finally get a stretcher, if your physicians have fallen behind and it will be hours until they're seen and the patient's condition changes for the worse, do you/should we change the score? I ask because in our EDIS system the physicians see the higher CTAS scores first and often we need to bump people up the "tracking screen". What do you all think? Matt

Well said ZippyGBR, very eloquent. I concur. Thank you.

there's evidence that rn's and medics can apply the canadian c-spine rules: [color=dimgray]podichetty, v. k, morisue, h. (2009). prediction rules in cervical spine injury. bmj 339: b4139-b4139 stiell, i. g, clement, c. m, grimshaw, j., brison, r. j, rowe, b. h, schull, m. j, lee, j. s, brehaut, j., mcknight, r d., eisenhauer, m. a, dreyer, j., letovsky, e., rutledge, t., macphail, i., ross, s., shah, a., perry, j. j, holroyd, b. r, ip, u., lesiuk, h., wells, g. a (2009). implementation of the canadian c-spine rule: prospective 12 centre cluster randomised trial. bmj 339: b4146-b4146 wiese, m. f, allen, j., pillai, v. (2008). facilitating the canadian rule. bmj 336: 233-233 wee, b., reynolds, j. h, bleetman, a. (2008). imaging after trauma to the neck. bmj 336: 154-157 armstrong, b p, simpson, h k, crouch, r, deakin, c d (2007). prehospital clearance of the cervical spine: does it need to be a pain in the neck?. emerg. med. j. 24: 501-503 pitt, e, pedley, d k, nelson, a, cumming, m, johnston, m (2006). removal of c-spine protection by a&e triage nurses: a prospective trial of a clinical decision making instrument. emerg. med. j. 23: 214-215 mower, w. r., wolfson, a. b., hoffman, j. r., todd, k. h., hall, f. m., stiell, i. g., rowe, b. h., lee, j. (2004). the canadian c-spine rule. nejm 350: 1467-1469 (2004). testing for c-spine injury: nexus criteria vs. canadian c-spine rule. jwatch emergency med. 2004: 5-5 yealy, d. m., auble, t. e. (2003). choosing between clinical prediction rules. nejm 349: 2553-2555 there's no evidence immobilization on a spineboard is more effective for preventing injury in the cooperative, alert and oriented patient. nurses can empower themselves with evidence and practice accordingly. this works in the other direction too. through careful history taking you may advocate that the cervical spine is not cleared clinically but by ct.

This is not an uncommon nursing intervention. Trauma trained registered nurses initiate spine board removal frequently, all over the world. The original poster is correct to be writing a policy on this. The harm of immobilization is serious, often EMS must immobilize based on mechanism. Nurses need to apply some critical thinking, a risk assessment and treat appropriately. Early board removal is advocated for in the research knowledge base, PHTLS, ITLS, ATLS and newer materials by ENA. Original poster, email me at matthewjdouma (at) gmail.com and I'll share what I can. Matt

Hi everyone, Our busy inner city ED sometimes boards ICU & CCU patients for days. We often resuscitate pt's and hold onto them for a long time. We're a tertiary care center with about 55 beds. I want to know how many departments out there provide their nurses with proper critical care orientations? Is it considered part of your ED orientation? Do you just learn it on the job? Does anyone cycle through the ICU & CCU as a part of their orientation? Anyone out there belong to a critical care float pool that includes the ED? Where/how did you all learn about central venous cath's? arterial, CVP & swann lines? vents? EVDs? intubations? inotropes & chronotropes? bypass? dialysis? etc etc etc Thanks for your help Matt

I'm in the process of writing an interdisciplinary guideline for managing violent / aggressive patients in our Trauma Center. If anyone has any SOP / policies / guidelines that can be emailed to me, please PM me for my email address. Also if anyone can share any helpful tips that would be great too. Thank you colleagues. Matt

Hi, I'm an experienced Canadian RN with ER/Critical Care experience, all the alphabet courses (ACLS, TNCC, CATN-2, PALS, ENPC, NRP, ATLS etc) and I'd like to contact ACNP's who work in trauma settings. I'm preparing my MSN-ACNP application and wish to know where I can arrange some residencies in Canada or the US. Any ER's that have ACNPs working in trauma/resuscitation? Did anyone have to develop their own job description/role? Thanks, Matt

Thanks, I found an interesting review guide and textbook on ena.org

Thanks for your reply, I'll keep the most right answer in mind. Did you use any specific resources to aid your studying?

I've just started studying for the CEN exam, any recommendations or tips from those studying or who have written the exam? Thanks!