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sorry the data were not complete.i accidentally clicked the mouse. anyway, here is the continuation of my story. the incident happened in the medical intensive care unit. Recuronium was ordered by the anesthesiologist and gave the initial dose. The issue came up when the nurse asked the anesthesiologist to prepare the next dose. The anesthesiologist said that it is now the responsibility of the nurse to give the succeeding doses but the nurse did not prepare it and insisted that it is the anesthesiologist who must prepare it. according to the anesthesiologist, the nurse can give it since it was already ordered just like giving antibiotics and dopamine. from the legal standpoint, is the nurse qualified to administer such drug and other anesthesia drugs in general? The nurse is only RN and licensed IV therapist and no other further trainings. need your advice as the institution i'm connected with is making guidelines/protocol regarding giving drugs that are peculiar to anesthsia. anesthesia is a specialty and the persons administering it must have special training. thank you.

the administration of recorunium ( a drug that depresses the respiratory muscle)

that is what is really happening in er. nicely written. thanks.

March 29, 2008 On that day, at around 9:30 am, a patient was to be brought to another hospital for lab/pulmonary exam which was not available in our center. A pulmonary doctor and a nursing aide were with me to complete the team. The patient was brought to the examination room but then the doctor has not arrived yet. We waited in the next room where we can observe the patient. We spent our time reading magazines. After a while, the doctor came and performed the said exam. Unluckily, the computer bogged down and we were told to wait for the result for thirty minutes. And this was when my memorable experience happened. The patient complained of blood-streaked sputum. I told our doctor about it. When we returned, the patient was having difficulty breathing and she coughed out blood. We did not waste any time. We immediately brought the patient to the emergency room and upon reaching the ER the patient went into cardiac arrest. Our doctor asked for an intubation set. My doctor was the one doing the intubation and I was just observing since this is not our hospital. But when I saw my doctor having a hard time inserting the endotracheal tube due to the presence of blood, I asked permission from the other nurse that I am allowed to do the suctioning. The nurse consented. I suctioned a lot of clotted blood and intubation was done smoothly. The attending physician came and he was very thankful that his patient was alive. We connected the patient to the oxygen and do ambubagging until our return to the lung center of the Philippines. The patient was brought immediately to the operating room for an operation called lobectomy. The patient was operated on and after a week she was discharged fully recovered. In retrospect, I was telling myself, if I were not assertive enough to ask the nurse to let me do the suctioning probably the patient has died. At first, I was reluctant to tell the nurse but when I saw that his suctioning was not being effective, I asked him to let me do the suctioning and he nodded his head. I was able to suction a lot of clotted blood that probably hindered her breathing and blocked the view. The doctor was able to insert the endotracheal tube easily as he can see the trachea clearly. My presence of mind also helped a lot. I did not panic. Why? Because when I report to duty, I always think of the worst scenario. In a way, I am always prepared. When my duty turns uneventful, well and good but when it is toxic, still I am ready to face it. To me suctioning is very routine but it can really save lives. After all the fuss, we told the ER staff that when the people saw blood all over, they really avoided us as if we are suffering from a highly contagious disease. Our uniforms were not even stained by blood while the others were because the patient was facing them and we ended up laughing.

in the hospital where i work the sop is like this: after getting the properly typed/crossmatched blood from the blood bank, the blood is usually checked by three people, the nurse on duty, the doctor and the supervisor in that order. if it is the first time the patient will be receiving blood transfusion,the med tech on duty will check the blood type of the patient at the bedside. only after going through this routine we can transfuse the blood. transfusion must start 30 minutes after getting the blood from the blood bank. we use normal saline as main line and the blood as side drip. we take the vital signs 3 times, before the transfusion, 15 minutes later and right after the blood is consumed. if there is any untoward reaction, the doctor is informed, blood transfusion is discontinued and the blood is returned to the blood bank. img]file:///c:/docume%7e1/dianne/locals%7e1/temp/moz-screenshot-1.jpg[/img]