star77

Actually, I've lost 50lbs in about 3-3.5 months and kept it off by doing a ketogenic diet. I eat very low carb (20-50g net per day, rare fruit, no processed foods, lots of protein and veggies). It actually *is* realistic but you have to work at it. If you want to read some research on low carb with good evidence based practice, check out Dr Peter Attia's blog (accessible via nusi.org), or for an easier diet plan -that still takes work- check out the book Always Hungry by Dr David Ludwig, a Harvard endocrinologist. There are a lot of articles that show benefits of low carb living, and these two examples above are just some places to start.

1L NS, Toradol 30 mg, Benadryl 25-50 and Compazine 5-10. OR 1L NS, Ativan 1-2mg, Benadryl 25-50 and Compazine 5-10. Either or, depending on how bad the nausea is.

I am going to quote word for word from a friend I work with: "On the manliness scale today while in triage: a FAT zero goes to the 21 year old with a chief complaint of 'hungover.' Really? Couldn't even state "nausea/vomiting" for us. Huh. And on the opposite side, a solid 10 goes to the guy with a GSW to the member: member intact and functional (small entrance wound in the shaft), bullet shattered. Discharged by urology." HOLY MOLE.

We rotate each day. Usually there are 3 RNs in there until 3am, and the Charge RN and another float will help scribe if it gets bad. Lesser, blunt-force traumas don't always end up in the trauma bays- our rooms are set up so that anyone can be treated anywhere (except for negative pressure and dialysis requirements). We're pretty good about helping each other out. If our resuscitation room nurse is getting overwhelmed, ie MCI or back-to-back BAD burns or penetrating traumas, we all pitch in if our patients are relatively stable.

Hey 13Virgo, PM me. I didn't start there but I have a good friend who did. He LOVES it. The nurse educators run Project Heartbeat. Josh and Alan are great teachers (I took ACLS/PALS with them years ago). :)

PS I couldn't live without caffeine.

I've gained 15 lbs from nights. I hate it. And now, I no longer snack on ANYTHING containing carbs in the ED. No chips, no cake, no cookies, no nothing. I never eat that crud at home anyway, and my snacks consist of snap peas (from Trader Joe's) and carrot sticks and almonds. I just remember that sinking feeling I have when my fat jeans started to get tight, and that's all it takes. I find that the "30g of protein within 30 min of waking up" rule works really well to keep me from being hungry all night. Don't snack on crappy food. I only eat two meals a day when I work nights, but I've still gained weight. There's an article in Wired from 2009 that cites a few studies where "shift workers" were found to have higher levels of cortisol in general. Part of the weight gain that happens with night shift is due to screwing up your circadian rhythms. I hate it. I had a small break from nights last summer when I switched hospitals, and I lost 10 lbs without trying within 3 weeks. It was amazing. As soon as I went back to nights, I just watched those numbers creep up. I've even done food journals and I consume fewer calories and work out more and the pounds still stick. My co-workers make fun of me for how healthy I am. I'm really a morning person and I'm stuck on this hellacious schedule. I feel for you. Hang in there.

Flagged immediately. All patients who are admitted to the hospital are given a nasal swab, regardless of "risk" - patient could be a healthy woman on the L&D floor giving birth or a septic bomb going to the ICU. All of our rooms, aside from the "holding area" are single rooms, multiple are negative pressure capable, and all curtained areas are 15' from the next gurney. Housekeeping is regularly paged and responds to MRSA/VRE cleans. They rock, and are under-appreciated. I don't ever want my nose swabbed. I know who's coughed on me. We have isolation carts all over our ED. But then again, our hospital is seriously going for Magnet.

Two nights ago I was looking through what we had in the waiting room, saw one and immediately thought of this thread. One word: "Hiccups."

Yes, WHO is, but ... studies were done specifically in Subsaharan Africa, where barrier methods are not as accessible or prolific as they are in the US. http://www.nejm.org/doi/full/10.1056/NEJMp0805791 http://www.ncbi.nlm.nih.gov/pubmed/17321311 ^^^Just an FYI for everyone discussing circumcision for HIV/HPV prevention.

