CrashED

D/C- Discharged ERP- Emergency Room Physician CAMS-CandyAssManSyndrome (We say but never chart it!) CP-Chest Pain CBA-Clear Bilateral Auscultation GAEBL-Good Air Entry Bi-Laterally PSBO-Possible Small Bowel Obstruction NIDDM-Non insulin dependant DM or IDDM-Insulin dependant DM HTN-Hypertension HLP-Hyperlipidemia PVD- Peripheral Vascular Disease AC-antecubital MAE-Moving all extremeties A+Ox3 (alert and orientedx3) R/O-rule out D/T-Due to

We have pharm techs in our department and have for a while now. Our techs do medication recs once the patient is placed in a room. It has really assisted in getting appropriate med lists, as they contact the pharmacy (community) and get proper updated lists sent right to us. They also help with some teaching and gopher meds which we may run out of in the dept! We initially had them seeing everyone but found that triage assessing was leading to a waste of resources due to walk outs etc.

Food......the one thing no ER nurse will refuse!:)

I moved to the ER almost 3 years ago with a background in General Surgery, Vascular Surgery, Urology. (And before that had worked Neuro and Rehab nursing). I found the transition was overwhelming at times, but it was the best thing I ever did. The first thing that shocked me was the sense of autonomy that you do not get from floor nursing. (especially floor nursing where all your MD's are surgeons!) Emergency nursing is a different kid of nursing from any other speciality, you do not have a care plan to refer to or order set, you do not have the ability to open a chart and find a history. You have to do your own dirty work, and figure out the problem. You need to learn to trust your own assessments, grow a thick skin because unfortunately working with the community can be a challange as some people are not as nice as others and learn to prioritize. And with your background you still remain somewhat specialized bc your collegues may turn to you for the wierd and wonderful tricks of gensurg!! Unfortunately it may make you the post-op-comp, woundcare, ostomy,catheter, ng and Chest tube queen... but for nurses that went to the ED as a newbie they don't have near the experience in those skills as we do seeing just that on the floor! They are great skills to have and I do not know how people go to the ED As a newbie! Good luck in your adventures to the ED! I hope you love it!!! It is an amazing place to work, there is always something new to learn and new to see!

It completely depends on the environment you are working. My ED is broken into 4 parts, fasttrack where the ratio is 1:9, Acute where the ratio is 1:4-5, and Critical/Trauma area has a 1:2 ratio. In fast track or minors it is completely acceptable to have a 1:8 ratio as these patients are normally triaged to be qiuck see and sends.

In my area we are in a nursing home shortage, so half of our acute care beds are being taken by LTC patients...so unfortunately when you work Med-surg, It turns out to be a bunch of seniors awaiting nursing home beds...really makes you miss the skill mix required for a med surg patient!

You are not alone! Sometimes you just need to hand it back...then fill out an incident report to cover your own ass!:)

We are working on that at my trauma center, more so because our medics have rediculous protocols. Anyone with fall or mvc below the age of 5 or above the age of 65 automatically comes in boarded and collared, even without neck or back pain! So due to impaired skin integrity issues, we can take them off if there is no complaint of neck or back pain on initial exam. We can also remove back boards that were just placed for transferring. (#hips sometimes come in boarded). They are currently working on a protocol for us to be able to take all patients off the board without MD at bedside.

Unless its an IV drug user telling you "I am a tough stick"....I don't believe it!LOL

I don't know about any of you, but at my hospital if a code blue is called, so many people arrive that it can spin someones head. We run our own codes in emerg, and it runs smoother then any floor code! The last floor code I went to, as the ER RN I have to manage lines, and do meds....well, I had to plow through 20 people just to get through the door to the patient! For that reason, we do not call ED Code Blues, unless its a mass casuality or something that our doc needs back up..if its just a run of the mill resussitation or trauma, we are quite capable of doing it without the audience of every med resident on site!

