rhkenji

What are some events that warrants reporting to PD? Aside from 1). Suspected child/adult abuse 2). Homicidal patients that straight up identifies a target 3). High risks elopement (SI/HI patients, patients with IV) I ask cause one of our ED nurses wanted to call PD for suspected drunk driving and I told her that we treat the patients and are not investigators/its not a reportable event This is in california.

Most nurses in my ER dont use a pump, but I always do but there's some times that I've administered blood wide open before on a 16/18ga and they finish within 30min to 1hour no problem. I stayed with the patient in the first 15 minutes as I should.

Sheey's. I recommend buying it but there's a PDF circulating online. I have it on my iPAD and its my go to sleep book.

I hate this! 2 nights ago, I had a patient come in via EMS. She demanded that they be discharged as soon as she got into an ER gurney. The doctor discharged the patient right away and she requested for a ride home. "I came via ambulance, WE need a ride home (she came with her sister)". I did my best to find her a ride as she was 50+ year old. Normally, I just say NO, which is 99% what the house supervisor would say. But, trying to do the extra mile, I called, I got yelled at but was able to get her some bus tokens. I offered what was available at the time. They just looked at me angry, "This is unacceptable!". They then was able to pop a phone out and was able to get somebody to pick them up. I will just say no next time.

I work in a very busy ER with very high acuity patients. I started off as a new grad and we hire and train new grads to work in the ER. It's a steep learning curve and about 95% of us did fine

Hello, I currently have 2 years ER experience and like you, I started off as a new grad and was only given 6 weeks training (with possibility of extension to 8, but was not granted). I work in a very busy ER with many critical patients, although 6 weeks was a short time, I was given time to grow after my preceptor ship by being assigned what we consider easy patients and progressively got assigned to more critical ones. That said, I still feel like 6 weeks is short but I also feel like its not impossible. It's going to be easier with time, going back to learn every day/night is the hard part.

I love my ER, 9/10 people in our ER treats ourselves as one family and is always ready to lend a hand even if you dont ask for it. They're just there when you need help and we strive to have a great shift every time. There's 1 or 2 nurses that REQUIRES help with everything that they do, even the simplest thing. As our work culture sees that the team is only as strong as it's weakest member, we try out best to help them out whenever we can. As my charge nurse always say, "She may only work 70% of what we are able to do, they are still part of the team and we should appreciate their presence especially when we are short" Well, this morning, I was helping out a registry nurse try to chemically restrain a female belligerent drunk patient. The problem was the other RN and I are male, and 3 of our EMTs are also male. I advocated that for the patient's safety and everyone's safety, a female nurse should be present when we go into the room to medicate her. This nurse was the only female nurse in the area, and the situation is starting to get out of hand, we needed to restrain this patient as soon as possible. This will take approximately 30sec to 1 minute to get everything done. I asked this nurse nicely and explained the situation. Her answer was "Well, I need to chart, so you guys need to find someone else". She even stated that she need one of the EMTs right there and then to help her do an inventory list. Frustrated, and after 11.5hrs of the shift behind me, I blurted out. "Well, I do hope that when it's your time to need someone to help you with a psychiatric patient that you get all the help that you need". The EMTs and other auxillary staff started chuckling and she became really defensive while I ran off to the other side of the ER to find another female nurse to help us out. After the shift was over, I thought about it and I felt like I was out of place. I just feel like, we are always there for everybody, but she cant be a team player even once in a setting such as our busy ER. I know I could have handled it properly.

This could be it as well, I agree. Analgesic was followed through afterwards. She was losing her airway and only medication included in our intubaton box are succ, etomidate and roc.

she was placed on propofol immediately after RSI. given that additional meds will take 5-10 minutes to get from pharmacy, she needed more sedation to control restlessness. immediate v/o to max out propofol was given when it seemed like her high BP and having been intubated will support it. Maxed out on 50mcg, and being that she still restless, the V/O was to go beyond 50mcgs and both my CN and MD stated that it's ok as long as BP can take it.

This was immediately after intubation while new med were being added.

The BP was later addressed with nitro and cardene. The propofol scenario and verbal order was right after intubation. While waiting for nitro, versed and cardene from pharmacy.

Versed. She was placed on versed afterwards. But I guess MD wanted the propofol for sedation and to lower her BP

So, I had a AMS patient who was awake but non-verbal, not following direction and had to be intubated. Prior intubation, we couldnt get an accurate BP reading due to the PT being restless. After intubation, her BP was found to be in the 260s/150s, rechecked multiple times. After her paralysis wore off, doctor wanted her to be maxed on propofol per our unit policy (50mcg/kg/min), but that didnt help the restlessness.. she was still moving all extremities and the sedation is not working. Her BP at 50mcg/kg/min was 220s/130s. Doctor stated that we can go pass our guidelines of max 50mcg/kg/min. The MD and my charge nurse stated we can keep on increasing the propofol up to whatever is needed as long as the BP can support it and the patient is intubated. I cannot find any articles regarding about it. How far have you pushed your propofol dosaging? I usually request a secondary sedation after reaching 50mcgs.

Don't do it! Listen to these nurses. We wanted to be what we are but we still get burnt out by the profession. More for you that doesn't want to be one. Do yourself and future patients a favor and don't do it

I work in the emergency department in a hospital with a very small ICU. Most of the time, ICU level patients stay in the ER when there is no bed available for them to be admitted, so we function as an ICU nurse as well, on top of our other 3 sometimes unstable new patients. ER is busy, and can be overwhelming. ER nurses are expected to function as well as all other specialty unit nurses combined.