remf3

When I worked in a larger, level II county facility, your ratio was dependent on where you were located. In the urgent care pod, 4:1 was the goal, 5:1 was the reality. I remember a short night running 15:1 with 2 techs and an LVN. It worked, but was a stressful 12 hours. The last two places I've worked strive for 4:1 with adjustments based on acuity of patients. I've also had the experience of never being able to rely on techs, so your mileage may vary.

I've recently changed jobs from a smallish (19 beds) Level III ER to a very small 9 bed ER. The change was made to be closer to home. I'm in my second (and last) week of orientation when an actual sick patient showed up. It's basically been a clinic up to this point. The patient needed some aggressive fluid resuscitation and I was digging through the IV cart for a 16G or 14G IV. The pt was 90, but had at least one vein that I could've squeezed a 16 in to. When I asked "Where are the 16s?" I got looked at like I had asked "Is it ok if I poop on the floor here?" Sorry for the crudeness, but that's me. Am I the only one that looks for large bores for fluid resuscitation? I could hear accusations of "trying to show people up" and that certainly wasn't my intention. I wanted fluid into this person quickly and big pipes save lives. Admittedly, I have some flight experience and have worked some ERs where you're made fun of for using less than 18 on anyone remotely sick, so my background is a bit different. Also, I know 90 is awful old to be making the heroic effort, but there was no "DNR" present and when they say "go," I go.