msjellybean

I was in the ER several times as a kid. I was 3-4 and being stupid in day care and split my chin open, needed sutures. When I was 5, I fell off a slide and had a humeral neck fracture. In my teen years, I went a few times - after a car accident (parents insisted, even though I didn't want to), after I had another accident wherein I fell and lacerated my inner jaw down to the bone & required the OMFS guys, and another time when I sat down on the couch and impaled my elbow with some kind of upholstery pin. For minor things though (earaches, sore throats, etc.), my parents were rational and just took me to my PCP. *knock on wood* Thankfully my accident prone-ness seems to have stopped at age 16.

In my ED, we have two nurses stations. One larger, more central area that shows all the monitors and a smaller area that only shows the monitors in the rooms close to that station. It seems to be an unwritten rule that everyone is responsible for looking out for the rhythms and responding to those critical alarms. I have frequently gone to rooms where critical alarms are sounding, to check on the patient. Thankfully, have never found anything worse than a slightly slower than usual bradycardia.

Access to our ED is badge controlled. Visitors get an ED visitor sticker, which allows them access through the locked doors. Mental health patients and combative patients are stripped only to a gown and their belongings secured in a staff only area. Multiple cameras around the department, with 4-5 panic buttons scattered throughout the department. We have a pretty large security department (considering the number of beds our hospital has), that is headquartered in the ED. I believe some of them carry tasers and pepper spray as well. IL just passed concealed carry, effective in January. If I recall correctly, it's now a felony to have a weapon on campus. We also have a special overhead page that indicates a weapon has been displayed somewhere on campus & we have a lockdown plan. If someone does that, security will contain the situation & notify local PD.

As always, refer to your P&P. In my facility, if a patient has a port, it is expected that you will access it and use it. Unless the doc suspects it as an infection source. In which case, we generally will access it long enough to draw quantitative blood cultures and then de-access.

This is tPA for CVA. We do use it PEs and DVTs, but I'm not sure what the standards are because we don't do that in the ED. All of that is started in IR and then sent to the ICU. VS and neuro checks, q15 minutes during infusion and 1 hour post infusion. There's to be an MD documented NIHSS, two hours after administration. Then after infusion, we have VS & neuro checks q30 minutes for some period of time that I can't remember... maybe 4 hours? After that, I think we transition to VS & neuro checks q60 minutes x16 hours, I believe. I'm probably off a little bit - it's been a while since I've worked with tPA. There's also another MD NIHSS at 23 hours post infusion.

We have an alcoholic frequent flyer, who typically presents drunk after a fall of some kind. She has had 8 brain CTs so far this year. I hate to think about how much radiation her brain has received over the last few years. Unfortunately my ED got a crop of young, new docs & they seem to be firmly in the camp of CT-ing almost everyone.

Forgot to add we also give 325 ASA if no contraindication/allergy

We're supposed to initiate the CP order set with in 3 minutes of presentation to registration. From presentation to registration we have 7 minutes to get the EKG complete. Our standing orders include: place on monitor with q30 minute vitals, CXR, 12 lead, 02, start heplock, draw CBC, CMP, coags (which we hold unless the pt takes warfarin), and an i-stat troponin. After the EKG is complete, the EKG tech or the RN takes the 12 lead to a doc (any doc, doesn't have to be the doc that signs up for the pt) to verify if STEMI or not.

Depending on what scrubs I'm wearing, the location tends to vary a bit. But... in my left top pocket I have my phone, gum, and carmex. Top right pocket is a couple pens, dry erase marker, & a sharpie. My trauma shears go in one of the cargo pockets on my pants and then I typically have a stash of alcohol swabs in my rear pants pocket. My companion phone goes in my right pant pocket. I've been organizing my gear this way for 3.5 of my 4 years as a nurse and trying to switch it up at this point feels VERY weird.

This is facility specific. My hospital allows our techs do d/c PIVs, provided they show us the catheter before disposing of it. Since that rarely ever happens, most RNs d/c their own lines.

Reminds me of an incident I had a few weeks ago while sending a patient upstairs. College age girl with SOB x5 days. Chest CT reveals multiple PEs... described by the radiologist as "significant" clot burden. As I'm waiting for her bed to be ready, I give her the heparin bolus & start the drip, as well as do a lot of teaching. Talk to the nurse that will be getting her and when I ask her if she as any questions, she says in this really snotty tone, "well it doesn't look like we've DONE ANYTHING for her." To which I ask her if she means have we started her heparin & bolused her? She says yes. I respond as politely as I can, that yes, in fact I had done all of that and if she had looked at the MAR, she would have seen that. Gah.

