shill

Hello, You're probably all thinking that, "man that was a long dinner", I guess with all that's been happening to me, I got a little tired and have laid back a little bit. and as I reread my last post, I see that I put my diagnosis as hippocampus, which as, most of you here know that hippocampus is not a diagnosis. I should have stated that, it was at the hippocampus that my stroke (tia) took place. just a little knowledge to the new RN’s…… and to myself, which I have learned, after experiencing this event, it has given me a better knowledge and understanding, of the patients that come into the er, who has either experienced a stroke, has alzheimer's or is going through what I have gone through. it has really given me a good understanding to the old saying, ” unless you have walked in their shoes and experience what they have experienced,” can you say,” I understand what you're going through”. below is just a few interesting points, about the hippocampus and what happens at this segment of the brain….. I found it to be interesting: I hope you do …. hippocampus (hippo camp' us) **the hippocampus is a horseshoe shaped region of the subcortical brain. as part of the limbic system, located in the temporal lobe, it has a role in emotion and memory. it also contains "place" cells that construct mental maps of position, and with the parahippocampal gyrus, is implicated in the learning and remembering of space (spatial orientation). ** it is important for converting short term memory to more permanent memory, and for recalling spatial relationships in the world about us. it is also part of the limbic lobe. it got its name because its shape resembles that of a 'seahorse'. **damage to the hippocampus disrupts recent memory, but leaves remote (already learned?) memory intact. **it is a center for short term memory. it weighs the importance of episodic acts and decides which should be kept as memories. therefore it has an important role in learning. **new memories are first processed and kept in the hippocampus for several weeks, before they are transferred to the cerebral cortex for permanent storage.. **it receives input from auditory as well as visual tracts **it allows for rapid learning of new items. **it helps construct a three dimensional "mental map" of our surroundings, and is crucial for our ability to move around in the real world. **this may explain why people with brain damage to their hippocampal region retain previous memories of faces and places, which are stored in the cortex, but have difficulty forming new short-term memories. **damage to the hippocampal region results in a failure to remember spatial layouts or landmarks. **stroke patients who experience navigation problems inevitably manifest brain damage in an area just below (and connected to) the hippocampus, a region called the parahippocampal gyri. this area is crucial to the storage and recall of spatial information. after stroke damage to the parahippocampus, patients develop graphical disorientation. they lose the ability to learn new routes or to travel familiar routes. **there may be a connection between children with navigational disabilities, stroke patients, and victims of alzheimer's disease. it may be that the blood supply to the hippocampus and parahippocampus is vulnerable, ie. more easily damaged by infarction, more prone to damage faster when oxygen (and/or nutrients) is reduced. **the hippocampus creates longterm memories (which are then stored in the neocortext). As a result of experiencing this condition, the only after effect I have, that I think I have, is a small problem remembering let's say, somebody's last name. but I had that problem before all this happened. when I mentioned this to my coworkers, they all say, hell that happens to them all the time, so maybe I'm not too crazy after all. the bad part about being in the medical field, is that we like to diagnose ourselves and sometimes we have a problem accepting medical conditions that we have been diagnosed with by the professionals. you know they're only human, and they can make mistakes too. in my opinion I think this is a freak thing that happened, I don't really know, but my neurologist himself, is still a little uncertain of what all went on, he's only going by the eeg, he'll know more when he sees the results of the mri. See ya, Sherry PS...by the time I got to posting this....time has gone by and the mri result are back, spoke to my neurologist and had a 2nd mri, it was done yesterday(no results yet on that one). let me catch my breath and I'll be back....probably the results of the 2nd one will be back by then.