Just curious if you think it's possible, and have you met anyone who has done so? I'm a CEN, and I LOVE the ED, but I also really love women's health, and have floated up to help out with the L&D floor in the past. Thinking about applying for a per diem job on an L&D floor now (supplemental to my ED time). I feel like the pace during delivery is like our resuscitation room - really fast, really focused and then a recovery time... and I love the intimacy that we get with patients in L&D. Ante/Post partum, totally enjoy all aspects- not just the "exciting" part of birth itself. Yes, I have NRP. Do you know of any ED RNs who have had this experience, or do you have any ED RNs with whom you have worked? Thanks for your input!

(Saline/O2) and... Albuterol/Duoneb treatment Zofran Morphine Dilaudid Acetaminophen Followed closely by: ASA, Plavix, Heparin (bolus and drip), Nitro (bid/stat/glycerin... all of the above, depending). Bicarb/D50/Insulin/Calcium/Kayexalate (for whatever reason, we've had a ton of hyperkalemic people this week)

Keep all of the patients as utmost importance. If it gets really bad, give a red flag to management that you've had trouble, but keep it short and professional (ie "this person and I just do not get along, and I have tried to make things work; I feel uncomfortable"). Document everything. Dot your "i"s and cross your "t"s and don't let her get to a chink in the armor. And good luck. We all have one....

Yes- I have used these in two different ERs. I have heard there is a "Level 1 override for boluses" and I have yet to see it. (BS.) I pressure bag or use our Level 1 for severely hypotensive patients. As to pharmacologic safety, yes they're great, but often have A LOT of safety traps - and often the tubing takes that extra 30s to load that you just don't have in the ED. We do NOT use them for blood, I don't use them for ABX like rocephin or cefepime, but they are great for a lot of other meds, including high risk/buretrol-worthy meds like heparin or insulin. They are easy to transport, and are much safer than the Alaris, I have to say. For those days when it's my 6th in a row and I'm dog-tired, I love 'em. When it's my first on, I could scream. And yes, they are VERY sensitive. Like any piece of equipment, you learn as you go.

AcBCD... Etc. (TNCC is really helpful, I'll echo this fact). And honestly, it depends on your hospital's protocol/system and resources (Level 1, Level 2...) and HOW BAD/WHAT KIND of trauma you are receiving. Is it a burn? Is it a penetrating? Blunt? If it's really bad and that patient is circling the drain on the table, and you're the primary nurse, you might be directing someone to run to blood bank with the non-crossmatched papers for your O neg or O pos blood, or you might be dealing with titrating a pressor, or hey, you could be looking for a third line in a limb that isn't burned to a crisp while pressure bagging a few liters in your other peripheral lines while a doc is hopefully putting in a central line, or you could be calling out the numbers on your monitor to someone who's hopefully charting for you (generally on a bad trauma you'll get at least 3 other RNs helping, plus a slough of gawkers/runners, at least you hope). You might help encourage closed-loop communication among ortho/trauma surgery/cardiothoracic/ED physician team. And you might be doing all of these things at once. All while helping maintain AcBCD....etc. If it's a minor car accident "hey we're not gonna take off the c-collar until your x-rays are back" kind of thing, yeah, that's different than a 65% TBSA partial and full thickness burn with bilateral tib-fib fxs, obvious femur deformity, systolic of 86/p on scene, unstable pelvis, tubed, and a positive FAST exam. Very different. But the methodology is the same. I guarantee that second patient is going to the OR, while the first patient is someone you have to monitor "just in case" (and one of my "just in case" folks ended up having a basilar skull fracture... hence we use the TNCC methodology). The interventions are pretty standardized. Your equipment and system may vary, and the intensity of intervention may vary, but it's the same systemic assessment in the same order for a reason. When you get something really bad and you're focused on the alphabet, it pulls you back into your job and you don't freeze. There have been some traumas that have made me drop my jaw. There are some I've seen where I've cried uncontrollably in the bathroom 10 minutes after that patient has gone to the OR and it's all over (kids - you see people do some horrible things to one another, and when kids are abused it really gets to me). But in the moment, I follow what needs to happen and do what's best for the patient, which is dictated by TNCC and the AcBCD pneumonic (Airway/c-spine, Breathing, Circulation, Disability/Deformity, Expose/Environment, Full set of Vitals/Fucntional Adjuncts/Family, Give Comfort, Head to Toe, Inspect the back)

