kevro1013

We had a pt come in in status asthmaticus tonight. After her her hour long nebs and solumedrol ivp, she wasnt much better (RR=32 sat93% on RA). The ER MD ordered Mag sulfate 2 grams iv over 30 minutes. I had never heard of that as a treatment for AE of asthma before. I looked it up in the med book and sure enough under indications, there it was: relaxes smooth muscles in AE asthma. We gave it to her and she got better almost immediately! (I'm sure the solumedrol was also kicking in too). Learn something new every day! Kevin

Great thread! Here is one I had last week. Pt pressents with abd pain and htn (BP 230/120). Non-contrast Ct abd and pelvis shows non-disecting AAA. MD orders nipride to titrate for BP >160/90. What type of medication does this pt need prior to nipride and why? Kevin

I once took care of a guy who accidently shot himself in the right upper leg with a .25 pistol. He was in Babies 'R' Us buying his newborn grandson a corificeat. When he reached into his pocket to get exact change at the register, he pulled the trigger! It was only a fleshwound not requiring removal but I would have loved to see the clerk's reaction!

If you attempt suicide by taking 200 assorted pills in front of your parole officer and you are brought to the ed to get lavaged, the sorbitol in the charcoal might give you explosive diarrhea. If this happens and you find yourself incontinent of stool, do not try to bite/hit/kick the nurse that tries to clean you up. You might just have to sit in your own stool all night. Sorry.

Anyone else use fentanyl in the ED for acute pain? We currently use it for most cons. sedations (with versed). We have a Doc that orders it a lot for acute pain with an order like: Fent. 50-100mcg iv q 20 min prn. Most pts with this type of order are ortho types(good for getting x-rays done),chronic pain med pts, stable traumas etc. Just wondering... I like it b/c it seems less vasoactive and has less accumulative effects with multiple dosing r/t its short half life. Kevin

A nurse in our ER got written up by an ICU nurse because she did not weigh a pt before starting them on heparin. The pt was having an acute MI! The pt guestimated his weight @ 95kg, when they weighed him on the bed in the CCU he weighed 96.5kg. Our ER stretchers are 15 years old and they do NOT weigh pts. Also, the difference in weight did NOT change the heparin gtt or bolus dose. Uh, you want me to walk an acute MI to a scale to weigh him ? I'll take the write up over the v-tach.

Actually, Bilateral BPs are a good idea when assessing for a AAA, greater than 20mm hg difference can be a significant finding.

Heard the MD tonight order Dopamine as "no hopeamine" (I guess he didnt want to "leave em dead" with levophed)

WOW! Really puts a new twist on pushing someone's buttons!

You have been preparing to take the nclex since you took your first nursing exam in school (thats what instructors try to model questions after). I agree with the above posts; if you have been reviewing the material and are doing well on practice tests you will do well. Take the day before your exam off (study minimally) rest, eat a good breakfast, get a good nights sleep. Good Luck!!

Great post! I must be a combo tool belt/joker (striving to be a good guy) would like to add: "The grass is greener nurse"- Sometimes an agency nurse sometimes not, always has a negative comment about this facility ie: "we never have hall patients @ blah blah facility and our ratio is Never > 3:1." Really? Why are you here then?

It sounds like your facility is already ahead of the game! I must say though one of the most challenging type of pt in the ER from LTC is a chief complaint of altered mental status with no base line to compare to and also when the symptoms were noticed. A nurse to nurse report always helps before the transport (if possible since by the time the pt arrives the nurse who transfered the pt from ltc may be gone) and transfer forms are good at summing up basic data. (again sounds like you are on the ball here) On the other end I always try to call a nurse to nurse when the pt will be returning (or be admitted for an update). h&p is good if you can read it, emergency contacts for family are helpful, code status sheets are a necessity of course. I think it needs to be simple and spell everything out since the form is actually for another facility to read. Btw thanks for trying to make our job easier!

Do not take left over medications out of the sharps boxes and mix them together and shoot them up in the employee bathroom of the ER you happen to work in. SOME of those medications MIGHT contain sedatives and vasoactives that MIGHT make your heart slow down so that you will pass out and drool on yourself.

-This would categorize as one of the sickest things I've ever seen. This IV drug user had been shooting in the dorsal vein of his member (I'm not kidding). It had abcessed and swollen almost to the point that distal circulation was being compromised. OUCH!