hi, i thought that this might be useful to the new nurses going to the "cardiac floors", as a quick reference: chest pain assessment for non-cardiac nurses acute coronary syndromes (acs) are imbalances between myocardial oxygen supply and demand (oxygen available vs. oxygen used). prompt coronary reperfusion limits myocardial necrosis, preserves left ventricular (lv) function and reduces mortality. failing to recognize and respond to symptoms has resulted in delays in care outside of the hospital setting. rapid reperfusion remains the patient's primary treatment and therefore early assessment of chest pain in non-cardiac areas of hospitals is of primary importance. women, diabetics, and the elderly more commonly present with atypical chest pain symptoms and should be evaluated for ischemia despite unusual symptoms. more than half a million women die each year from cardiovascular disease, making it the number 1 killer of women in the united states. one-third of patients presenting to hospitals with confirmed acute mi (of 430,000) had no chest pain (cp). absence of cp (or atypical cp) is important for therapy and prognosis, patients without cp were much less likely to be accurately diagnosed on admission and therefore treated with the appropriate therapy. your goal… is to determine the cause of chest discomfort and initiate appropriate therapy. initial assessment of the patient situation and management must be rapid, systematic, and evidence-based. initial evaluation distinguishes among the potential causes of chest pain: * acute coronary syndrome - myocardial infarction (mi) or unstable angina (usa) * stable angina pectoris - follows a precipitating event, usual severity, typical dose of ntg relieves pain * nonischemic chest pain, including life-threatening conditions such as aortic dissections, pulmonary embolism, or esophageal rupture the goals of prompt action are to: * increase oxygen delivery, increase diastolic filling time - more time in relaxation phase coronary vasodilation - early reperfusion oxygen - minimum of 6 hours of onset of chest pain revascularize - fibrinolytics, ptca, cabg - provide blood flow thus oxygen back to heart * decrease oxygen consumption decrease heart rate * manage hemodynamics * assess for cardiogenic shock immediate management of the chest pain patient: (assessment of pain occurs while performing skills and procedures) * assess pain * know the patient's risk of acs - know your patient's pertinent history, admitting diagnosis, procedures/diagnostics, lab work, etc. are they at risk for a cardiac event? vs. pe, aneurysm, esophageal rupture? * airway, breathing, and circulation assessed - remember your abcs! * obtain 12 lead ecg * resuscitation equipment to patient, nearby - abcs! * cardiac monitor attached * oxygen given * iv access, obtain blood work - cardiac enzymes/troponins and electrolytes * aspirin 162-325 mg (unless contraindicated) * nitrates and morphine (unless contraindicated) assess your patient's pain: (use the opqrst mnemonic) * onset - ischemic chest pain is typically gradual in onset with a coming and going of intensity * provocation and palliation - typically provoked by activity like exercise, it doesn't change with respiration or position * quality - characterized as a discomfort more than pain, difficult for the patient to describe, squeezing, tightness, pressure, constriction, crushing, strangling, burning, heartburn, fullness in the chest, band-like, knot in center of chest, lump in throat, ache, heavy weight on chest (elephant), bra too tight, or toothache (radiation to lower jaw). (levine sign - places clenched fist in center of chest) * radiation - ischemic pain radiates to other parts of the body including the upper abdomen (epigastrium), shoulders, upper and forearms, wrist, fingers, neck and throat, lower jaw and teeth (not upper jaw), infrequently to the back (more common in aneurysms) * site - diffuse discomfort that may be difficult to localize, pointing to a specific area with a single finger is usually noncardiac * time course - angina is usually 2 - 5 minutes and relieved by rest or ntg. patients with acs may have cp at rest and duration is varies lasting usually longer than 30 minutes. *associated symptoms - shortness of breath reflecting pulmonary congestion (possible diastolic dysfunction), belching, nausea, indigestion, vomiting, diaphoresis, dizziness, lightheadedness, clamminess, and fatigue diagnostics (concurrently obtain) * history - patient and family history of risk factors look for hyperlipidemia, hypertension look for cocaine-associated myocardial ischemia * abcs - assess airway, breathing and circulation. patients experiencing chest pain may be having an episode of stable angina, usa or an acute mi, be prepared for evolution of the situation cardiac decompensation - vital signs, skin color, temp, jvd, edema, s3 or s4 * place patient on oxygen - does the patient require more than nasal cannula? do we need an abg? lactic acid? requiring high o2? * obtain 12 lead ecg stat * resuscitation equipment nearby - allows for early and rapid treatment of decompensation and/or lethal rhythms call rapid response team - if your organization has a team available * cardiac monitor - place on patient. don't remove patient from telemetry monitor when placing on defibrillator, maintain both monitoring systems * iv access - maintain at least one iv site, #20 gauge or large and obtain labs draw cardiac enzymes (myoglobin, troponin, cpk-mb) and electrolytes to evaluate cardiac status and send to lab stat. if the patient is on digoxin (medications) may check level * aspirin, unless contraindicated (allergy) - then the physician may order clopidogrel * nitrates and morphine - unless contraindicated sublingual nitro followed by iv nitroglycerine (ntg) for immediate relief of ischemia, coronary vasodilator, decreases preload * check policy in your organization regarding ntg iv tubing morphine acts as vasodilator and blocks the physiological response to pain ****notify the physician - of the patient status including symptoms, vital signs, i & o, labs and interventions. unable to read 12 lead and can't send it to the physician (fax, scan) tell the md what you see in each lead being specific. if available, call your organization's rapid response team for assistance. obtain orders for care provided. * keep the patient on bedrest, monitor vital signs every 5 - 15 minutes during active chest pain and while on vasoactive drips, while awaiting further orders * prepare patient/significant other(s) for revascularization - fibrinolytics, ptca, cabg remember to follow your organizational policies and standards of care in dealing with a floor patient suddenly develops chest pain, prep for revascularization. (when in doubt remember "mona" - morphine, oxygen, nitro and aspirin). .....any corrections accepted...... sherry

