argos

My thinking exactly. Thanks for your perspective. I also have a little hydraulic engineering experience and was questioning a comment from a peer. I think they were perhaps confusing BP reading during CPR and the pressure bag. Cheers.

Is the BP reading affected when fluids are being infused by a pressure bag in the same arm? If so, please explain the mechanics or reference.

I have used them for years and never for an art line because art lines are mostly done in the ICU in the shops I've worked at. They are better in my experience than standing there and holding the bag. The pressure limit is 300 and it won't inflate higher because of a relief valve. It takes a minute to pump it up and then it will slowly lose pressure and you will need to pump it up about every 3-5 min. I use them 1 per patient not one per bolus. A level one infuser is best but not every shop has one so use it if needed but attach it to a fluid warm if you are using it for blood.

This sounds like it is for me! Thanks friend.

I am wondering how many patients do you recover at a time. I have been in the ER for 10 years and I' am looking to get out because when we are a nurse or 2 down it is expected that I pick up those rooms and it is not safe. I don't mind picking up an extra 3-4 patients but 6 on top my 4 is too much. I am looking into PACU but I don't want to be in the same boat expected to provide care for more patients than is safe.

And this is exactly why I am looking into another area of nursing. I have been doing this for 10 years and now due to cut backs patient care is compromised. I can't take care of 8 patients and then be expected to take care of the psych holds on the other end of the department that I can't even see because there aren't enough nurses. Yes they all have sitters but they still have to get their meds, assessments, gbs, showers. They would tell you that they can't control staffing and people still need to be cared for no matter how many come in. Well I would argue that you are not providing care. You are providing harm.

My facility does not do bp on kids under the age of 6. Children do compensate very well and then abruptly crash so you can probably rest easy if they don't have a tachycardia which would be compensating for low bp. If they look that bad then the child needs to get to back right away and all vitals can wait. Rule of thumb is to get all vitals on anyone being transferred because you may feel like a dumby if you can't answer the receiving rn's questions.

atropine is given to peds to dry oral secretions and prevent reflex bradycardia.

You really should invest in electronic charting. Registration can wait if there is an empty bed in the ed. Registration is important but not a priority and can be done at the bedside. Some other folks had some good ideas about color coding clip boards for acuity level. The chart rack system is so stone age and unsafe. What if the charts get switched somehow? I recognize there are financial limitations that may not allow for computer charting but it is the most organized way to manage pt charts.

Triage is the FEBA. Forward Edge of the Battle Area, that's a military term. I'm on a committe to try and reduce triage waiting times when at high capacity. Does anyone know of any online resources that could help me hatch a plan to decrease triage time? Just a little food for thought.... You need to get TNCC and ACLS to work in the ED but you don't need any formal training to be a triage nurse. OJT is not formal training and triage is the most dangerous place in the hospital.

I don't think it matters what shift you work. Anything can happen at anytime of the day so it is unrealistic to think that you can learn better depending on the time of the day. I feel that new grads should start precepting on the opposit shift they will be working to get an idea of how it feels to work that shift and then finish their preceptorship on the shift they will be working.

A patient has the right to refuse a wheelchair to the exit and any other treatment. I would try to comply with policy but if the patient wants to walk out they have that right. Some people see leaving in a wheelchair as a loss of dignity and all patients have a right to be treated with dignity.

If you had to wait 4 hours to get seen then it means the staff in the ER were very busy that day. The MD was in a bad mood and probably has a poor attitude to begin with. Seekers are notorious for refusing iv narcs so they can get their po narc rx filled. When you refused the iv meds and your labs came back normal you fit the profile of a seeker.The Doc answered a question that they get asked a million times by seekers before you could ask it. It was a pre-emptive answer. The attitude from the doc was because seekers are a drain on ER resources and they delay care for other patients.

It is always the physicians responsibility to explain ama. If the pt does not want to wait then there should be a place for 2 rn's to sign verifying that the pt left ama without signing or eloped. Also be sure to document that the md was informed that the pt wants to leave ama but the md did not explain risks prior to pt leaving. Also state that pt did not wish to wait for md to explain risks of ama. You can't force the md to do the paperwork or the pt to sign but you can document what occured in your documentation.

Thanx for all your advice. I have looked at the RN scope of practice for this state. We didn't study the LPN scope of practice. I am just finishing up my first year. I think that this assignment is just busy work. Maybe it's a tool to teach us the differences in liscensures. I did ask my instructors where I can get info on the GA LPN scope of practice and they wouldn't tell me. Hope ya'll have a happy Easter!!