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rjflyn

rjflyn ASN, RN

Emergency
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rjflyn's Latest Activity

  1. rjflyn

    Does This ED Tech Screening Question Seem Odd?

    Most are looking for a certain personality type but anyone can BS at test. What you can't is a first impression. Can tell if someone is going to fit you mix with in the first 5 mins or not. The questions you ask are just because you have to.
  2. rjflyn

    No cardioversion due to risk of embolism?

    But doesnt ACLS also say a pt with chest pain and a heart rate in excess of 150 is by definition unstable and waiting around for a hour and a half for a test probably isn't the greatest course either. I for one want to know what the cardiologist he talked to said.
  3. DONT Am I clear. Everyone in the ED will hate you. My last place had Plusechek and its great noiw I'm at a place that has Cerners First net and its slow and bulky.
  4. rjflyn

    Cooler weather and homeless "patients"

    I dont know how much work up "ankle pain" requires. At my facility thats a complaint that typically if its during the hours its open goes through our express care area, if not its treated as such and they are in and out as fast as they can be seen and x-rayed if required. I we have one an its needed they get a bus pass and sent on their way, we provide them with the hotline number for shelter placement if they request it.
  5. rjflyn

    What is your ER's PCI med protocol?

    The standard of care for PCI is 90 mins. Though if there is no in house cath lab, then the standard is thrombolytics within 60 mins of arrival. I even know of some EMS systems that carry Retavase as they have transport times that cant exceed an hour and time is muscle.
  6. rjflyn

    Why drug someone who does'nt want to be drugged?

    May have given you Morphine because if that ED was like mine they may have not had any IV Toradol to give. We have be without for the last couple months. When we do have it pharmacy has be limiting it to 15mg and then only one time dosages and admitted NPO patients. As far as skipping the CT, its not unusual as it sounds for persons with known history. No use dosing with radiation if there are no signs of obstruction. Though renal labs general help back up this decision.
  7. rjflyn

    Need some advice / reassurance

    Well, thats quite a conundrum. From a supervisory stand point most of the problems a department has is due to attendance. HR erred by even letting your file get to the interview stage, so now they are kind of stuck. What I would personally do, would be to allow you to come onboard with the condition that you not miss any days of work for set period of time, maybe in excess of the standard attendance policy. Now I would be reasonable, if you were somehow were to be injured or exposed on the job that would be the one exception. Once you have shown that the past discretion is not likely to repeat, I would treat you like any other staff, as a valued member of the team.
  8. rjflyn

    Do you give mag off pump?

    Generally 2G hour on pump is the limit unless its 1) OB for pregnancy induced hypertension/ and its complications, 2) asthma. On Zosyn our facility too has gone to the hour time frame save for the ED we still do 30 minutes because ED doctors generally order more than one antibiotic. To meet the standard, for example in the case of pneumonia all the antibiotics have to be given and if there is a miss you miss the indicator and we are not going to keep a pt in the ED an extra 4 hours just to start a second med, as the floors have a tendency to miss them for us.
  9. rjflyn

    What is up with all the Dilaudid?

    Well since i work as a supervisor and deal with complaints. I give my two cents. When I get a pt who complains that " the doctor didn't give me anything for pain". But then I check the chart and more often than not there is clearly Tylenol or Motrin ordered, I generally explain to them that these are in fact pain medications and that it appears from the documentation that you have refused them. I further go on to state that the ED physician's are independent practitioners and I cannot tell them how to practice medicine. I generally go on to explain that if they have a license and privileges at my hospital I will be more than glad to get them anything they want. But as it is I think we are finally actually treating pts pain
  10. rjflyn

    jehovahs witness- refusing to..

    Though we do work in the ED and on occasion a person will be unconscious, unresponsive, have massive blood loss and they will get O negative. At the time we had no idea as to what their religious preferences were. It is something that we all have as emergency nurses have to reconcile.
  11. rjflyn

    Pts right to refuse treatment

    Kind of thin as far as suicidal goes. Though most doctors and facilities wouldnt let a patient whom has received narcotics leave that soon after receiving them though there are exceptions. Personally I know the kind, the providers I work with would let them go without a second thought, as we have too many patients who actually want to be taken care of. I myself also am not going to beg someone to stay, I just make sure they are making an informed, competent decision.
  12. rjflyn

    STEMI Protocols

    I can say its about universal everyone has a STEMI box. Paperwork, we catch up later- ours is computerized as is the orders. Consent is the MDs to get, if the need a witness the are required to ask us for it. As for all the stuff we do to the patient himself- thats streamlined too- lines 2 IV's generally, Nitro drip, hardly ever because "we just stop it as soon as we get them in the lab", same goes for the heparin drip so we just give the bolus. ASA, Plavix or Effiuient and Morphine is about all thats left along with O2- the EKG was done at triage though sometimes we have the machine attached and are doing serial.
  13. rjflyn

    Drug testing a RN while a patient in the er

    What the OP describes would be something that would fall under my facilities fitness for duty policy. She describe abnormal behavior that if I as a supervisor would have observed I would have most likely needed a UDS- of with the policy requires to be observed. That said like a prior commenter has noted pts coming to the ED with mental heath complaints get a drug screen, though in my experience these are never collected observed. There reasoning for the negative could be as simple as the med not being take frequently enough to keep a level to be detected- it happens. That said the only drug screens commonly observed are federal ones for truck drivers post accident.
  14. rjflyn

    "You've got 4 days to improve or else..." ... advice?

    At last check Med/Surg is now being considered a specialty so where is one to go. That said 20 wks is an awful long orientation. Most jobs only have 90 probationary periods, were you or the employer can say you didnt work out and thats it. I think you were behind from the start, time on the floor first, really now I just have to undo anything bad you just picked up. Makes the first weeks basically cancel each other out. To me I see flashing lights and bells going off when they are more concerned about a survey score than staff bullying and turnover. Sounds like a place I dont want to work.
  15. rjflyn

    Giving narcotics to patients with no ride

    I wanna work where you can afford/have cab vouchers, I as the supervisor would spend my whole night writing them. Having said that there is even liability in putting someone in a cab after narcs. Whats to say once said cab leaves the guy just doesn't get out around the corner. A bus is no better option- he could get hit as he steps off. Worse is " oh I just withhold narcs if they dont have a ride", is that policy or is that you now practicing without a license. The best option is a comprehensive policy that allows for prompt care, puts the decision in the hands of the practitioner and gives you an options if the patient breaks the rules. When in doubt, ask the provider, your charge person and goodness talk to your patients.
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