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TerraRN - Your posts are so angry that I'm not sure it's worth answering you anymore. I think you just needed to vent because you can't possibly be asking if there is a LAW out there that states you can't transfer a patient from an in-patient ward to the ED. Maybe it's a moving violation???

Sorry to hear this. I just can't understand why nurses eat their young Whatever you decide to do don't let this change who you are. I'm pretty certain that your patients love your bubbly personality!

Circulation (by the AHA) has put out an article with guidelines on Hypothermia in November 2005. It's a great read. http://circ.ahajournals.org/cgi/reprint/112/24_suppl/IV-136.pdf

My understanding is that J-point elevation that is caused by hypothermia is called a J-wave or an Osborne wave, so yes, it is essentially the same thing. We only use the term J-wave/Osborne wave if the patient has hypothermia. J-point elevation can be a normal finding in some patients or a sign of pathology (Brugada syndrome, short QT, hypothermia etc.) but the physiology is the same... it occurs when the transmural voltage gradient becomes exaggerated (epicardium >>> endocardium) and causes the notching.

b eyes, I'm confused too. I'm not sure why you wouldn't use a bear-hugger on J-waves are the conduction defect of a cold myocardium. They look like a notch or a bump on the S wave in the QRS complex. They can vary in size depending which lead you're looking at. Hope that helps...

Who was presuming? You asked if they are 'ALLOWED to do that', many people answered. There was no presumption in any of this. The real question is... what did you do about it? If you knew it wasn't safe and you or your charge nurse allowed it to happen, you are responsible for your part in it.

A lady called in to say that her parrot ate one of her valium tablets and she asked what she should do... My colleague told her to 'lower the perch'.

The answer is yes and no... it really depends on your hospital's and emerg's policies. Unfortunately, many administrators don't see a problem with making the ED a dumping ground for all of the hospital's problems... so, not only do you get sick patients coming in off the street but you get them internally too. This is just wrong on many levels (interrupts ED patient flow, increases ED overcrowding, no privacy for the 'in-patient', noisy environment=no rest ((your pt was a post MI it's just not a good situation for the pt at all)) etc etc). They tried this at my hospital and we have a fantastic ED Chairman who jumped on it quickly. In the past they've also tried to make us have the hospital code bed one night because ICU was full:eek: . We now have a policy that states once the patient becomes an in-patient they never return to the ED. If a patient deteriorates on the floor and the ICU is full, the ICU must find a way to accommodate the patient (transfer a patient out etc.) It is an internal problem NOT an ED problem. One solution to this issue is the recovery room. They have all of the monitoring equipment and if the recovery room nurses aren't capable/comfortable looking after this type of patient, an ICU/CCU nurse should be called in. Another thought... don't the ED attendings have a say in this? Afterall, another service is coming and occupying a valuable ED bed reducing ED resources that should be available to the ED. In our hospital, the ED physician can trump the nursing supervisor. Personally, I think the nursing supervisor made a very bad decision.