Hi Everyone, Long time no hear, and to some I wasn't missed, but through a rough upbringing, I've learned to be kind to the ones that are resistant, and to continue to help those that are interested. Oh gosh, where do I start? Let me start by asking you all a question. "Has anyone here, experience feeling great one minute, then get hit with a sickness that put you down for about two or three weeks, you're feeling great ready to go back to work, and then Bam!! You get hit with something else?(Sickness that is!)" Now remember, what I'm about to tell you, is not for anybody here(not that some would) to feel sorry for me by all means!! So here goes.......( mind you, I am a type of person that "never calls in sick and really has never had anything medically wrong, very seldom do I even get a head ache.") Well, when September 13 came around that really change my medical history. I went to work doing my usual shift 7p-7a, feeling a little "a-gi-da", (oh yeah I do have a history of Gerd). I didn't really think anything of it, just a little discomfort. The oncoming doctor, who is a really great doctor, was having some left lower quadrant pain. So joking I said, "we'll be a great working team tonight". As the night progressed, four hours into it, the doctor asked me how I was feeling, and I said it's not getting any better, and she said you look a little pale you should get checked in. So, to make a long story short, instead of my gallbladder being five to 6 cm long, it was 17 cm long.(Yeah, I even impressed Dr. Brady my surgeon)." It looked like Santa's sack, only it was filled with stones and fluid."(Ho ho ho) I did get a nice vacation of about three weeks. The week of, October 8th, I was planning on going back to work. That Sunday, I was having a garage sale, "thank God my girlfriend was there," two hours into it, she noticed me doing funny things, and I felt myself doing things out of the ordinary. I wasn't stumbling or having problems speaking. I remember waving my hands over the cash box, she stepped in and took over. At one point she asked me what her name was, and I couldn't tell her. Then she asked me how many goats were across the street, (yes, there really are goats across the street), I looked over, then up to the sky and said, "WHAT GOATS!" I remember putting my fingers to my temples, looking at her and saying, "something's not right!" The next thing I remembered was waking up in ICU. I got updated on what went on in an emergency room, by the RN and Dr. who took care of me. In short, my right side was paralyzed(stroke) for about 15 minutes in the ER while my left side was going to town, making up for my right side. Then my right side regained movement, both arm and leg, and joined my left side, and continued to seize for a total of 45 minutes. In the process I apparently bit the side of my mouth and tongue, aspirated blood. They landed up intubating me, for my own safety and protection from the sedation I had gotten, my vital signs weren't the best either. In the ICU with the sedation that I gotten, I still was fighting everything,(being filled in by my girlfriend) they had to strap my arms and legs down because I was still fighting. Not to brag, but I am one tough, B#@%*,let's settle for "Cookie"! I was transferred to the floor, to recoup and because I had developed, rhabdomyolysis and to find out exactly what was going on. To those of you who know what this is you can skip this part, and to those of you who don't know what rhabdomyolysis is... here's a short definition: Rhabdomyolysis occurs when muscle damage and destruction develops. The causes of my rhabdomyolysis was due to the length of seizure that I had. My rhabdo level was hitting the 1000 mark which really isn't good, so I got pumped full of fluids, sodium bicarb and potassium. And my rhabdo level came down to 450 which was a safe level they felt, so I could go home. In patients with rhabdomyolysis, the muscle destruction allows leakage of muscle components, resulting in abnormalities of electrolytes, and kidney function. If not recognized and not treated appropriately, in some cases the next step is dialysis. Thank God recognition was early in my case. While on the floor, being the :nurse:/patient, I did my own urine output measurements, and wrote then on the board along with the time. And only used the call light when the fluids ran empty and new ones needed to be hung. (Wasn't that nice of me). I went for a MRI five days later. Has anyone here ever had an MRI of the head? For those of you who have never had a MRI(of the head)... just imagine, putting your ear against a jackhammer, as the guy is chiseling away at cement. And for those of you who have had one, will agree with me. All in All, they came up with a diagnosis of Hippocampus . And the saga goes on..... but for now, I'm going to stop (gotta fix dinner)... and I'll continue later. But I have been on this site, reading the new posts. I've also have read the additional responses to my topic ER 101, and I appreciate the responses and comments. Remember, no oooo's or aaah's, or pitty felt.... because I'm back and fully CHARGED!!