From the ED side: I can speak for myself and say I am completely mystified as to WHY bed control releases beds to us at 0615 or 1815. We hate it as much as the ICU nurses do. And, I also want to say (not trying to be snide here, being serious): Last I looked, my RN license didn't magically go away at 0715 or 0730 (or 1915/1930). From our side, I can tell you that we are watching for that bed to be "assigned" the moment we get a patient - any patient who is being admitted- because we have another 30 (or more) in the waiting room, 2 on the way from an MVC or a gang fight with multiple penetrating injuries. Yes, I might be taking care of the guy who has a fractured femur, multiple decubes, is intubated, and his lytes are all over the place and his pressure's in the toilet, but changing OUR staffing ratios downstairs to ensure that we're 2:1 for the ICU patients in the ED means that the guy in the waiting room who is having chest pain and has a history of stents placed 5 years ago might have to be placed in a hallway on a telemetry monitor.... or that girl with abdominal pain and a positive pregnancy test with a history of 3 ectopics might wait longer... or the COPD'er with a fever and hypotension who is going to be my next septic patient might be delayed until the ICU can take the patient who has an Assigned bed... so that we can open up another few and I can go back to taking 4 patients. Remember, we're trying to treat people as quickly and safely as possible- and once someone has a bed somewhere else, that means another waiting person can be treated for their injury or illness. And this issue is also why we get so mad at all the BS that walks through our door... (but that's another thread). Yeah, I'm tired too. In fact, the last thing I want to do at the end of my shift is to take some unstable patient upstairs to an angry ICU nurse who thinks I'm trying to wreck their world by giving them an admit, when really, I would have taken that person up 3 hours prior had bed control said it was cool to do so. I promise, I've done everything I can to make your life easier. I apologize if I forgot something. Sometimes we are trying so hard to stabilize someone that little things go by the wayside. In any case, it's not a malicious thing. At our hospital, our hands are tied until bed control/admin gives us a bed.

Ah yes, sorry. I stand corrected. :)

UCSF has a DNP: http://nurseweb.ucsf.edu/www/ps-dc.htm

wow yosemite! you just shattered my california idealism. i guess i'm lucky here where i work - when we're sick, we're sick, although if we call in more than once in a three month period, we are subject to management's scrutiny and will have to produce a note- if it's 3 days in a row or more, it counts as one time, but should you call in twice then try to go to work and call in the next week, you're twice in a three month period. hmm. other than that, they're ok with people being sick, but i have to say, i always wonder if they actually believe me.

I know that coming from California, I'm spoiled. We have the 4:1 staffing ratio for "urgent patients" and a 2:1 for ICUs, and often 1:1 if they are really sick. I work ER in a very good research institution that has a huge staff and we get a lot of trauma. I am home sick (and truly am, taking a Z-pack, but just adjusted to a night schedule) tonight, but I know that nobody is going to have to suffer for me not being there. Not only is my hospital open and VERY willing to pay OT, they are maniacal about tracking it perfectly- even 15 minutes over a shift they will absolutely make you sign for it and an admin will approve it. I feel like even when we're "short" it's not generally nurses, and management will call people in, and even if we can't divert, we at least can hopefully staff to our best ability. Even if we're short, we still have our ratios in place. And we're paid well. And our patients stay mostly safe because of it (there are nights when honestly, I should have less than 4 patients because a med/surge patient in my hospital might be an ICU patient in another one, and we get sick, sick patients). Our hospital uses a float pool, and even if they're more accustomed to another floor, they still float to us. And there are hospitals in our area who use registry. OT is reserved for those of us who want it. And it's always approved. It's a good way for those who want to pick up extra money to do so, and I have to say, I think that overall, the ratios help with the safety, and the OT issues fall in place afterwards. And I am so thankful for all of the nurses before me who fought for the ratios. So. Thankful.

