b eyes

I have a quick question for you? How do you handle.complaints? Does anybody use the chain of command anymore? Or does the squeaky wheel get the grease? I was called into the supervisors office today after a nurse acting as recorder during a trauma felt I did not release her from her recording duties soon enough when not needed. I do not recall her complaint being accurate as I let her go when I felt it was time. As the lead! This is my decision. I responded to the complaint with 1. I let her go when it was no linger necessary to have her there. After the surgeon left. Because if i am going to be assisting the surgeon, i will not be able to keep an accurate Record of events.Then I asked why this is an issue.? Its clearly going to be a he said/ she said. So we went over when it was appropriate to dismiss them and when it was appropriate to keep them. Which I felt dummied me down. I asked why she didn't come to me st the time? I guess my second question is what was I supposed to take away from this complaint as a positive.? When I asked my supervisor, he stated well....communication. huh? The only.one not communicating was the recorder who thought she should be able to leave. But truly, in my haste, am I missing something important? And third, am I wring I'm feeling that my supervisor did not defend me by explaining to her how a trauma code is run and the lead nurse responsibility.?

I just returned from a CALS class and many of the providers were discussing treating their chronic pain patients. Many of them stated that they do not use pain clinics due tot he fact that they feel the pain clinic use too many narcotics and create addicts or jhust patients whose narcotic tolerance is so high it is really very difficult to treat them in the ER. An interesting thing was a provider whose hospital is sending her to accupuncture training and to use this to treat her pain patients. Of course I believe acute pain needs to be treated but hopefully another avenue for you to go down in the treatment of your chronic issues.

Yes, thank you for your input. He was getting antibiotics. The OR was aware of him, surgeon, CRNA, and OR nurses, Scrub tech, etc. Everybody was aware. I think the only thing I couyld have and should have done is get a different medication order. My question however, was when a patient is going to the OR and going to get anesthesia, is there a cap on how much narcotic to give? This was the issue, whether it is morphine, dilaudid, fentanyl, and the patient is tolerating the med as mine was, when do I look at anesthesia concerns regarding too much. so lets say VS are stable, pt alert/oriented, rating pain 5/10, kinowing full well pain relief is not going to be an option for him, do I give more, or do I start to say, OK, Pt is going to be going under general anesthetic in 1/2 hour. Need to be careful what I give here. That is what I am not understanding. Am I making my concern clear here for you all?

Gotcha! Thank you again!

Thanks for your input. The patient was completely alert. got up out of the bed and into a wheelchair independently to go to OR. Able to answer all questions for me and talking to his family appropriately. He was my only patient at the time, which made it able for me to give him the one on one care he needed. Thank you for helping me to better understand the OR perspective. I would not ever continue to medicate someone who was obtunded or sleeping. The patient continued to rate his pain at a five or greater asking for some relief. I did the only thing I could do besdies get a different med which I should have done sooner.

You are so right! I agree with you 100%. Always a difficult situation for nurse, family and patient.

OK I understand . Another question, If the patient is still experiencing this type of pain after two or three doses of dilaudid, do I give more? I know how to monitor my patient in the ER as far as when to give meds and when to hold off, but I do not understand when enough is enough knowing they are going to get anesthesia.

Thank you and I will. I have been racking my brain looking up meds for two days, trying to find dose limits, etc and not coming up with much. yu have been a tremendous help! Should have known to contact allnurses first!

OK thank you. Makes sense to me now. I felt terrible but on my end, what I was doing was OK, not fully understanding anesthesias end.

Also the boy had been ruptured for about three days the surgeon felt. I really don't feel pain relief was even acheivable for him. But thanks, next time I am giving frequent doses of morphine, will ask for something stronger. I just remember the CRNA being angry once because a patient on the floor had been receiving dialudid prior to surgery and again thought she had been given too much despite stable VS etc.. I beleive the patient had received 3 or 4 mg through the night shift. So I am wondering is there a limit prior to a patient having anesthesia? Is there something I should be considering that I am clearly not aware of?

Hi and thanks for replying..first, no the morhine did not have a limit. Just our discretion hence pain level, VS, Pts LOC. Pt fully alert and so uncomfortable. So using dialudid or fentanyl would not have created the same issues regarding anesthesia because now they have to deal with two different narcotic medications, or would that have been more appropriate because of less dosing?