:studyowl: "please slow down and take care of yourself!!! see your doctor about your bp asap! try to switch to a slower paced unit--i don't care if i get flamed on this, but new grads should start off sloooowwwwly and not in a unit like icu, micu, nicu, etc. i pray that you can get it together soon, and please don't push yourself too hard! good luck in your future, and don't feel bad if you end up leaving nursing. that degree can lead to other less stressful avenues in life, such as: doctor's office, informatics, insurance verification, check it out before you give up!" i agree with the above. for one thing, your hospital apparently goes along with the quote," throw them to the wolves" because that's just what they're doing. normally, as a general conversation from other nurses that start after getting out of school, state that they have to go through a course, as i did, with a couple of weeks in med surg, telemetry, icu and then did a six-week orientation in er. i don't blame you for feeling overwhelmed. you can do all the training, teaching and hands-on learning, and you will still never know everything. there is always something new to learn. it almost sounds like your hospital is looking for a lawsuit to walk in, and the one that really gets screwed is you, and your license will be out the window. so i would probably go to your leader, and tell them flat out, "look, i really need more training elsewhere in the hospital, that will help better your confidence in taking on patients in the icu". don't get discouraged, the medical field is so huge that it can cover the alphabet from a to z. remember,you went to nursing school because you wanted to become a nurse, you did a lot of hard studying, learning and testing and you got your rn degree. if they don't see it your way, and let you the go, then there are not worth working for. i could go on and on, but i'd only get madder in madder...... best of luck to you, and do what you feel is really a right. you go girl! sherry ps.doesn't your hospital have a lawsuit going on right now? if not i foresee it in the future.

i think it's a great article too. it covers just about everything from the beginning to the end. it's a great teaching for anybody thinking of going into hospice care. i myself for the last year have been thinking about opening a hospice house. we have a cancer center in our city, connected to our hospital but we don't have a hospice house, close to the area. i think one about 5 miles from the hospital would be nice. we have a couple in the surrounding areas, ones like 22 miles away and the other one is about 15 miles away. i guess why i haven't started yet is because i don't know where to start. i'll take any input and/or ideas and suggestions. thanks in advance. sherry ******************************************** "death is not a failure of medical science but the last act of life." ***************************** patch adams, m.d.

How about, "I'm going to stick this in your mouth under your tongue, don't bite it, just hold it with your lips"...:imbar. as you go to take an oral temp..

.... a couple of months, huh and you have notified your nurse manager many times, almost seems like there's a problem with your nurse manager,... it seems like this nm can't prioritize the importance between, patient care and safety and keeping a rebellious and incompetent cna on. ..... rebellious, lying, absenteeism, argumentative and pointing the finger at others...... let's see, you say retirement.... is it because she's, nearer to 65-year-old mark-this might have something to do with some psych issues or some medical condition (example: alzheimer's, dementia etc. etc.) ..... if she's not near retirement age, again it could be some psych issues or in real plain english.... from what you have described, either this girl is not taking her medication like she should or taking too much of it... or let's face it she's on drugs. hand in your resignation!... no way!!!!! you're only 38 years old you still have a lot years ahead of you to work, this other person doesn't have anything to lose, but maybe gain the enjoyment of seeing everybody else either quit or get fired or just make your life miserable for them if she continues working there. if you can go to the meeting with the list of the events that took place when she worked, and with a true feeling of no guilt and a lot of confidence, you should have no problem in partaking with meeting. good luck, you got my vote!

