MICPEricRN

There are roughly 60mg in 1 grain. 1/6th of 1 grain would be 1/6th of 60mg 1/6 of 60 is 10. therefore, the concentration is 10mg/ml. For 5mg, you need half of that 10mg in 1ml, or 0.5ml. And when are these nursing schools going to realize that no one uses grain, drams, minims, or avoirdupois ounces any more?

Gloves, lots of gloves. Alcohol wipes, a lasix tablet (I know I didn't miss any meds), 3 flush syringes (unused), more gloves, a roll of tape, a carpuject, did I mention gloves? :)

One of my fellow EMT instructors shot his thumb with one. Pulled the cap and then put the end with the cap on the table and pressed... It was the only "live" EpiPen we had at the program site. Right into the sharps box it went. Then we watched as we gave the rest of the students a demo on the side effects of epinephrine. To this day, I use this as a scenario when we do practical skills stations with the students and I see one holding it backwards: "OK, you hear a click and feel a sharp stinging sensation in your thumb. You begin to feel palpitations. The patient develops more severe shortness of breath and becomes unresponsive..." It gets the point across to them!

Had a similar situation with a patient I had recently while working my paramedic job. We were called to a local long-term care facility for a "request to transport patient on a monitor." Mind you, I was not working the SCTU (transport unit), but a 911 paramedic unit. What happened was this: At 1130, patient (with multiple hx including DVTs, obesity, type 2 diabetes, HTN, released from hospital 2 days prior s/p knee replacement) c/o chest pain. Nurse gave pt mylanta and called doctor. (hmmm ?) Pain resolved within a half hour or so. MD finally called back about 1800 and told them to call for transport with monitor to the contracted SCTU service. The contracted service did not have a unit readily available. The doc then told them to call 911. Thus why we were summoned. Of course at this point the patient was totally complaint free, so as a paramedic in a 911 situation, we were not really needed. We did a complete assessment on the patient, EKG, vitals, blood sugar, etc., and found nothing outside of normal limits. Patient had no drips or running IVs, only a capped, heparinized PICC line. Our role is not to provide monitored transports to a patient for whom ALS can not be justified. We called our medical control physician and explained the situation. In our system we respond as a non-transport ALS unit with a dual dispatched BLS ambulance. With the base physician's authorization, we released this completely stable patient to the BLS unit for transport. This of course did not sit well with the nurse in the LTC. I felt for her, because as an RN, if I were placed in a similar situation, I'd be very uncomfortable. When I asked why they did not simply call 911 when the patient was acutally experiencing chest pain, they said that they were told that they have to have authorization from the MD first and he didn't call back...for six and a half hours. I was dumbstruck. Do the LTC folks out there really have restrictions like this? We ultimately explained to the nurse there the patient was stable and really did not need our services on the relatively short transport to the ER. She understood fully, but I think had some trepidation about explaining the situation to the MD. I would certainly not have wanted to be in her shoes. IMHO, these folks need to have a little more autonomy in decision making. They should not have their hands tied playing phone-tag with the doctor in a potentially serious emergent situation.

Very sad, but the cynic in me says "Wow, what a charting nightmare!"

I would hope that patients that have been prescribed NTG at home have been tested in their PMD's office for excessive sensitivity to its side effects. Doesn't mean that they won't drop their BP the next time they use it, though. Here in NJ, basic EMTs can give patients their own NTG tab or spray SL x 3 PRN for continued pain and SBP >= 110. The federal curriculum standard for EMT-B is 90!! The EMT protocol was set where it is here because the ALS standing order for paramedics is 110 and they wanted to avoid confusion. With EMTs giving this, there is NO IV, NO EKG beforehand. The criteria is the NTG is prescribed for the patient, it is not expired, their systolic pressure is >= 110, they have pain in their chest, and they have not taken either an ED drug or 3+ NTGs already. As a medic in the field and as an RN, I've had a few patients seriously dip their pressure after giving NTG, but always had a line in place. Lay them flat, open the fluids up and they seem to come back around pretty quickly. These were always naive patients, though, that is, patients that have never had NTG before. Never had one do that who was prescribed NTG for use at home.

As a nurse and a biker, all I can say is stop typing and twist that throttle! Ride on!

In my ER, we draw a lactate level on any pt that comes in with any 2 of the SIRS criteria: Body temperature 38 °C (100 °F). Heart rate > 90. Respiratory rate > 20 or a PaCO2 White blood cell count 12,000, or > 10% band forms. We have a SIRS protocol, so if any two of the first three show up in the initial assessment, we can draw the lactate as part of the initial labs before the patient is seen by the doc. We enter the protocol order directly into the computer and tube the samples straight to the lab.

I work ER. Every job has a specific solid color. Nurses are in hunter green. That's my preference, too. I look like the Michelin Man in white. :)

Can I bring nitro? :)

GI Bleeds. Specifically lower GI bleeds. I can do almost anything else, and working urban EMS, I've seen most of the bugs living where they shouldn't be and such type patients. Dealt with plenty of codes and patients vomiting, sometimes on me. But the one thing that will push me right out of the room is a bad lower GI bleed. Blood and poop are two smells that just shouldn't be smelled together!

When working the paramedic unit, I put *everything* in my pockets. I'll come home with 5 or 6 pair of gloves (clean!), backings from EKG electrodes, angio wrappers, sometimes angios. Had a bad asthmatic one day at the end of the shift, came home with two unopened vials of epi, two "bullets" of proventil, and a 1ml syringe (unopened). I don't like leaving things all over the patient's living room, and I tend to grab what I may need quickly out of the jump kit just in case. It all goes back the next day... Worst I ever did was bring home the keys to the truck. Fortunately there are two sets.

As a student, they may be asking you to check all of those pulses to get comfortable with locating them. Like any other psychomotor skill, and certainly assessment skills, you should be practicing all of them as much as you can.

I'm in NJ as well and just passed NCLEX last month. I received a letter from the BON 3 weeks after I passed NCLEX. The letter was my "official" notification that I had passed and had my license number on it, so at least I could use that information to begin filing applications. It said I would be receiving my license withing 10 business days. In fact, the license came exactly 1 week after the letter. Supposedly the BON updates their website every month, but I haven't seen the update containing my information yet, either. So, don't despair, the official paperwork is coming soon! Good luck!!

Her pulse pressure was 81 at the first reading (121 systolic - 40 diastolic = 81). This tells you that her left ventricle is doing a very good job. Her MAP was 67 at that reading. Well within limits to provide normal perfusion, although 70-110 is considered a "normal" value. As one of the other posters stated, she could be a little fluid depleted though.