I have only been an emerg nurse for a few years but my previous back ground is Gen Surg. And I have seen the wait and see approach to a ruptured appy many times. There is obviously certain criteria that go allong with it (IE: No trauma to the cecum from the rupture). The logic was explained as they are going to get the antibiotic treatment with surgical intervention or without surgery. And research has shown that the body will take care of the infection and laceration to the appy on its own almost like it would with an intra abdominal abscess, and take care of rupture same as it does with the spleen (Low grade spleen lacs/ruptures are not sent to the OR). So we would watch appy's and give IV antibiotics. If there were any signs of infection not resolving, fever being uncontrolled, sepsis, or bleeding, then they would without question go to the OR! This non invasive approach to appendicitis is mind boggling to alot of laymans, and medical staff alike, but I have only seen a handful of "wait and see's" go to the OR!

Emerg drugs are scary, because we deal with everything from pain and nausea meds to antibiotics and PALS/ACLS Drugs. See if your facility has a parenteral drug therapy manual. We have one and it is marvelous! We have one at every medication dispensing unit as well as an online resource so it is quick and easy to access. It breaks down everything to who can give each med, how to Dilute, Push, hang piggy back and titrate for all drugs that are in our formulary! Micromedex and Epocrates also has a great aps for this! It also has a syringe/IV and ysite compatibility AP which is great for determining what drugs can be hung together etc. Its good for antibiotics but also other things like Potassium and other drugs. Learn your resources and use them it makes things alot easier for newbie and oldie nurses!!

Does your hospital not have policy for venipuncture?? We are only allowd 2 attempts per RN unless its an arrest/emergency situation and then we pull out the old IO to get things going until we can get IV access! I personally am a difficult stick, lets say my arms are well insulated since I am from the North! And I find the worst thing you can say to a nurse is "I am a hard poke"...if they know what they are doing when assessing for a vein then will know that you roll, have tiny crappy veins or are dehydrated!

We have several nurses in our department who preceptor Medic Students. It gives them an eye opener of what goes on once they drop the patient off. As their clinical rotations, they do several shifts in the ED shadowing a nurse. They also do some shifts in the OR and with Respiratory Therapy to get experience with BVM's, OPA's, intubation and resp assessments. In the ED The RN is ultimately responsible for the patient but we allow the Students to Start IV's, draw bloods (they are only allowd one kick at the can, if they miss they are done), give IM medications, SL medications and PO withing their scope, as well as do head to toe assessments and assist in proceedures. Our students have alot of sign offs they need before they can even access the trucks and graduate. They hope is that the hospital time and experience will give them a better understanding of the interdisciplinary team in the ED and hospital....but some of it see it as "Look at them with all the help and we do it solo, were awesome!"

Good old smoking cigarettes with the home O2 cranked at 6lmp via Nasal Prongs....KABOOM! (((And they didn't learn the first time, because it happened again)))

We can basically wear whatever we want. T-Shirts or scrub tops. And some of our Male Nurses wear Cargo pants.

The ED is a hard place for any nurse to go. The style of nursing is completely different. You need to be able to prioritize, recognize problems, emergencies and acuity. Some new RN's have trouble with it, but eventually it gets easier. I came from Acute care ICU stepdown and went to Emerg...(Frying pan to the fire!)....And one seasoned nurse told me "If you are comfortable and feel safe in your first year here, give your head a shake" it takes a year or so to get your groove on in the Emerg Dept! Whether it be a small center or a large one! Emergency Nursing is not for everyone, but don't jump ship and give up on yourself before exploring other education options and preceptors!

Diversions are really hard. I work in a city where there is a level 4 center that is open until 11 pm. It will see almost anything that can be seen, and sent....but people are afraid of waiting!!!! Even though the wait they are looking at is hours and hours! We have to OFFER diversion to any Triage patient who is level 4 and 5...even some level 3's. And we also have After Hours Clinic Bussiness cards in our triage room. Unfortunately though, all ambulances come to us in the city and surrounding areas!