The answer to this question lies in the anatomy of the abdomen, which has to harbor the ever-increasing uterus as the baby grows. The Vena Cava is the main vein that drains the entire lower half of the body. Anatomically, it lies just to the right of the midline--just on the right side of your spine. As the baby gets bigger, certainly the heavier uterus, lying flat on the Vena Cava will (like stepping on a garden hose) obstruct flow up towards the heart. The drainage of the lower half of the body becomes sluggish, which not only increases the swelling of your ankles, feet, and legs, but will also impact on hemorrhoids as well. Decreased return of blood flow to the heart will cause hypotension (lowered blood pressure) down the line, and with diminished arterial blood flow to the uterus, placenta, and baby. Sometimes this hypotension is evident when a woman has an ultrasound, during which she lies flat. One of the symptoms of hypotension is nausea that will accompany the light-headedness. In answer to your question, lying on the back is the worst possible position in the third trimester. Lying on the right side is better than lying on your back, but lying on your left side is the best of all, because this is the position which will have the least amount of weight upon the Vena Cava.

this doctor is amazing, he actually took timeout and responded to my e-mail, (with in a matter of five hours(i believe ohio is an hour behind ny)). **************** just a suggestion for those that responded to this post, (just like ererer said he welcomes your feedback).... it only took me but a minute to click onhis name, and write what i did. and in reading his response, and in as short as it was, i could feel compassion that he has for er nurses. i'd work in dr. baehrens' er department any time. **************** sherry - thanks for your kind words. feel free to distribute the article. that was fast getting it on that website - they just asked me about it the other day. best wishes dave ----- original message ----- sent: monday, september 25, 2006 3:20 pm subject: your article.. hi, i was just reading an article written by you, that was posted to a web site called allnurses.com . it was posted in the emergency room section of this web page. i felt the article really described us er nurses to a t. it really feels great to be appreciated and recognized. i hope you don't mind me copying this article and posting it in our break room in my er where i work. again, thanks for the recognition and my hat is off to you.:yelclap: sherry

I know one thing that I would love to change but it would be impossible, is to make the primary care physicians to stop telling their patients,:angryfire "if you're not feeling any better go to the ED". Sure it's different if the patient is short of breath, continued chest pain, conditions that are life-threatening etc. etc. etc.. That's different! But you get the ones that come in let's say, one example: with pain to their left wrist, from a fight :smiley_abthe were in at school yesterday, and Mom says," I called my doctor and told him about it and he said go to the ER". Granted, we do take an x-ray and 99.9% of the time there is no fracture, and send them home but the instructions to take ibuprofen and instructions on R.I.C.E. How about changing the "Floating nurse" to "Keep going Nurse"... the keep going seems to be self-explanatory, and the floating title has a need to be explained to some nurses, at least where I work.

hi “humor-‘laughter‘.. is the best medicine”…(isn’t that an ancient statement)..but it’s true, not only for the nurses but the patient themselves.. ’maybe not for the patient with abdominal pain, kidney stones, fractured ribs, or a mom to be, that’s about ready to deliver.. etc’ … oh, wait yes they can, can’t they?…”splinting”…comes to mind, remember the “patient teaching” for c & db? (just a little humor) ..and working in the er, a lot will come back to you. seriously though, when i respond to a post, i like to insert a little humor. my responses to posts, are by no means with any intentions of insult to any peoples…and i stand to be corrected for any misgivings unbeknownst to me…i’m not perfect(if i were perfect, do you think i’d be a rn in the er) ..you’re dam right i would be!!! i enjoy it immensely!!! “he who laughs, lasts.”.. norwegian proverb …so, with that said, on to your topic: as with the previous responses i totally agree, your preceptor is going to be your best buddy and is going to be the most important training you’ll get for working in the er. but make sure that your preceptor, is somebody that you feel comfortable working with, is somebody that you feel is teaching you because they want to teach you, someone that when you asked them a question, “why did you do that?.. what is this for?..etc.”, they answer your question, without an:icon_roll attitude! guarantee you’ll know all this after your first day of orientation. make the necessary changes then and there, because after your orientation, ”your on your own”,… scary huh…(just joking) well, you’re really not on your own, others around you will help. remember, you will never be taught everything that you’ll need to know, in working in the er during orientation. :idea:here is a helpful hint: :typing start now, and make a list of all the possible things that you might need to know about working in the er, you probably don’t need to write down the obvious, but it won’t hurt(just some examples: ng tube placement, gastric lavage, dka crisis, sickle cell crisis, prepping for cardio conversion, etc. etc. etc.), the list will be long, and when you go home at night check off the list of the things that you were oriented to. in the er, you will never experience or know everything! ”most of the important things in the world have been accomplished by people who have kept on trying when there seemed to be no hope at all”….dale carnegie nicu.. wow, the closest i’ve ever been to teeny tiny babies,(aside from giving birth to my own son, he was not teeny and tiny) is when i was a phlebotomist, and was called to maternity to do heel sticks, or draw blood on newborns. that was an experience itself. i have a girlfriend, that comes to my shop,(oh yeh, i’m also a hairdresser), she works in a nicu, up in the city 30 miles away from where i work. when she comes in we discuss our jobs, and it is amazing to hear some of things that she experiences there. carol says that she has to start ivs and give meds to babies that only weight in “grams”..wow! there’s no rounding to the nearest, of any meds.. as she explains, “if you round off your calculated meds, and give that same med dosage over a period of time, you are actually overdosing that baby”.. that does make sense. yes, start lifting weights, you'll need the muscles:pumpiron: ..and come on in! sherry