Pt came in via EMS for a fall. A&O x4, no SOB or cardiac complaints. BP stable. Lab calls with a critical hemoglobin of 2.4. A recollect is automatically ordered, based on that level. After the phlebotomist drew her, he showed us the tubes. Looked like cherry Kool-Aid. Repeat level comes back at 2.6. I'm not entirely sure what her final diagnosis ended up being, because I left shortly after the second level came back. Crazy!

I don't mind taking holds, so long as they aren't ICU patients. And my reasoning is this: while they're held in our department, they are to receive the same care standards as if they were actually on the floor. Except I can still have up to 3-4 more ED patients, with varying levels of sickness. Unfortunately when patients are roomed from triage, thought isn't given to what nurses also have holds. While actually in the CCU, those nurses have two patients. I don't relish the thought of having 4-5, one of whom is ICU status.

I'm an ED nurse now, but worked on the floor for 3.5 years, frequently with a 6:1 ratio and one tech. If the IV site became problematic, I'd would start a new line and move on with my day. I don't understand why it's such a big issue for so many people.

Anecdote from when I was a floor nurse... had a rapid response code on a patient and by the time EKG got there, she was already to the ICU. They ended up performing the EKG on her roommate (oops!). But here's the kicker - found new ST elevation.

Anytime an EMS patient arrives and they are ambulatory to the room. If you weren't even in bad enough shape to come in on the cot, you should go to triage.

Had a college age girl come through the fast track part of our ED yesterday for jaw pain. R/t ahem, sexual activities from the night before.

This this this. When I used to work the floors, while I was looking information up before report started, I would always scroll back 24-36 hours and look at their vitals. I've managed to catch several patients starting to circle the drain, that no one else noticed. Simply by looking at their trends.

I know this isn't the topic at hand, but I just had to reply because this struck a chord with me. I have a previous bachelors in a health field + a minor in chemistry. I went back and got an associates in Nursing. My hospital (and really the nursing field in general) don't recognize those 4 years at all. And my hospital has started treating associates nurses like second class citizens. So I've essentially been shamed into going back to school, so I can feel as "tall" as my peers, if you will. Even though I really don't want to and don't really have the financial means to do so. :-/

I think one of the most irritating things I deal with is when lab calls me to tell me that a specimen hemolyzed or something. And then they ask if I want a re-collect. Yes. Duh. Why are you even asking?

My worst shift ever. Worked a 12 bed in patient oncology unit. It was me + a newish RN, who had been off orientation probably 3 months. Plus one CNA. We had 11 patients. There were multiple total cares and at least two medical patients who were actively withdrawing. At about 2100, we get buzzed for a pneumonia patient - takes up our last bed. About 90 minutes later, I get a call from the house supervisor and I'm told that one of our regulars is in the ED and needs a bed. So transfer off one of the etoh patients and get this new guy settled in. At some point during the night (can't quite remember the timeline - but I want to say it was between 2100 and midnight), a patient of mine who had nasopharyngeal cancer with a recent CEA (so her INR was up about 4.0) started bleeding out. Blood everywhere. I thought she was going to die on me right there. All three of us were in the room for half an hour dealing with this. 10-11 other patients were totally on their own. This woman was in our "neutropenic area", so her door was closed, while being in a seprate area, behind another set of closed doors. Stat transfusion of at least 3 units. And then when I left that morning, she was to get 3 more units of packed cells. I didn't start my charting until 0500. No one took lunches & we ate oreos all night, whenever we could find a few seconds. I called and asked for more help, but there was none available.

About 9 months ago someone in our ICU found the tax records from my hospital online. Since we're a NFP organization, I guess with the freedom of information of act, they have to be available? Anyway. It listed the top 10 salaries in the company. Our CEO got a bonus that was equal to 50% of his salary. He took home almost two million that year as a result. Meanwhile, we don't have enough money to buy 10 refurbished feeding pumps.

Used to be an onco nurse and I've seen several patients with plt counts Given the hypercoaguable state that exists with cancer, it's appropriate to give it.

No but you said that students do some of our work. I think the majority of people would assume that you are insinuating that since you are doing some of our work, that our load is somehow lighter.

Just this week, we finished up with a group of first semester students. I'm the first to admit that I don't like students (especially first semester) because they are often more of a hindrance, than help to me. That said, I don't let on to this fact, nor do I treat them poorly. I help them out, answer questions, etc. My biggest gripes about them though? Vitals. If you're in charge of AM vitals (as in not allowing my tech to get them), then you need to document them when you do them. Not 45 minutes later. I've had this problem with two of the last four groups we've had (different schools), and speaking to the instructor and the students seems to do nothing. Gah. We had one girl in the most recent group who is also a tech. She would sit at the main nurses station to look up info the night before, as well as the day of. That drove me nuts. And her scrubs were impossibly tight - so much so that she split her pants on the first day, when she bent over to start a bed bath. Her choice of top wasn't much better. The lack of professionalism amazes me.