Last week I am pretty sure my whole city had DIARRHEA/VOMITING, and ofcourse INEFFECTIVE COPING! And everyone of them came to emerg! I must have triaged 80 people with the runs in a 8 hr triage shift! Towards the end of my shift I had this gentleman come into my triage room saying I had to go help his daughter in the bathroom.....So I go to the public washroom to find a young woman covered in s**t! I asked her what happened and she said "Are you the nurse, you need to clean me up right now. You didn't get me inside and look what YOU made me do!". (Like I held her hand and told her to deficate on the wall, get it on her clothes, then proceed to wipe her hands on things!) She had diarrhea on her clothes, hands on the wall.....it was a mess you would expect from a child! I for a moment thought maybe she was special needs....until I realised Nope! I politely gave her a attends, and 2 johnny shirts and towels and such to clean herself up. As she bluntly told me that sh***ting herself was the only way she could get a bed inside! BOY WAS SHE WRONG, I told her that incontinence was no reason to rush her in because she was not dying, and there were sick patients inside! She was Irate and looked at me and send "Next time ill just have to go in the chair". I wanted to strangle her!!!! The girls inside were running off their feet, it was a "sickie day"....in which every second ambulance that came through the door had someone trying to go to the light! People like that drive me nuts!!!!!!!! GREAT JOB PLAYING THE SYSTEM LADY, I STILL AM NOT BRINGING YOU IN! TAKE AN IMODIUM AND LEARN TO COPE WITH LESS MANIPULATION !

What is the thing that you hate seeing in the Emergency Room? Is it kids, traumas, lost causes, frequent flyers or........... What gives you heebeejeebies, Creeps, Chills, gags. Tears, bad taste in your mouth and Pulls your heart strings.

I tell them we are instructed to keep them NPO until a physician order along with all disgnostic results are reviewed. If they are diabetic, we will monitor their sugars....and if they are really grumbling I tell the family they can feel free to wait at the coffee shop on the second floor.........BUT THE PATIENT IS STILL NOT TO HAVE ANYTHING!:) We also don't have TV's in our dept anymore, which was the best improvement our ED ever made! Last weeks Nutrition Nazi Adventure------>I had a guy come in with a STEMI quite disgruntled we were putting in IV's and trying to reach the Cath Team so we could avoid TNK. He was distraught at me for not letting him finish his big mac meal on the bedside table he brought with him!!! He said "But I am diabetic, you could kill me by starving me!" (((Well buddy Your Big Infarct is gonna kill you before your Sugar Drops!)))

We have 2 NP's who work at our trauma center, and the implementation of them has been a marvelous asset to our hospital. They see the levels 3-5 within their scope. It works great, and makes for faster ER times and Patient Care!

They present with _____ pain, and you go to get them an order for something and this is what the allergy list looks like....HINT #1 TORODOL FENTANYL MORPHINE ADVIL TYLENOL CODEINE TALWIN LYRICA GABAPENTIN DEMEROL ALL NSAIDS ELAVIL then you go to give them 0.2mg IVP of Hydromorphone and they call you cheap and tell you that isn't gonna touch them!!(HINT #2). hopeful lesson to seeker, do not complain to DOCTOR that the nurse is a cheap witch who won't give him the "whole dose!"....when the Doc ordered 0.1-0.2mg! .....Next we gave a warm blanket for comfort as per MD!!:)

I love the gardenhose explaination!!!

1) Paramedics report patient is found acting "Bizarre", diaphoretic, co Chest Pain radiating to his neck. Turns out the patient had a whole slue of problems. STEMI, Menningitis and to top it all off he had a CVA too!! Needless to say he had quite an impressive CT scan and his Lab work lit up light a christmas tree! 2) Man comes in with 4 ruptured aneurysms in his head...Talking, GCS15, Neurologically intact...only minor complaint sinus headache! CT showed the entire frontal lobe as a puddle of blood! 3)4yr old comes in with decreased LOC, did a full work up...turns out he got into someones special brownies, he woke up asking for some chips!