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brainkandy87's Latest Activity

  1. brainkandy87

    Cooler weather and homeless "patients"

    Funny/sad story.. We had one of our regular homeless come in quite a lot recently (a lot even for him), for stuff like back pain, knee pain, a fall, etc. It was so excessive, I wanted to explode. One day, I see he had arrived once again by EMS, to our main trauma room. I laughed and couldn't believe he was taking up our trauma room. And then I walked in and saw a man who was having a STEMI and AAA rupture. Every once in a while you have to get put in your place. Even though they use and abuse you, every now and then they actually are sick, so you must always treat them as such.
  2. brainkandy87

    Triage: Documenting Ambulance Handover.

    In T-system, we have an entire page that we can pull up to put in an infinite amount of information about EMS and their report, ranging from IV site and meds given to detailed information about a 12 lead. I rarely do anything more than the IV site, blood draw, and meds, but it is nice to have in case you have a very critical pt brought in by EMS to have the PTA picture on your charting.
  3. brainkandy87

    ED support

    Level 3, 20 bed main ER, 10 bed fast track. We have a nurse-patient ratio of 4:1. Typically we have 1-2 float nurses/medics (3 on a fully staffed midshift) and 1 am tech, 1 mid tech, 1 pm tech, along with a free charge nurse. If needed, we have lab techs available to come draw blood (and they have to be present for t&s and codes). If we are extremely busy, we can call a code purple, which means that the floors have to come transport their own admits and radiology transports all of the pts for scans and films.
  4. brainkandy87

    Whats your biggest pet peeve working in the ED?

    The patient dictating to me their course of care and what I'm going to do. Sorry, no. You are in my bed, in my room, under my care. You are here because you need me to take care of you. Emphasis on the need me part. I don't need you bossing me around. You do, however, need me fixing whatever is wrong with you.
  5. brainkandy87

    Happy ER nurse week!

    On Monday, Krispy Kreme gave us donuts all day! That rocked the casbah, to say the least. Today we had catering from all around town and had the "Scrubby" awards. In the words of Nurse Jackie.. only the overworked and underpaid have a week devoted to them. However, I quite enjoy it. :)
  6. brainkandy87

    New Graduate ER RN vs. Floor Nurse

    This is an endlessly discussed topic. My opinion is that it depends on the new grad. A motivated, teachable new grad can succeed anywhere, just like a lazy, hard-headed new grad can fail anywhere.
  7. brainkandy87

    Ugh, those "I'm so stupid" moments

    This whole situation just blows my brains out. Does your facility not let RN's do EJ's and/or US PIV's independently (our ER docs "check" us off on skills such as EJ, US, etc)? I love my ER docs and the great procedures they do, but I'd never want a doc to put in a PIV over a nurse. How often do they do PIV's compared to us? But I do know every facility is different with policy concerning RN's and EJ's. I think you might've avoided a lot of the yelling had you not trendelenburg'd her until he was walking in the door (it doesn't take that long for those veins to distend once the head is dropped) and you would've had a lot less worry about her BP. Anyway, it happens. Docs get mad and yell, even the nice ones. No matter how many years you do this, you'll always end up doing something that makes you feel stupid. We are just human. :)
  8. brainkandy87

    starting in ER next month

    Yup, I got a job as a new grad on a step down unit and then transferred to the ER. There's a lot of things on the floor I learned that really help me in the ER. I think working on a tele floor and having to learn cardiac rhythms (and many times being the tech and having to monitor them all night) was the best thing I could've learned for the ER from the floor. It's nice transferring to a new job in the same hospital, that way you aren't completely shell shocked by orienting in the ER AND learning a completely new facility.
  9. brainkandy87

    Organizing the maddness

    This. A simple way to explain it to someone who's not having a life threatening emergency is that we are here to make them feel better and their PCP is there to cure them.
  10. brainkandy87

    New to the ED

    Erowid This is a site really meant for people who do drugs, but I think it's a terrific resource for education about drugs. Personally, I think people who do drugs are a far more reliable source on the effects of drugs than most other sources available to us.
  11. brainkandy87

    Certifications for an ER nurse

    Actually, let me correct what I said.. they are 1200 ml/hr. I had to grab one to double check it. For some reason I had it halved in my brain. My bad! Anywho.. 600.. 1200.. my thoughts on 24 gauges on adults remain the same.
  12. brainkandy87

    Certifications for an ER nurse

    24g angiocaths, that is.
  13. brainkandy87

    Certifications for an ER nurse

    Our angiocaths state 600 ml/hr on the packaging.
  14. brainkandy87

    Certifications for an ER nurse

    Sure, there are definitely varying degrees of trauma and yes, pretty much anything you can do in an 18 you can do in a 20 (however, I don't think a 22 should be put in any trauma pt, I don't care how negligible of a different the flow rate is). Everyone has their own way of doing things. Nursing is a very objective profession, yet it is even more subjective, IMO. I worked with a CRNI that wouldn't put anything bigger than a 24g in an adult and wouldn't put it anywhere other than the hand. She provided evidence and research for what she was doing, but there are a lot of variables and intangibles that come into play in nursing that research can't cover. Is the evidence there that says putting a 24g in an adult with no issues with venous access is acceptable? Sure. A 24g angiocath can hold 600 ml/hr. However, I think the majority of nurses with any experience at all would find it laughable that a nurse is putting in a 24g IV into an adult that is not a difficult stick. We just naturally "know" that's not the IV that should be placed. Anyway, to each his (or her) own, I guess. I'll stick with my trusty 18's. They haven't failed me yet. :)
  15. brainkandy87

    Just a question to understand the ER better

    Maybe the 15 minute wait was due to shuffling. We have hall beds in our ER that get used when we are totally full (as was the case tonight). However, I'd rather have a pt hang out in triage/waiting room for 10 minutes while I move someone non-emergent from a room to a hall bed instead of putting an emergent pt in a hall bed immediately. My rationale is that it's much more unsafe to put an emergent pt in the hall where you don't have a monitor or supplies. I'll hold that pt for ten minutes while I shuffle a non-emergent out. Who knows, maybe that was the case. Like I said.. lots of variables we don't know.
  16. brainkandy87

    Just a question to understand the ER better

    I think Stargazer said it best: triage is an extremely subjective area. One man's emergency is another man's, well, non-emergency. There's a lot of variables we don't know.. the experience of both nurses, the other patients in the waiting room, what was going on in the ER at the time, your father's presentation, and so on. Don't take it as the ER not taking your father's complaint seriously. Fifteen minutes is not a long wait at all and at a high level ER, this would actually be considered a short wait time. Sometimes when you're the patient or with a patient, it's hard to step back and look at the big picture of the ER. Yes, you might be worried and yes, it might be an urgent problem that should be addressed by the ER, but as always, emergent complaints take priority. Hope your Dad is ok though.