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HMartinho

HMartinho

High School student
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  1. HMartinho

    Oxygen order changes

    Protocols!! This is why I love protocols. Protocols just keep us from look like a complete idiot, and use our own brain. Yes, oxygen is a drug, but, for real, are you telling me that I need to call a doctor every single minute, to titrate oxygen on my patient? Are you serious? Most doctors who I work with (and most of them are really nice), will throw me under the bus, if that's the case. Obviously, if I feel that my patient need an high flow oxygen device, or he/she is getting unstable, I call the MD for sure. In my 2 current jobs (ER, and prision), we have protocols for almost everything. Pain management (except opioids), chest pain, trauma, altered mental status/agression, asthma, possible anaphylaxys/angioedema, shock, Dyspnea, hypotension, fever, etc etc. In my last job (nursing home), the doctor's staff had the iniciative to create some protocols as well, just to avoid calls for some "stupid" things: "Hey dr. XXX, it's nurse YYY, I apologyze to bother you so late, but I just check the temperature on Mr ZZZ, and he had 38.5 ºC. I just check your orders and I don't see any acetaminophen prescribed. I wonder if I may give some??" Give me a break.
  2. HMartinho

    Getting yelled at by a doctor for the first time....

    Yes, I didn't mean it wasn't. However, there are some countries in Europe, like Germany, where nurses can not refuse doctor's orders/prescriptions, like we can in Portugal or USA, or other countries. I can not even imagine how unsafety are to work in such countries.
  3. HMartinho

    Getting yelled at by a doctor for the first time....

    I can't even recall how many times I got yelled by a doctor. The last time was last Friday, when I refuse to give 20 mEq of KCL, as ordered. However, the patient last potassium level was 5,6 mEq/L. So, a chart it properly and stated my reasons to skip that potassium drip order. The doctor just got crazy, and started yelled at me just in front of all my coworkers, in a rude manner, and asking me how do I dare to denny his order, and where did I get my medical degree. Well, I just said: Are you done? Did you review the last patient labs? I'm not a doctor, but I got a 4 year degree where they teach me how to use my brain to nursing science, and I'm responsible for my patient safety, and in my non medical BSN degree, I was taught to not give potassium to a patient who is already slightly hypercaliemic. And I would never ever do a such thing, despite your order. Not even I was full impaired with blood alcohol. He turned around and go away. Fortunately, in my country (Portugal), my Board of Nursing allow nurses to refuse passing meds, based on our assessment and clinical judgment, since it was properly chart and documented.
  4. Hello, I work in a different country (Portugal), so laws may not be equal. Anyway, my Board of Nursing allow nurses to refuse medical prescriptions, based on our nursing assessment. I'm a nurse in a Nursing Home. Nursing homes in Portugal, usualy have residents 24/7, and ambulatory patients, who spent day time in the facility with some activities, and then go home. All the medication is prepared by nurses. So, going straight to the point, I have a patient who take 100 mg of quetiapine and 150 mg trazodone at night, and last week, doctor just add 0,25mg alprazolam at the same time. It is safe to mix all that medications, in a ambulatory patient, who I can't monitor to interactions? Thanks for your help and by the way, sorry for any typo.
  5. HMartinho

    Order that says "Don't call MD for pain meds"?

    In Portugal we really use a lot of IV acetaminophen, with some good results. But thankfully, the hospital where I attend my orthopedic clinical, have protocols for pain management, and nurses can give some drugs per protocol, without an MD prescription. That protocol includes acetaminophen (PO/IV), metamizol PO/IV (I don´t really know the english name), clonixin (PO/IV), ketorolac, and tramadol. I saw great results with metamizol and tramadol. When the pain was hard to control with this meds, we should call anesthesia.
  6. HMartinho

    Do you ever say "no" to an inhaler request?

    He/she is right. I've seen a lot of asthma exacerbations during my Pediatric ER clinical, some with a lot of wheezing (that wheeze you can hear even without a stethoscope) with pulse ox between 95-100%. A friend of mine is just an exemple. She had an severe asthma exacerbation during one of our clinicals, with a pulse ox number of 97%.
  7. HMartinho

    Someone can explain my doubt?