"wow.. what an article to find. it's great! it fits the er nurses to a t!":thankya: i salute dr. baehren! :yelclap:

Just a tid-bit of info to those who are planning to work in an ER, or would just like to understand terms and what certain meds are for and what their uses are and why they are used. Correction of any mistakes are appreciated and by-all means, inputs are more then welcomed. How about some of the vintage ER Nurses, pick a topic and lets see if we can help educate our future ER Nurses, so when they step into the "ER" they won't be totally "Green" behind the ears. Next Topic-ER-102-More Meds and "The Gallbladder" Routes of administration IV Intravenous administration is when the drug is given in liquid form directly into a vein. This is often done by placing a venous catheter to allow easy administration. IM Direct injection into the muscle. Often a painful mode of administration, and provides a slow route of absorption. PO By mouth (Per Orum). Typically intermediate between IM and IV in speed of absorption. (is this true?) PR Rectal administration (Per Rectum). The rectum is actually a very quick method of drug administration as the rectum is highly vascular. This route is often used in children. ET Certain drugs can be given down an endotracheal tube. The drugs are given at 2-2.5 times normal IV dose. Drugs are followed with a saline bolus of ~10ml. The acronym for drugs that can go down an ET tube is ALONE: * A - Atropine * L - Lidocaine * O - Oxygen * N - Naloxone (Narcan) * E - Epinephrine Drug List Lidocaine Lidocaine has 2 uses: It is a local anesthetic when injected subcutaneously (and it can be used for a nerve block). It is also an antidysrhythmic drug when injected IV (used to treat cardiac dysrhythmias). Anesthetic preparations come in 2 forms: with and without epinephrine. The epinephrine is added to reduce absorption and prolong the effect. A classic question by the resident/attending is: What is the toxic dose when used as a local anesthetic (Answer: 5mg/kg for lidocaine without epi, and 7mg/kg with epi.) Epinephrine Epinephrine is a natural substance produced by the adrenal gland (a.k.a. adrenaline). Epinephrine is used in emergencies to stimulate the heart or to dilate the bronchial tree. It's use is limited by cardiac side effects. It is also mixed with lidocaine to prolong lidocaine's effect and to control bleeding. Furosemide (Lasix) Lasix is a diuretic, which is given IV or PO, which causes the patient to produce more urine. This is often given to reduce the fluid overload in patients with congestive heart failure (a.k.a. CHF) or hypertension. Diazepam (Valium) Diazepam is a benzodiazepine that is used both as a powerful sedative and as an anticonvulsant for patients with seizures. You will see it used for alcohol withdrawal, cocaine toxicity, and status epilepticus (I.e. uncontrolled seizures). Diazepam may produce respiratory depression. Midazolam (Versed) Versed is a very powerful short acting benzodiazepine type of sedative and is used to sedate patients for painful procedures. Excessive dosing may produce respiration depression (when given I.v.) or coma. Haloperidol (Haldol) Haldol is a antipsychotic with powerful sedative properties. It is often used for patients who are acting in a psychotic manner. It should not be used to treat alcohol withdrawal or cocaince toxicity. In sufficient quantities it will render the patient unconscious. Succinylcholine Often called "sux" (pronounced sucks), it is a paralytic, resulting in total muscular paralysis. It will most often be used for "rapid-sequence-intubation" to make tracheal intubation easier and to allow the patient to be mechanically ventilated. It has no analgesic properities and paralyzed patients see, hear and feel everything - like a zombie! - thus it is never used without sedation. Atropine Atropine is used for several purposes, including inducing the heart to beat faster (I.e. chronotropy) as well as an antidote for certain organophosphate poisonings. It is sometimes used as a drug for patients with severe asthma. It can also be dripped into the eyes to produce dilation of the pupil (although this is a different formulation). Can also be used to dry up respiratory secretions during procedures. Heparin Heparin is an anticoagulant used to prevent blood from clotting. It is used in patients suspected of having a myocardial infarction and to prep the syringe for an arterial-blood-gas for the same reason. Valproic Acid Valproic Acid is used as an anticonvulsant medication. It is not typically used in the emergency treatment of seizures, but toxicity can often be seen with seizure patients who have taken too much. Phenobarbital Phenobarbital is a barbiturate which is used either as a sedative and/or anticonvulsant medication. Pentobarbital Similar to phenobarbital but much faster acting and with a duration of effect. It is used as an anticonvulsant medication and to treat severe alcohol withdrawal. Often used in a continuous drip for patients who continue to seize. Methylprednisolone (Solumedrol) Solu-medrol is a long acting corticosteroid. It is often used to prevent the recurrence of anaphylaxis after the epinephrine has worn off and for patients with asthma. It has a half-life of around 6 hours. Albuterol (Proventil) Albuterol