danger

i commuted 2.5hrs one way and slept in my car (literally) for my first ER job. you have to want it!

urban level 2 trauma center w/ 40 beds and 160 pt.'s/ day. our "acute" side has 12 rooms w/ four of those set up for trauma and we staff these w/ 4 nurses ideally (3 rooms/ nurse). our less acute side has a 4-1 ratio. and we're just now trying out team nursing where we pair a nurse w/ a tech and take 5 rooms.

i'm new to nursing and working in an ER and just starting to pick up on the more obvious signs that my pt. is sick. -chief complaint: apnea additional obvious additions are welcome dan

i tend to agree w/ the last post. i'm a new grad living in rural colorado w/ a critical access hospital. out of school i chose not to apply there and instead drive 2.5 hours one way to denver to work three 12's and sleep in my car between shifts in order to get my skills up to speed. my thought is even though trauma and sepsis and mi's happen in small towns once a month they happen nightly in the city and i want to be competent and safe and provide excellent care for my pt.'s. after a year i might feel more comfortable working in a rural setting but i still plan to keep working a shift or two a month in the city to keep my skills fresh. if you can make it in the city in an er that sees 200 pt.'s a day then the rural stuff will be easy. dan

new grad here working in denver making $23.91 base (before differentials). this is with some credited prior experience working as an EMT in a hospital. yup

i hope you're not in the ER for 24 hrs! in the most recent ACLS they put the IO route just after the IV route and before the ETT; med absorption through a tube is unpredictable. is the risk for osteomyelitis w/ IO access greater than phlebitis w/ IV? and what is the infection rate for a cut down? that seems overly invasive and time consuming as opposed to IO access. also, i understand the critical thinking aspect of IV selection but it seems you have more options w/ an 18 vs. 20. all of this assumes an emergent and not urgent situation. anywhoo, thanks for responding.

i didn't see this in the search results. what is the consensus regarding IV size and placement? go big within reason, 18g in the AC, or small and distal 20g below the AC? what is the flow difference between these two? time for a liter to flow through a 16, vs. 18 vs. a 20? i know some CT contrast can't go into a 20 (head CT? do to the slower speed?) during a recent ACLS class the instructor noted the increased speed and accuracy of dropping (drilling) in an IO vs. an IV and alluded to trauma situations going to the IO route over IV. how long can an IO remain in place? and what gauge are they? big i assume. dan

why do you replace K+ if the serum level is 3.6-4.0? what is your target level? dan

what's the consensus with giving drugs through a blood line? i talked to a friend of mine that had a code on an MVA w/ a bit of blood loss. he had two IVs, one giving blood and the other giving dopamine. the doctor ordered bicarb which isn't compatible w/ dopamine and said to give it w/ the blood. is this kosher? can all drugs be given w/ blood? or should it be avoided? dan

so as long as you have a prescription then you can't be fired for controlled substances in your urine? marijuana is legal in colorado w/ a prescription so can a nurse be exempt from testing of this substance? dan

thread drift... how can you leave an icu or any other nursing floor without someone else to cover your patients? isn't that abandonment? i understand it isn't safe to stay but can you just leave? dan (still under the influence of education)

IV certified EMTs work in EDs but not CNAs. (my experience is limited though.) dan

how do you give lovenox IM? i've only seen it available in autoinjectors w/ a short large guage needle. was the patient an athlete w/ rockin' abs of steel? dan

carbuncle? is that a barnacle stuck to your car? i'm intrigued and of no help at all. dan

i wish i knew more; i don't have access to her CBC. this was a patient on a med/surg floor one day post-op for a cellulitis (sp?) surgery of her foot. late 80's, maybe early 90 year old female w/ history of diabetes. on my way out in the morning the doctor said that he was troubled by her low H & H. he ordered blood and an erythrocyte count. i believe the H & H was 8.9 and 26.6 and the RBC was 5.5 ish. she also had a K+ of 3.2. just trying to tie my education to the patients. if i can i'll post her CBC next week. thanks, dan