    > I forgot to put here the link of the video lol. my head is even forgotten lol Here is it! Thanks for the links you put here :)
  8. HMartinho

    Someone can explain my doubt?

    Yes it is. This article is a bit old, but is the reality of our country. There are very few Emergency and Resuscitation Medical Car (VMER) and the alternative was to put nurses on board the ambulance with an EMT-B within the country to stabilize the patient until arrival of emergency medical vehicle and resuscitation. Attention: "In my opinion, it is time to invest in the education and training of emergency prehospital personnel. Currently, only physicians and nurses are authorized to start IV's and only a physician can administer medications, intubate or defibrillate." It is wrong. The nurses that are trained in ALS can intubate and defibrillate through medical authorization by radio or mobile phone! In nowdays, the doctors don't use a map, they use a GPS on Emergency and Resuscitation Medical Car;) who want to watch, I'll leave here a "video link" about the medical emergency services in Portugal. Sorry to be in Portuguese, but later I will do the translation. For now, i can say that "enfermeiro" is nurse and "médico" is doctor/phsysician and "edema agudo do pulmão" is acute pulmonary edema. Just one more thing: Appear in the video "SIV ambulances. " In Portugal, the acronym SIV means immediate life support.This ambulances are manned by a nurse and an EMT-b "TAE". This Ambulances are more advanced, and the nurse can do 12-lead ECG, endotracheal intubation, administer emergency drugs, use infusion pumps and use a manual defibrillator (usually they use lifepak 12), without the direct presence of a doctor, just a medical control via radio or mobile phone!
  9. HMartinho

    Someone can explain my doubt?

    Yes I'm from Portugal but I wanted to compare the differences between the two countries (Portugal and United States or UK too), because in the future, i liked being a nurse, and work in USA (I don't like Portugal lol). You're right! There are other professionals in the U.S. who can intubate inside the hospital which you may not have in Portugal, for example, in Portugal we don't have respiratory therapist, just nurses and doctors can intubate (nurses and doctors trained in ALS),such as we don't have paramedics (only doctors and nurses can apply for advanced life support algorithm in prehospital care in Portugal, despite the government wanting to create and train paramedics in Portugal, many nurses are against this measure, so it is not regulated yet ... Sorry for any typo...
  10. HMartinho

    Someone can explain my doubt?

    Thanks for the answer. I made this question for curiosity. In Portugal I know that some times are the nurses who intubate the sick person in the ressuscitation room and other services (the nurses trained in advanced life support), therefore exist a great lack of doctors in some emergency room's, and this has raised some questions, therefore some doctors more conservatives have raised some problems about nurses intubate. who want to participate in this theme, feel free:) I also apologize for any typo. I still have to improve my English
  11. HMartinho

    Someone can explain my doubt?

    Just one more question: a "pre-hospital" nurse and a emergency nurse can do a endotracheal intubation and a manual defibrillation?
  12. HMartinho

    Someone can explain my doubt?

    yes, I was referring to physical therapists Pre-hospital nurse:Those nurses working in ALS ambulance, and nurses who make transfers of critical patients to other hospitals, or even nurses called "flight nurse"...
  13. HMartinho

    Someone can explain my doubt?

    Can anyone explain me what's the difference between a nurse anesthetist and an anesthesiologist? Between a rehabilitation nurse and a physiotherapist? Between a psychiatric and mental health nurse and a psychologist? Between a pre-hospital nurse and a paramedic? I'm not a health professional but in the future i'll be, and i have this curiosity... Thanks for the future answers!
  14. Hello everyone. I'm a portuguese student and i have 17 years. When I finished high school, I want to study nursing in the United States of America. Someone can help me to clarify my doubts? How can I do to study nursing there? the course is very expensive? What are the job prospects there? There are possibility that I apply for a scholarship? How much money is needed per month there, including studies, food, house rent etc? What is the average salary of a nurse there? I have no preference for any state, and especially like pre-hospital emergency care, emergency department and intensive care. I thank everyone who help me. Thanks
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