is a bronchodilator, used in a nebulizer for asthma patients. Typically a drop (0.5 mg) of albuterol is suspended in saline and nebulized with oxygen. Often referred to as "how many nebs the patient got". Ampicillin/Sulbactam (Unasyn) This is an antibiotic (ampicillin) with the second compound added to prevent bacterial ßlactamases from working (which interfere with penicillins). This over comes the antibiotic resistance acquired by many bacteria. Flouroscein This is a fluorescent dye used to stain the cornea to look for scratches or ulcers. Scratches and ulcers will selectively retain the dye, making them glow under the cobalt-blue light of an opthalmoscope. Ketorolac (Toradol) Ketorolac is a powerful NSAID, used for severe headaches, musculo-skeletal pain, kidney stones and inflammation. Morphine Sulfate Morphine is a powerful opiate (derived from opium and similar to heroin) that is used as a pain killer (I.e. analgesic). However, as a side effect it can suppress respirations. Narcan is the antidote to opioids such as heroin or morphine. It is very rapidly acting and competes with the opioid for the opioid receptor. Be careful when administering this drug, as it may cause withdrawal in opioid tolerant patients. Prednisone Prednisone is a corticosteroid that is given for asthma and as an anti-inflammatory. A side effect of prolonged use is Cushing's syndrome and often you may see tremors. Rocuronium Often called "rock", it is a paralytic. Administration produces total muscular paralysis. It is most often used for "rapid-sequence-intubation" to make tracheal intubation easier and to allow the patient to be mechanically ventilated. It has no analgesic properities and paralyzed patients see, hear and feel everything and should never used without sedation. Pilocarpine Pilocarpine is dripped into the eyes to produce constriction of the pupil in patients with glaucoma. Dopamine Dopamine is a mild pressor agent, which is administered IV to produce vasoconstriction and raise a patient's blood pressure. Phenytoin (Dilantin) Dilantin is an anticonvulsant. As a side effect, when administered too fast, it can induce hypotension. N-Acetylcysteine (Mucomyst) Mucomyst is given in cases of acetaminophen toxicity (e.g. Tylenol). tPA Tissue plasminogen activator is a thrombolytic agent, used to lyse blood clots in patients with myocardial infarction (a.k.a. heart attacks), non-hemorrhagic CVA's (a.k.a. strokes) and PE's (a.k.a. pulmonary emboli). Thrombolytics can cause hemorrhage and should be used with care. Streptokinase Streptokinase is a thrombolytic (note: discovered here at NYU) made by Streptococcus bacteria which dissolves clots, similar to tPA (although through a different mechanism) Diltiazem(Cardizem) Diltiazem is a calcium channel blocker used to slow the heart down in patients with certain types of tachycardias such as atrial fibrillation. Metoprolol is a beta-blocker which is used to slow down the heart and lower blood-pressure. These drugs are not typically used in asthmatics, as they can induce bronchoconstriction. Atenolol Atenolol is a beta-blocker similar to metoprolol. Adenosine Adenosine (the A of ATP fame) is used as an antidysrhythmic to break certain cardiac dysrhythmias; it is often used in patients with supraventricular tachycardia. The half life of the drug is only a few seconds, and can often induce non-pathologic asystole (flat line on an EKG) for a few seconds. Digoxin Digoxin (a derivative of the Foxglove plant) is a cardiac drug used to slow conduction through the heart, especially in cases of atrial-fibrillation. As a side effect it can produce various dysrhythmias including ventricular fibrillation and aystole. Metronidazole (Flagyl) Flagyl is an antibiotic used against anaerobic bacteria and certain parasites. As a side effect patients can become violently ill to their stomachs from consuming alcohol with Flagyl (similar to Antabuse) Vancomycin Vancomycin is the "last ditch" antibiotic, used for highly resistant bacteria. It is fairly toxic to the patient, and often is a hobson's choice to administer to a septic, shocky patient. Trimethoprim/sulfamethoxazole (Bactrim) Bactrim is a "sulfa" class antibiotic and is often used in urinary tract infections. Ketamine A sedative often used in conjuction with other sedatives (such as midazolam or diazepam). Pepcid Pepcid is a systemic antacid (H2 blocker) which takes 30-45 minutes to take effect, but lasts for several hours. Similar to ranitidine (Zantac) and cimetidine (Tagamet). NS NS stands for Normal Saline, which is 0.9% Sodium Chloride, and is the usual fluid given to a patient who needs fluid due to dehydration. It is approximately isotonic. LR LR stands for Lactated Ringers, which is Normal Saline with other electrolytes. Due to the presence of the other electrolytes, there is a limit to how much can be administered within a specific period of time. D5, D10, D25 and D50 The D stands for Dextrose, which is a stable form of glucose. This solution is given IV to give the patient glucose. This is never given IM, as high concentrations of glucose cause tissue death outside the vasculature. Other useful terms QD-Once per Day BID-Twice per day TID-Three times per day QID-Four times per day QHS-At the hour of sleep NPO-Nothing by mouth