I have a very close friend who is a successful FNP, attended UCSF for her MSN, graduated with highest honors, and has a history of being bipolar, hospitalizations. She is well-controlled now with medications. She was an ICU nurse for many years, and is a CCRN. She has won awards, nationally. She did not have a criminal record, so I can't directly address your questions regarding drug rehab, but I can tell you that her illness has not kept her from accomplishing her dreams. Not everyone is alike, but she is someone who proves you can do what you desire if you put your mind to it. She had a long, hard, road and worked very hard on her own sanity and had a LOT of support. Don't let anyone ever discourage you - you know yourself better than anyone.

Honestly it wasn't so bad... But I did my first disimpaction in the ER. It was either me, or the second year resident, and honestly, I had kinda bonded with my patient, who was FOS (full of... well, figure it out) but had nothing else wrong with her. She was about 50ish, AOx4, totally embarrassed, and hadn't pooped in a week. Poor thing. That would make me grumpy. I gave her what we call a Pink Lady (enema) and that didn't work. So it was time for... The. Fickle. Finger. Of. Fate. (cue music). Fortunately, her husband was asleep. I got as much out as I could, and left a bedside commode for her. Apparently, when you disimpact, once the "cork" is pulled, it all flows. And what came out? My. God. I cannot believe a human could pass that. I've seen baby heads that are bigger. And she was so proud. And honestly, I was really happy for her, but holy cr#p it smelled like rotten onions. But the best part? The docs WANTED TO SEE IT. And she was proud, and you know what? I was proud of her. That was a week's worth of backup, right there, in a little tub. Ah, the small victories. Yep, gross. And awesome. And that's why I love being an ER nurse, because well, if it's truly an emergency, it's probably both. And that took the cake. And I felt like I actually helped someone. But it still made me vomit a little bit in my mouth when I had to flush it.

1) Available inpatient rooms with RNs who WANT to fill them and are more than happy to take our ER patients. 2) Everyone likes helping out, isn't burnt out, and doesn't give anyone "the evil eye." (No lateral violence). In fact, maybe people pay it forward because they know how hard a shift can be (oh wait, I actually *almost* have this scenario, which is really cool). 3) Labs don't hemolyze. And if they do, the lab techs have to come draw them (oh wait, that was at my LAST hospital... and it was kind of awesome). 4) The docs keep acting exactly like they do, because I have to say, the attendings and residents I work with? Rather awesome. 5) Only people who want to work night shift work it. And if you work nights, you get extra vacation, extra medical benefits, a 30% differential and you only have to work 2 nights/week because 2 nights is really like 3 days. If only... 6) The techs actually do their jobs. And we actually have enough techs. 7) Everyone rotates through the trauma room and has an awesome call with enough help in any given night they're there. 8) Pediatric patients always make it. And their parents are appreciative of our efforts. 9) Magically, those with a DNI/DNR actually arrive with a perfect POLST in place and with family members/durable powers of attorney who agree with the patient's original plan of care and allow them to die peacefully. 10) Triage gets to say NO to the drug seekers/regulars. Oh and there's a 24 hour "urgent care" next door to take these folks. With a pain management team. 10a) There's a statewide narcotic management alert team who tracks those who receive narcotics cross-county and where they are purchased and by whom. 11) Management promotes appropriate people, instead of those who elicit eye rolls and sighs. 12) We pick our perfect schedules. 13) Free. Coffee. (If you're gonna go, go big, eh?)

Dumbest: "I need a note so my kids can go to camp tomorrow." No kids with the parent, and the parent's excuse for not taking them to the pediatrician? "Well, they don't like going to the doctor, and you guys write better notes anyway." Ooo-kay. (And no, there was no work conflict for this parent). ************************** Most incredible: Whenever I see "retained object," I'm always curious to see what it is... Well, the two most amazing were: 1) Butane canister (wow!). Cap still on, thankfully. Surgery took him upstairs shortly after he came in (GI couldn't get it out, and they were really worried about the cap coming off and the butane leaking into this poor dude's colon). On a "lighter" side (oh the bad jokes that followed): I can say that "sparked" many "explosive diarrhea" comments... talk about "bad gas." (Oh, ER humor). 2) A bowling pin. Yes, a bowling pin. The *entire* bowling pin. I don't know how, and I don't wanna know. Does that count as a strike or a spare? ******************************** And it always makes me sad when you get the little old ladies who call EMS because "I'm lonely and feeling anxious."

I just threw up a little bit in my mouth.