V. Nightingale

I aspirate, and what's more, I have gotten blood return! On one patient the needle apparently hit a little vein beneath the surface of the skin; I was glad I checked, because my SQ injection almost became IV.

I'll be the voice of dissent here; I don't necessarily think that you need to go off work just yet. I worked in the ER up to delivery with my first, and worked my last shift there last week (I am scheduled for a c section on Monday). That said, your coworkers need to do what mine did -- step up and make sure that you aren't taking patients who could put you in danger. A pregnant woman at any stage has NO business taking care of patients who are high or violent. Let your friends take those patients, and you take the little 90 year old grannies for a while.

In my dreams I am a: successful novelist FBI agent stay at home mom

I've worked in places where none of us got together after work, I've been in places where a group would go out, and one of the nurses at my job now has becomse one of my best friends. We get together every few weeks on a day off and shop or go swimming or have lunch -- in fact, we took my son to the zoo this morning and had a great time. A lot of it depends on individuals and it also depends on the 'culture' of the unit. I like having good friends at work; it makes the shift easier to handle!

I think a lot of us feel the same way. When I was floor nursing (I'm in the ER now) I carried a clipboard and wrote down everything, much like geekgolightly. The first thing I did each day was make a list of what each pt. needed -- lab result to be pulled, dressing or IV site changes, discharges, permits, the works. It really helped me to stay organized. And eventually my mind got into the habit of holding onto that stuff so that I didn't need the list so much. I'm in the ER now and am pretty good at keeping up with what needs to be done. And honestly, if a patient asks you for something and it slips your mind, tell them that and apologize "Oh, Mrs. Smith, I am so sorry I forgot your glass of water. I got called away and it slipped my mind! Let me get it for you now." Something as simple as that can go a long way toward making things right.

Legal in Alabama, and I'm fine with it. Mothers who, for whatever reason, can't handle caring for a child are provided with a safe place to leave the infant. It's not about punishing or not punishing 'bad' mothers, it's about keeping babies safe.

"Hi there, my name is Valerie, and I'm one of the nurses who will be taking care of you today. I understand you've been having some (insert chief complaint here). Tell me a little about that." I also make a point to explain anything I'm doing. "First we'll hook you up to the heart monitor, and then I need to draw some blood and start an IV." I find that it just puts the patient at ease to know what's happening.

Leave the container of charcoal (pre-mix) in a basin of hot water for a few minutes -- the amount of time it takes to perform a gastric lavage is just about right. Softens the stuff right up.

My last shift (I work ER) was 2 days before my son's birth. I maintained my regular work schedule throughout the entire pregnancy. I avoided psych patients, fever/rash of unknown origin, and extremely heavy lifting, but other than that had no restrictions. Mine was a normal, healthy pregnancy without complications until the day before Sam was born, when my doctor diagnosed mild PIH and suggested we go ahead and induce labor.

My baby was born on Feb 1 of this year; I worked a 12 hour shift on Jan 29. It was rough! I found myself getting very tired and extremely cranky during the last 6 weeks or so. My coworkers were great about helping me with things, but it was really hard to work right up to the birth.

In my experience, drunks aren't usually too bad. Irate family members are usually more likely to create a problem, or patients who didn't get what they wanted. Family members pitching tantrums are the worst; they'll shout, swear and threaten violence. I've worked in ER for four years, and in that time I've seen my coworkers threatened with knives and guns, I've been bitten, and I've known of a physician who was slapped in the face by a patient (she slapped him back, and more power to her!). ER is just like every other arean of nursing; there's always the possibility that trouble will break loose, and you just try to either defuse the situation or get the heck out of the way.

well, she swallowed the spider to catch the fly. . .

My husband bought me a G-Shock watch for Christmas 2 years ago and I love it. It's solar powered, hooked into the atomic clock in Colorado so the time is always right, and it's practically indestructible. Instead of metal or fabric it has a resin band, so it doesn't hold onto yucky stuff I pick up at work.

A surgical mask or non rebreather applied to the patient's face works wonderfully to discourage this behavior I work in ED and we use restraints for both patient and caregiver safety. Mostly they're applied to keep the pt. from falling out of bed ( a last resort, but we don't always have personnel to stay at the bedside with someone who is confused and repeatedly tries to get out of bed), or with patients who are combative (fighting a lavage, or trying to hit/bite/kick staff). Restraints are a last line of defense after other methods have been tried, and we almost always try to use soft restraints to the wrists only, but attempting to harm staff members will buy you four point leathers in a hurry!