I have a Tungsten E2..on it I have downloaded Epocrates,ERSuite,ABG Pro and a drug book.....once you learn the operation of the programs.....you get split second info on whatever you are looking up. erRN06, since you are new to the ER, you will see many-a times, the DR also looking up things in the books.....with repetativeness(not sure if this is spelled right) on our part as nurses, do we continue to gain the assurance of knowledge and the ability to apply ourselves in a more confident way. :wink2: As always...if unsure, open the books. Good Luck Sherry

Hi, My name is Sherry, 2nd time on the board. I work the 12 hour night shifts (7p-7a) in the emergency dept. here in the FingerLakes area in New York. I have to admit that 3 in a row is tough, my shifts don't always fall like that, usually 2 on and 2 off 1 on. :monkeydance: I'm a hairdresser also(for 30 yrs) and I own a shop, so these shifts enable me to still do my regular customers on Fri. & Sats. and then I work an extra day or two at the shop to do whatever...you see I also have a Heat Transfer Press machine, where I can print up teeshirts, canvas bags, mouse pads things in this line. In my "Spare" time I assist with autopsies, I enuculate eyes and do hair at Funeral Homes. I also have a 14 yo son(going on 40) who is the #1 guy in my life,who I love to spend time with. But he's at that age, where he likes to spend the time, 4 wheeling, going to the movies, races and so on with his buddies, which is great for him, we get our times in together. I'd like to thank Allnurses for wishing me a :hbsmiley: , I am as old as the year I was born. I'd like to say I was born in '35, but in REALITY the numbers are reversed. Oh well, I don't feel my age, and alot of people say that I don't look my age, my son says, "You don't look that old"..wasn't he sweet! That's about it for now, ..have a great day! Sherry :loveya: