lvnlrn

Examples of trauma flow sheets: (You could probably google any state & "Trauma flow sheet" and see examples) http://dphhs.mt.gov/Portals/85/publichealth/documents/EMSTS/trauma/cmctraumaflowsheet.pdf http://dphhs.mt.gov/Portals/85/publichealth/documents/EMSTS/trauma/Ronantraumaflowsheet.pdf

ICU nursing is focused, constantly reassessing, 2-3 patients at a time (usually), detail-oriented. ED nursing is different. You have anywhere from 2-5 patients, and you don't know what's wrong with them usually. You get your patient in the room while assessing just how sick they appear, put them in a gown, get them hooked up to the monitor, start your IV & get your labs, get urine & ECG, (whatever, depending on the complaint). While you're doing their ECG & IV, you're asking them questions, assessing them. Hook up some saline, give them some Zofran if they're nauseated. Implement standing orders, chart. Wait for MD to see the pt and go on to the next patient. You should be able to do all that in 30 minutes or less (this example is a vitally stable patient). Get your next patient and repeat. Go back to patient #1s chart, hopefully the ED MD has seen them & written orders. Fulfill orders. If patient #2 not seen yet, start on #3 or help your team out. Eyes on the monitor whenever you pass the nurses' station, eyes on the patient when you pass by their door. (I never close the curtain/door when I'm out of the room unless they ask). Start a new patient, reassess the other patients you have. Pop in at least once an hour, throw in a quick set of vitals. Status change? Get your vitals, intervene, get the MD. I like the autonomy of ED nursing. BP in the 80s, tachycardia? No hx of CHF, heart issues? Throw up a liter of saline and see if VS improve while you're waiting for the MD to get in there. I had a 20 yo F patient last night with altered mental status, straight cath'ed her for urine the color of tea, her LFTs are through the roof, so I went ahead and ordered an ammonia level. The MDs (95% of them) are fine with this, once they know the nurse. I am not surprised this is a big adjustment, especially coming from a small town ICU. Get the patient, vitalize & stabilize them, and either ship them out or get them upstairs. ED nurses are not the most detail oriented. We don't care about doing comprehensive skin and head to toe assessments. I give report to the floor nurses: "Any skin issues?" "None that I saw." Are you taking ENPC & TNCC? Those courses are great. I am willing to bet you are doing great right now, but maybe are trying to do too much. I hope this helps. ED nursing will help you multitask, prioritize, and give you more confidence in other areas of nursing. Between ICU & ED experience you'll be a rock star. :)

I'm assuming one of those appointments was to see the doctor for her shingles? I hope so...shingles in the eyes can be nasty and lead to long term effects. The MD can write for an antiviral (probably too late now).

Ugh...not a frequent flier but I had an elderly patient demanding that I give her an enema before discharging her for her chief complaint of neck pain for last six months. Never mind that she had no problem having an extra large bowel movement while she was in the ED.

I think you made the right decision. Some of the ED nurses I work with (we're at a level II trauma center) came from tiny EDs in the middle of nowhere. They are able to be so independent because they literally have to do it all in these tiny EDs until help comes. I heard one story of a patient who was intubated and couldn't be flown out for two days because of bad weather. I almost think I'd rather start a Level II ED with little to no orientation because there is always someone else around to answer questions. In these tiny EDs, you're pretty much it.

In your shoes, I think I would have documented your report, as well as what you said in quotes. And then I would discuss it my manager to see what she feels, if anything, needs to be followed up with regarding the other nurse's charting. I can see why you are a little upset...it wasn't fair for her to put that on you. Like PP said, you do not dictate where this patient goes. In my hospital, it seems like there is a little bit of ED vs. floor nursing going on. Wish we could all just lay off each other and realize we're all doing the best we can.

Artemis Safe Dose Pro iPhone app is my go to app for double checking peds meds before giving them. I've caught overdosages with it. You just enter how many kgs they weigh, the med you're giving, and it tells you how many mgs to give, and figures out the mls to give based on different strengths of the med available.

