JessicaSN

A guy came in last night because he ate a piece of moldy bread. Wasn't having any symptoms, just "wanted to get checked out". YIKES.

Oh, by the way, the ER physician did not believe MULTIPLE registered nurses who re-checked the manual blood pressure. We used different size cuffs, both arms, etc and the physician still wanted different people to re-check.

I work in the ER. An older lady came in complaining of nausea, headache, and upper back pain. She had not had her Clonidine (0.2mg TID) in over a week, along with her other daily meds. Her blood pressure was over 300 systolic (that is the highest our sphygmomanometer went). Her diastolic was around 170. :uhoh21: Got it down to around 230ish with some Nipride before she went upstairs.

A young woman, 7 months pregnant, came into the ER because the skin on her breasts itched due to NORMAL swelling/growth from pregnancy. AAAAAAAND what are we supposed to do about that?

Our ER has a 2 hour wait time after someone is discharge before we will CONSIDER calling a taxi for them if the bus is not running. And am I a big ole meanie if I say I kind of enjoy telling the "abdominal pain x 4 months, came in by squad, btw I need a pregnancy test" patient that? :) Of course we make exceptions for for elderly people, non-FF with legitimate transportation problems, patients who have somehow melted my cold heart with their story, etc. BTW, *most* of the patients who throw a fit about not getting an immediate taxi end up finding a ride home. Who knew!

Yes, the CCRN is for ICU nurses. I think studying for the test and eventually passing would be beneficial for ER nurses though. It is a goal of mine to pass the test :)

I'm assuming you already have your ACLS certification. TNCC - Trauma Nursing Core Course CPEN - Certified Pediatric Emergeny Nurse CCRN - Critical Care Registered Nurse Certification

Part of our triage is getting a height and weight on everyone. I weigh all children; I don't trust the parents to know how much their kid weighs. We get estimates from the adults.

If someone refuses the gown or blood work I flat out ask them, "Why don't you want to put on a gown? Why don't you want blood work/an IV?" Sometimes it's because they don't want to be cold (so I get them plenty of warm blankets, pts loooove them). Sometimes it's because the pt is obese and has always been given regular sized gowns that don't fit (so I go get them our XXL gown). If they say they are afraid of needles or have "bad/rolling/small veins" I assure them I will only poke if I feel very confident I will get the IV or blood work. Most normal people I can convince to do what I want with a little explanation. If they refuse after that, I chart it and tell the doc the pt refused if the physician asks why this or that wasn't done. On another note, how about when we ask them to take off their clothes and put on a gown, and you return a little later and they put the gown over their shirt, jackets, pants, etc? :)

We don't do gastric lavage very often in my ER, but the doc wanted it done on a young lady recently (swallowed multiple types of meds 30 minutes before arrival). We tried out the "garden hose" tubes without success and ended up placing an 18 French. Unfortunately our ER doesn't have a wide variety of choices - we go from 32 to 28 to 18 and smaller. So my question is.... What is the largest size NG tube you have placed for the specific purpose of doing gastric lavage on an overdose? I'm not talking about NG tubes for suctioning bleeds or bowel obstructions. When you need to lavage to suction out large pieces of pills, what size NG do you use? I'm not taking about OG either Thanks

There is no way this *hasn't* been said in this thread, but it bears repeating: We don't get any kicks out of calling report before/during/after shift change. When a patient is assigned a bed is totally out of my control. It happens at all times of the day, just like how the ER gets squads, traumas, and codes all times during the day or night. Do we get angry at the medics when they bring in a Level 1 Trauma at 06:50 or 18:50? No, because that is ridiculous and out of their control. It is the same situation when transferring a patient from ET to ICU. I wish the ICU nurses would do what the ER sometimes does. When the ER gets a code or trauma alert within 10-15 minutes before shift change, the next shift will clock in early and take care of it. If I took care of an ER patient for the past 5 hours and now they are going to the ICU, wouldn't you rather get report from me and not a second hand report? And this is only concerning those patient who are assigned a bed right before shift change. I wish the ICU nurse would clock in early, take report from me, and then get report for his/her other patient. This is assuming a lot of things (ICU nurse is at work early, charge nurse knows who is going to get pt, etc) but I think it would be best for the patient. *phew* :)

I don't have much foot or leg pain after working (thank goodness) but I can definitely tell the difference between the nights I wear my compression socks and when I don't. My feet feel much heavier and my lower back hurts more when I don't wear them, the back pain could be a coincidence though :) I believe I have these: http://www.allheart.com/nm9153.html They stop just below my knee and those suckers are tight! Hopefully they will prevent varicose veins too. I began wearing them in nursing school because I wanted to keep my legs good looking.

Emergency RN: Oh, they got you good :) I have made many embarrassing mistakes during the whole 1.5 years I've been a nurse. I guess the funniest one was I had just come back from taking a lunch and I had a new patient (I work ER). I was told in the brief report she was here for a headache. She put on the call light and I went into the room. She was in her 40's, sitting up in bed watching TV, alert and oriented x 3. She asked me to help her on a bedpan. Well, I paused for a second and pointed to the restroom that was attached to her room and said, "The bathroom is right there" (in a nice way). Then she pulled back the covers and showed me that she was a bilateral above the knee amputee. Oops. So I of course then helped her on a bed pain. I went back to the desk to tell everyone my goof up and everyone laughed because she is a frequent flier in our ER.

In my ER there is a designated person who is the "scribe" on every shift. It is written on a dry erase board that also shows who has what rooms. I am scribe a lot because I apparently do a good job (so I've been told). We have trauma paper work and separate code paper work. Once you do a trauma or a code a few times you get the hang of it. The scribe in my ER is also kind of the "leader" and can tell people to be quiet if it's getting too loud, ask the doctor for clarification if something isn't understood (so you want Morphine 4 mg, is that correct?), and also should be on the ball if the doctor asks a question (How long ago was the last Epi given?). The scribe in a trauma has to pay attention to what all staff are doing the entire time - it can be pretty stressful!

We have an online system called Micromedix that will allow a nurse to enter multiple medicines and see if they are IV compatible. There are only 2 that I regularly mix: Dilaudid and Phenergan. It really doesn't take that much more time to flush in between IV pushes. I would also never taken any one else's word that certain drugs are compatible. Look it up yourself. Call the pharmacy if you still have questions. If I already have an infusion going (not counting 0.9% NS) and need to push something, I pause the infusion, take the tubing off the IV site, flush/push drug/flush, then reconnect the tubing and resume the infusion.