The other day in ER, I had a patient with a ruptured appy. Waiting 2 hours for surgery to take him, the patient was experiencing pain consistently rating it between 5 and 10. Pt was alert/orineted, VS, 101.5, HR 116, Systolic BP 140's, O2 saturation 98%. Over the 2 hours he got a total of 32 mg of morohine as the doctore ordered 4 mg q10 min prn pain. VS were as above when surgery came to take him yet they were upset at the amt. of moprhine the patient received. What would you have done differently? Different med? Also said he should have been on a ETCO2 monitor. I am not sure how to have treated this patients pain. Kowing full when I would never acheive pain free with him, but trying to get him somewhat comfortable. Pt was 22 with no med problems. Just not sure what I should have done differently. CRNA angry because of dose received and I anesthesia requirements, breathing, etc. Thanks for your input.

Hello all. Just wanted to talk about something that has been going on. Working in ER recently, received a threatening phone call from a very angry family member about the care his wife received. This person was threatening in that he made a threat which was reportable tot he police. My conscious told me to reprot it, by heart said he is absolutely distraught in that this wife just received a poor diagnosis. My feelings come into play here in that I know he was spouting off out of anger hoping he didn't mean to follow through with thte threat. Police found him today. He told a different story, denied the threat. I then had to care for his wife today. She was brought in by her two daughters. Tears poured down their cheeks. They were so appreciative and thankful for the care I had given. They do not know I was the one who called the police on their father/husband. The whole famiy is so distraught over her diagnosis of stage 4 cancer. And they are upset that she had been seen in the ER three times prior to this without a diagnosis. The husband told the police he said things to me that I absolutely have no recollection of! So now I am questioning myself, did i mishear him, did I not hear everything? I wrote it all down as soon as I got off the phone. Did I forget something? What is going on with me?

Hello, I will try to make this as short as possible, but I am pretty stressed out right now. I was wondering if any of you know or can tell me the staffing standards for a cardiac stress lab? I currently work in one and have gotton myself in to an area I am so uncomfortable in I could just quit. Our stress lab in staffed with only one nurse. thats it. During echo and sestamibi the echo tech or nuc med tech are in the room, but they have no idea what I am doing. I have done 5 dobutamine echo/sstamibi in the last month which have resulted in teh person going into `10-12 beat runs of v-tach or rapid atrial fib. I get so scared when this happensbecause there is nobody around to help. No doctor, no other nurses. Yes, I have a crash cart and know how to use it. but I feel like I knew how to use it better when i was working in the ER full time. when you aren't exposed to it, you lose it. this is a clinic setting by the way... I am looking for a new job currently but I live so far away form everything 1 1/2 hours drive one way. I just don't know what to do. I feel sick to my stomach with worry on a daily basis. I hope this doesn't sound rambly, but there are so many things going through my head right now I have asked the doc about dobutamine and when to use it and when to not use it and he said that if they have a history of v-tach, don't use it, glaucoma, don't use it, but they all seem to have ventricular ectopy once it gets started. bi-geminy, tri-geminy, I just don't know enough to do this. I don't know how else to get the education. I have read and studied whatever I can find. but the real situations happen while I are doing the tests and there is no one there to bounce anything off of. Can anyone help me?

Hi pedi nurses.. Need some help.. I started a new postition and one of the areas I was put in charge of is pediatric conscious sedation. I am in charge of setting up the room with all the equiptment, getting it ordered, etc.. My questions are.. 1. Besides the crash cart, monitor, bp, co2 monitor, o2, suction, thermometer, ambu bag, airway, What else would you anticipate needing in teh room? 2. Do you do the ASA classification or does the MD/Anesthesiologist? 3. Which peds do you leave for anesthesia to do? 4. If you do moderate sedation, do you have anesthesia in house to rescue you in case it turns into deep sedation? I was told today that anesthesia will not rescue us if they are not initially involved in the sedation, however will respond to a code. 5..How long do you monitor children after moderate sedation, providing everything goes according to plan, or does it depend on the child and how they wake up and respond to anesthesia? 6. Do you have a physician in the room during sedation of children? At all times? or an anesthiologist? 7. meds talking about being used are versed and fentanyl, nothing else? I can't think of anthing else right now but I am sure there will be more. they want to have this up and running by mid december thank you in advance...appreciate all of you more than you know:p b eyes