I drew up Valium and put it in a 10 cc syringe of saline. Immediately it precipitated, turning into a nice cloudy mixture. I had to waste the syringe and put the second dose in a 3 cc syringe. I had no precipitate in the pts line when I flushed with saline after giving it. Hth.

And I'm curious...if this pt is on room air and is so sob he can't get out of bed and is on palliative care for copd why is he not on oxygen?

Keep in mind that this resident will have anxiety related to the sob and not just the death process. Try breathing under your covers for two minutes and you might be able to empathize with this anxiety from being so sob. I had a resident like this during my first nursing job fresh out of nursing school. It was awful watching her...she was literally suffocating to death bc of her end stage copd. She seemed almost eager to pass

I'm sure this topic has been hashed and beaten to death, but it's new to me, and definitely not something i can vent about to Facebook or even my family (non-medical)...I started working in the ER setting in January, in the "Minor Care/Fast Track" area. ESL 4's and 5's and "soft 3's" are ours to deal with. Loving the kids, but sometimes their parents/guardians/whatever blow me away. The lady who insisted I give their kid ibuprofen before they left because she had none at home and couldn't afford any. Of course I got the order and gave it to the patient, but in the back of my mind I'm thinking resentfully, "$5+ for that pack of cigarettes you were out smoking when they called your daughter's name in the waiting room but you can't afford $3 generic Tylenol?" I try to put myself in their shoes, but sometimes it gets difficult to understand how a parent's priorities can get so out of order. At least she brought her daughter in, though... Obviously working in the ER you see, hear and deal with a lot of things you wouldn't otherwise be exposed to...how do you deal with these situations in your mind? The example I gave is nothing compared to what I'm sure a lot of you have dealt with...how do you keep from becoming cynical and jaded???

My preceptor (she actually is fairly new as well) and I were starting an iv on this sweet high school girl. I had no problem getting flash, but her skin was so tough that I couldn't get the cannula to thread. She didn't tan (which I know makes skin leathery), but she was definitely cool to the touch. I tried twice and couldn't get it. My preceptor tried once (pulled the cannula out, with it bent at a 30-40 degree angle). I grabbed the flight medic to finish the IV and he said she was a tough stick but really didn't have any advice. I would love feedback, tips, whatever on how to handle this next time...tia!

I just wanted to share something with you. I've been HOH all my life (it was hereditary). I've always worn BTE and did a little lip reading. I really never had problems until it came to using the stethoscope. I tried amplified stethoscopes, but they just weren't powerful enough and I was frustrated with having to take out the hearing aids. I finally went to my local Voc Rehab and explained my difficulty. They set me up with Bluetooth hearing aids and a receiver that I wear around my neck. The stethoscope they gave me attaches to the receiver and sends the heart/lung/etc sounds to right to my hearing aids. (It's all from a company called Phonak). While it does surprise patients because it looks like I'm not using any earpiece to listen to their lung sounds, I've had several comments that they think it's cool. Just wanted to let you know there are alternatives out there, and I strongly recommend going to Voc Rehab. :)

XmasShopperRN and Rhi007, those were the exact kind of things I was looking for...tips and tricks that I wouldn't find in a typical pediatric nursing text. I completed PALS today, and picked up a few more good tips and tricks. You all probably know this, but for a kid in stable SVT, pull the plunger out of syringe and tell them to blow into it like a straw to help them stimulate the vagal response (since they might not understand how to "bear down". Thanks for your input, and I'd love to keep the tips coming!

Wow, thank you so much for your time and effort with your reply! I really appreciate it :) I've started in the "minor care" part of our ER (soft 3's, 4's, and 5's) and will take PALS Monday, and am required to get my ENPC within 2 years (starting to think doing this sooner will be better). I love kids, but I hate giving the shots and feeling like I'm torturing them (even though it's to make them feel better!), so I thought I'd see if anyone had any tricks up their sleeves when doing the procedures that are particularly unpleasant! I agree with brushing up on my kids' shows. Phineas and Ferb? Never heard of them until now!!