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Pediatric ED RN

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  1. PedsED-RN

    Tips/tricks regarding peds and triage

    Esme, I figured you would post this =) I need to actually remember where I post to be able to copy from previous. =) great info there!
  2. PedsED-RN

    Tips/tricks regarding peds and triage

    If you can, take ENPC, that is a helpful class. Will help narrow down the things you should watch for, true emergencies. Our #1 CC is fever, so for 85-90% of our fever patients, that is something that could have gone to their PCP. Try not to let them scare you =). Definitely get used to normal VS ranges for different age groups, that will make it easier. Try to see what the kid was acting like while in the waiting room, will give you a more accurate assessment, since most little ones freak out once you pull them into triage and are messing with them. Upper airway congestion noises refer all over in little ones, so get used to distinguishing that from actual "course" lungs. Also, heading into respiratory season, nasal suction is your best friend, and will work miracles. =) That's what I have at the moment, sure I will think of more. =) good luck with the new job!
  3. PedsED-RN

    Conscious Sedation in ED

    Our Procedural Sedation policy is very specific. Defines Anxiolysis/Moderate/Deep sedation differences, including required monitoring, and gets into each drug, and the specific routes/doses that constitute each level of sedation. For example, nasal versed up to 0.2mg/kg is Anxiolysis, but any higher dose is sedation, etc. it's a pain, in that out Ad Locum docs *****, that the dose ranges are too low, but at least for my sake it's all very cut n dry, and eliminates needing to interpret gray areas. I know things are probably different for kids, but I would see how your policy lays it out, and maybe you can help spur a change if needed. =)
  4. PedsED-RN

    Cyclic vomiters (drive me up the wall)

    This is exactly it for many of the kids we see with it!
  5. PedsED-RN

    Why can't nurses intubate?

    I know for our Transport team (peds hospital), they are all trained in IO, intubation, etc. I know they maintain tubing skills in the OR each year to keep current, not sure about the rest though?
  6. PedsED-RN

    Preceptorship in ED..any advice?!

    Good point! We have many RNs that started with us as Student Interns, loved our department, applied, and are RNs with us. Home-Grown! =) it can definitely be a good In!
  7. In a Peds ER, this kind of thing is our bread-&-butter. Also love any complaint that has since stopped before bringing them in: baby wouldn't stop crying (as the baby looks up and smiles at me), nose bleed, headache, anxiety attacks in pre-teen girls. Most ridiculous ever in my years, had a 2-yr old come by squad on an for "possible seizure activity". After arrival, mom pulls out a bottle of Vicodin, pops one and starts going on and on about her horrible toothache, then climbs into the bed herself. Meanwhile, the kid is playing and tearing the room apart. At one point before she passed out, the kid threw himself on the floor with a typical 2-yr-old-tantrum, mom points and says "There! He's doing it again,see?! A seizure". We transferred mom across the street to the neighboring adult ER, after she insisted on checking herself in for her toothache. A few hrs later get another squad call that sounded a lot like the morning one......yup, they were back! Had another "seizure". Mom crawled into bed and passed out, must have just wanted a babysitter so she could take pills and sleep. Social Work helped us with that one. =) nothing like wise use of resources!
  8. PedsED-RN

    shotgun knowledge from emergency geniuses

    US for trauma, looking for free fluid in abd help identify internal organ damage, as either something is bleeding (and how much based on amt of fluid), or perfed bowel leaking bowel contents into the peritoneum, etc. Gives an idea before something more definitive like a CT, but can be done at the bedside while other interventions are underway. I have read some articles on some docs questioning the true value of FAST exams, but it's non-invasive, no radiation, so why not? I think the other questions were all pretty thoroughly answered so far, good luck =)
  9. PedsED-RN

    Preceptorship in ED..any advice?!

    Agreed. If you are already a proactive personality willing to take initiative, you will be fine. Get the feel for the flow and pace in your ED, and jump in with what you can, that you are safely able to do. ED is a different beast than inpatient, but those of us that call it home love it. =)
  10. PedsED-RN

    Rules for Triage

    "Her nose was bleeding yesterday, but it stopped. We just wanted to get her checked today". Smh.....
  11. PedsED-RN

    Nurses dressing up for Halloween

    Peds ER, staff often wear something, but are pretty conscious of it being something easy to remove if in the way of a critical situation. The vast majority of our kids are fine, and live the costumes. Definitely some settings where it would not be appropriate.
  12. PedsED-RN

    Rules for Triage

    Agreed =) I more often say the same as you, but sometimes ask what is the emergency more because they usually seem to stop for a second to realize "oh, yeah, this isn't an emergency". Probably comes out more when I am to the point of being "over" all the non-emergent complaints, that are the first to complain about wait times. =) but, then we have a crap day when a kid passes, or an ugly abuse case, and it reminds me I prefer the ear aches and crap way over something like that any day.
  13. PedsED-RN

    Rules for Triage

    When I start with "what is your emergency this morning" and the reply begins something like "oh, it's not really an emergency....." Smh I know you are scared about whatever brings your child to me today, but that doesn't require your entire extended family to also come to my tiny triage room, and please don't give me the stank eye when I say so. If I call your kids name, and you are on the phone/at the vending machine, and hold a finger up for me to wait, sorry, I'm grabbing the next patient. If you child is here for vomiting, don't get ****** at me when I make him NPO. Stop shoving things down his throat so he has a chance to stop throwing it back up! Please don't act like I'm violating your infant when I take a rectal temp, when you brought him in for fever. I will take your word for it that your child had a fever/was in miserable pain at home. For the love of God, don't deny them some ibuprofen/Tylenol "so I see how high the fever is/how miserable". That's the first thing I am going to do, and 99% of the time, 45 minutes later the kid is brand-new. Might have saved a trip and ER bill! Ok, enough for now. Flu season isn't even here yet, and I'm in rant mode. Ruh-roh, may be a long winter! =)
  14. PedsED-RN

    Bladder Cocktails?

    When we have to fill a bladder for pelvic US we actually fill while in US, and the tech lets us know when it's full enough. Looks pretty cool on US, can see the fluid swirling like confetti. Works for eliminating guess work. One of my least favorite things to do though, I never hold my tongue about questioning the necessity. Seems invasive unnecessarily most times, just to expedite getting the images, rather than waiting it out with IVF.
  15. PedsED-RN

    Cyclic vomiters (drive me up the wall)

    We see it regularly in our ER (Peds only). Sometimes it seems like the diagnosis for "I have no idea why your kid keeps vomiting every week/month/fill-in-the-blank, since every test under the sun has come back normal". At least 1/2 the time it seems legit, but usually seems to stem (IMHO) from some kind of stress/psychosocial place. Most often pre-teen girls. Sometime parents bring them in not even amidst a current episode, but "Our appt with GI isn't for another month, and we are sick of this and need answers, so we came here". similar for our frequent abd pain kids that have no other symptoms, and are asking for a cheeseburger. Parents are always very receptive to the fact that if GI specialist hasn't pinpointed the issue yet, ER doc isn't going to probably either. I hate chronic GI stuff that doesn't have an obvious answer. Too many possibilities, and people aren't willing to make diet changes to optimize their health and minimize their symptoms.