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thelema13

thelema13

ED
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thelema13 has 3 years experience and specializes in ED.

Canadian

thelema13's Latest Activity

  1. thelema13

    2016 Salary thread

    Central FL, charge nurse in ED with 5 years experience. BSN, CEN. $28 base with 20% night diff, no diff for weekends. No bump in pay for BSN or CEN. I'm told compression raises due in April... but I'm not holding my breath. Nonunion, not for profit hospital. Mortgage is $650/mo with taxes and insurance included for 3/2 1800 sq ft house. Utilities 300/mo.
  2. thelema13

    Sepsis

    Most of our docs stick with 1-2 litres as a bolus, and I have given 8 litres before. Our cardio and infectious disease docs agree, give more fluid and place BIPAP if you are causing HF or respiratory distress. Has anyone else noticed once you start abx, the pressure goes in the toilet and you end up playing catch-up until you get them in the ICU? Read a study somewhere sometime that stated there is a massive release of endotoxins once abx are initiated, and extreme hypotension ensues. Does anyone's facility have pressor guidelines without CVP monitoring capabilities?
  3. thelema13

    Potassium Rates

    10 mEq K+/hr (you can ask the doc for a vial of Neut, which takes the burn out completely, its 5 mL added to 10 mEq, you are adding 5mL of sodium bicarb to raise the pH of the K+ bag).
  4. thelema13

    Ideas for improving flow...

    We are switching to a 'pull til full' model in a few weeks. We have done this before with bad results, mainly because our ED hires new grads and most of the charge nurses remain stagnant in their chair. Pull til full only works if you have great flow control, that is, supervisors willing to give beds ASAP, doctors willing to sit down for 15 minutes and dispo as many as possible, etc. Our ED was remodeled and now holds 32 beds plus hallways, and the managers got us a mid-level and are proposing 2 charge nurses, taking away the triage nurse, having a full time float nurse, yada yada. Our mid-levels are not allowed to see peds under 1 year old, and they have to be a level 4 or 5. They are underutilized to say the least. The ED works as it is, and it is my mantra that 'if its not broken, dont try to fix it.' Someone in corporate that has their Master's degree that has never held a nursing job is trying to implement change and test a hypothesis. No other way to put 6+ years of school to work! Sounds like if you do not have a charge, why not designate a team leader? 3 nurses for 7 beds is awesome, you guys have enough manpower but how is patient flow? Do you have a medic or tech? And I think a room assignment would be awesome, split the room 3/3/1 and whoever has the 1 trauma room will be the float/charge. Walkie talkies for staff for easier communication?
  5. thelema13

    IV sites for Abd CT

    20g for CT's, but some techs will use 22g. CTA's are 20g AC or higher, preferable R AC. Per policy.
  6. thelema13

    Know How to Improvise a Tourniquet

    We use a manual BP cuff and inflate to 30-60 points above the systolic value.
  7. thelema13

    Input about gastroparesis

    Have any of the above posters tried high doses of high quality probiotics? Like 500 billion+ a day as a maintenance regimen?
  8. thelema13

    Cannabinoid hyperemesis syndrome

    How 'bout some Zofran ODT and a sandwich?
  9. thelema13

    How to treat?

    If the patient is truly recovering from their addiction, you should not give opiates because they are an addict, and the patient should state that as well, having known first-hand. You will just substitute one addiction for another. Give tylenol and have them follow up with PCP. There are plenty of non-narcotic pain remedies out there. In the ED, we have to deal and address with the emergency and we look for evidence to support our diagnosis, and too often the physicians give opiates because they work fast and make the patient happy (re: Press Ganey). Toradol and phenergen work well together, if your hospital still uses inapsine, talk to the docs about it. It's great for migraines/ super whiny pain seekers. Very closely related to haldol, and actually I just read an article about ED physicians using haldol/toradol/NS bolus for pain control.
  10. thelema13

    Patients who want to be admitted for minor things

    I once admitted a woman with a dx of morbid obesity.
  11. thelema13

    HCA salary

    My advice would be to RUN AWAY from HCA facilities. They have terrible management and treat their nurses like dog doo-doo. I worked for an HCA facility in South Florida, the ED was a joke (the rumor was most of the ED staff used cocaine and CCC's to stay awake all night) and when I was upstairs in PCU and ICU, they were consistently short staffed, never had a unit clerk for PCU or ICU (ICU charge would handle that responsibility, as well as being the tele tech for the entire hospital). They had really wierd staffing rubrics, such as if your department had 11 patients, you were allowed 2 RN's, but if you got 12 pts you were allowed the courtesy of a tech. Just from personal experience, I would never work for an HCA facility unless they doubled my annual salary, because you do the work of 2 or more RN's. Med-surg nurses routinely ran with a 10-patient assignment, PCU had 6 patients, ICU had 3 (routinely). Good luck!
  12. thelema13

    Case study: emergent penis ring removal

    We did try using gauze wrap around his penis and testicles while he was sedated with etomidate to try to compress and push some blood back to his core, but that just made his HR jump to 130's and made him very uncomfortable.
  13. thelema13

    Case study: emergent penis ring removal

    The latter.
  14. thelema13

    Case study: emergent penis ring removal

    No urology coverage for over a month. If the Dremel didn't work he was going to try either injecting neosynephrine at the source or aspirating some blood out. I have seen priaprism reversed on a 24 year old by urology after doing a local block with lidocaine/marcaine mix and aspirating with an 18g needle, but that was brutally scary.
  15. 51 year old male with a very large metal cock ring that was purchased a few sizes too small. He put it on and had a solid erection for 4+ hours PTA. No other medical history. This is what we did: 1: Ice packs 2: Ice bath for penis and testicles 3: Copious surgi-gel and digital manipulation 4: IV neosynephrine, 10mg in 500cc NS wide open, did not affect BP more than 10 points systolic but had little effect on diminishing his erection. 5: Patient urinated x3, minimal size reduction 6: IVP toradol, morphine, etomidate, versed and brought out the ring cutter, then the ring cutter broke.... the ring was surgical stainless steel 8mm thick 7: A whole lot more surgi-gel and I sent a nurse home to grab his Dremel. 8: Used the Dremel on and off for 1.5 hours, allowing time to allow the metal ring to cool (iced surgi-gel helped here) We used tongue depressors as a barrier/guard in between the penis and ring. 9: Ring pried open with some monstrosity tool from the OR. 10: Patient took a cold shower for 30 minutes, then ended up going home with a urology consult, percocet and a lesson well learned.... He had the ring on and a solid erection for approximately 7 hours. He was a retired firefighter/EMT and was cracking jokes left and right. It was a very sensitive, delicate, dangerous situation. What did you just learn???????? Buy a rubber ring, and invest in a Dremel for your ED!
  16. thelema13

    How does your ED handle stocking

    Our techs stock throughout the shift, with nursing staff helping as well. The techs never stock too well so I usually end up stocking my own assignment.