NewERLPN

In the last 2 years I have learned how to really advocate for my patient. Even if it means ruffling some feathers or having a doc be completely rude.

As an ER nurse I can tell you MANY stories of blatant abuse of EMS. For example- Chronic Foot Pain N/V x1 The list goes on and on...

and we usually give Toradol 30mg for IV use and 60mg for IM use.

Ugh...in my ED we give a IM combo of : Narcotic: Demerol Dilaudid Morphine and one anti-emetic Phenergan Reglan Zofran there is an occasional Toradol slipped in there for pt's who are not *allergic* to every NSAID or non-narcotic pain reliever known to man. And the MD's wonder why we have such a drug seeking problem.

When you have a discussion of a GI bleed, abscess, etc over lunch.

i can totally identify with this. as a nursing student i would frequently gag during dressing changes, cleaning bm, etc. the worst is a lower gi bleed! i usually just grab a little vick's and keep going. luckily i have been able to disguise most of my gagging by having the patient turned the other way. toenails disgust me but abscesses fascinate me. weird huh? you just learn how to deal with it by facing the pt another way or using vicks. after 2 years i have become a little desensitized.

Thanks for the feedback y'all. Generally if someone comes into the ED, well my ED at least, under the influence of any substance we can 1013 them for a preliminary screening at least. I know I can't fix everybody but darn if I don't try. The wierd thing is that he had done it 1 year prior. Idiot. Oh well.

i have been racking this situation through my head and needed some outside input. so, the other day a police officer presented to the er with a 30ish male. pd stated that he pulled over the pt for failure to stop at a stop sign. when he approached the vehicle the pt was shoving bags of cocaine in his mouth. since he had done such a good job and got it all the officer couldn't charge him with posession and brought him to the er as a voluntary pt. when he arrived his bp was about 210/110 and p 150. the pt was cooperating until pd left. he then decided that he wanted to sign out ama. i was not in charge of this pt but was helping with his care. the md in charge is historically non-agressive with pt treatment. instead of doing a 1013 (which we call it in ga, the form to make treatment mandatory), he allowed the pt to leave. his nurse and i did everything we could to convince him to stay for treatment. finally, the other nurse took off his bp cuff and said that she would see him later and allowed him to leave. of course, he came in 1 hour later as a code and didn't last long. i just don't understand why a 1013 wasn't imposed (if anything to cover the mds butt). i just needed to get it off my chest and see if you guys had any relateable experiences. i hope no hippaa violations thanks

We give Demerol IV like it is going out of style. Good to know.

In my ED we use IBEX which automatically transferes data to Meditech that is used in the rest of the hospital. We love IBEX (especially when they buy us lunch ). We have many protocols which usually aren't used unless there is prolonged door-doc time.

I once had a frequent flyer psych pt pull out a knife, proceed to slit his forearms multilpe times and then point the knife at me. Thank god for a brave male tech that came to my rescue. Ugh, security sucks at my ER.

Another memorable favorite. I've had several C/O diaper rash x 1 hour. Of course, no OTC meds tried. Grrr.

I have had a lady come in because she "hid" a hundred dollar bill in her rectum. Needless to say, she couldn't get it out. She said that she had unsuccesfully tried to "dig" it out. The MD did a rectal exam but refused to get an anoscope to go searching for something that would come out on it's own. The patient got panicked and cried until he gave her a bottle of mag citrate and sent her back out onto the streets. Apparently, she was mad because she wanted a fix and wanted it out that second. Just think about that the next time you use money! Ash

I work in a very busy ER where we pay critical staffing for extra shifts that a nurse picks up. I have an amazing Nurse Manager whose goal is to have a waiting list for ER nurses. The critical staffing shift diff is an incentive to come in for extra shifts that are low on nursing staff.