CPR is brutal, for both the patient and the caregiver. The first few times I did chest compressions my arms were very sore the next day! Frankly, if you aren't breaking a few ribs (on the patient!) you probably aren't doing it right. It's very tough to get good, effective compressions on most people, especially those who have extra tissue (either muscle or fat) around the chest and abdomen. And for what it's worth, I've more commonly seen/felt ribs breaking loose from the sternum, rather than breaking the sternum itself. Just remember, broken ribs will heal. Dead won't.

I had a patient last week with a hematocrit of 5.2. She was alert and oriented, although he behavior was a little strange, and had a systolic pressure of 112. Darndest thing I've ever seen.

LOL. . . It only gets worse. I happened to see part of an episode of "Dr. Vegas" the other night and thought I was going to have to claw my eyes out when they started doing CPR. I don't expect every tiny detail to be perfect but good grief! stop compressions before deciding that the patient is in Vfib!

LOL. . . It only gets worse. I happened to see part of an episode of "Dr. Vegas" the other night and thought I was going to have to claw my eyes out when they started doing CPR. I don't expect every tiny detail to be perfect but good grief! stop compressions before deciding that the patient is in Vfib!

A patient bit me on the hand yesterday! She presented with AMS and we were trying to obtain labs/urine, she went berserk. It took 3 of us just to keep her in the bed because she was screaming, kicking, and flailing her arms. I grabbed her wrists (hoping I could at least control her movements, if not pin her down) and while someone else was trying to get restraints on the patient she reached up and chomped down on my hand. I had forgotten how much that HURTS! Fortunately didn't break the skin, but left a heck of a bruise. So has anyone else been assaulted by a patient recently?

bonemarrowrn has it right, of course; keeping the patient breathing is pretty much the point. My main complaint (this really happened to a patient of mine) was that 15 liters O2 was the first thing EMS tried for a patient whose sats were something like mid to high 80's, when 4L per NC and a breathing treatment might have helped turn the corner. As it was, we intubated upon arrival to the ER because the patient was only breathing 2-4 times per minute:o. Protocol is a wonderful and useful tool, but so is critical thinking.

Most of the EMTs/paramedics I work with are AWESOME. We tend to see the same guys bringing pts to the ER every week, and I try to maintain a good relationship with all of them -- after all, I've cared for some of these guys in the ER, and who knows when I may be calling them to my house! That said, my biggest pet peeve is a lousy report, either because the medic doesn't know half of what was done or else they have made a determination based on a poor assessment (example: 40-something yo female brought in for c/o seizure. Medic tells me "She's faking it. It stops and starts, plus look at all the psych meds she's on." Hmm, I thought, you might be able to fake a seizure, but it's pretty hard to fake diaphoresis! Pt had been seizing for 45 min during transport and recieved no meds! Ohter example: 30 yo black male motorcyclist vs truck. "He's very stable," says EMS. "He's diaphoretic and has decreased breath sounds," says I. Final diagnosis was bilateral pneumothorax, fractured pelvis, and lacerated liver.). The other thing that really bugs me is a lack of critical thinking. If a patient has COPD, please do not treat her shortness of breath with 15L O2 per NRB, or we will be intubating her upon arrival to the ER because she will be breathing about 2 times per minute! Sometimes you have to think outside the protocol.

My personal favorite. . . "fel like i fin to fall out". I think what he meant was that he felt a little faint. . .

20 something newlywed presented in the ER with a golf ball up the, well, you know. Apparently she and the new hubby had been "playing around" and the ball got stuck in a skin fold of the lady parts, created a suction, and they couldn't retrieve it. After much (discreet) laughter and a lot of jokes involving the husband yelling "Fore!", one of our docs retrieved the offending item with a plastic spoon. We've also retrieved wine bottles, toilet brushes, and various other items from people's rectums. Life in the ER is never dull. ..

Oh, wow, codebluechic, that's an awful thing to have happen. My heart goes out to you. Plesase don't take this question the wrong way, but how did the patient get 8 units before anyone noticed a reaction?

Had an attending extubate a CHF patient in the ER; ya'll know the type of patient -- the kind with NO neck that it was darn near impossible to intubate the first time. His logic was "Her Sats are fine now." Yes, Dr. Moron, that's because she's on the freaking ventilator! All the ER nurses were just kind of looking at each other when he waid he was pulling the tube, and as he extubated the pt, I casually stuck my head out the door and called to the pt's ER doctor, "Hey, uh, don't go too far, m'kay?" Yes, we ended up reintubating in about 3 minutes, and yes, Dr. Moron had to get the ER doc to do it!