AM-RN

i think, at the very least, a further inquiry into child's risk of developing malignant hyperthermia is justified before proceeding with the tube placement. as healthcare PROFESSIONALS we often need to educate patients about risks and benefits of treatment. while having a child who is miserable with ear infections is difficult - so is planing a funeral for a child after a tragic outcome of an ELECTIVE procedure.

i try to be pleasant to everyone. but also to convey to them that i am in charge of triage - not them. when people ask about the wait time - i let them know that all of our rooms are full and that as they become available the sickest people go back first. i also let them know that they are free to leave at any time and they are free to be re-assessed if they are feeling worse to see if they fit into a "sicker" category.

my er actually has portable call lights. they hook on the iv pole on the cart. pt pushes button on cord - yellow flashing light appears. i hate hallway pts. however, we frequently have to pull a patient out of a room to accomodate life threatening illness. the 'pulled out' patient is usually just awating admit & is stable. the truly sick have no problems being anywhere...if you are well enough to sign out ama...they you're well enough to be at home.

I'm a Gen-X-er and i LOVE the computer-based learning modules. Even if they aren't quality it is usually more efficient for me to complete versus driving to work, parking, walking a mile and a half, sitting through "let's go around the room and introduce ourselves" and then driving home again. of course, i like to have actual classroom experiences for hands-on courses (ENPC, TNCC, ACLS, PALS, etc) I think the Baby-boomer generation prefers to have an actual classroom environment. And the generation after Gen-X (Gen-Y or Millenials, i think) probably would prefer to have the course text messaged to their cell/palm/etc.

In my ER we use dopamine a lot for hypotension (not low dose to improve renal fnx) and so usually pt is getting a hefty NS bolus. I generally like to piggyback my dopamine to NS (even if it's just KVO) because my dopamine drip is usually a low ml/hr.

I try to be very general with my med explanations. When the chest pain pt asks why he is getting metoprolol, I answer with "it helps your heart be more efficient." Generally I get a nod and an "okay," and we're on to other questions (what do all those numbers on the monitor mean?). When I was brand-spankin new I would give very detailed explanations and patient's would follow my explanation with "but how does it help me?"

First - welcome to the ER! I started in ER as a new grad. I had 10 weeks of somewhat orientation (sometimes I was counted as staff, sometimes I was an orientee). To be honest, I felt pretty uncomfortable with anything/any pt that had a time sensitive illness/injury for several months. After approx 6 months "on my own" I started to feel more comfortable and after one year I was feeling even better. It's been almost three years now and there are still things that have me running to the more experienced nursing staff. For the most part - day in and day out- I feel confident and comfortable. There will always be new things to learn. Taking ACLS, ENPC, TNCC, CATN, an EKG course, and a critical care course during my first year helped A LOT. And knowing your department's specific protocols will help, too. Good luck!

for those of you doing this protocol - are your er docs placing the art line?

great. looking forward to it. thanks!

Anybody out there using a hypothermia after cardiac arrest protocol? We've just recently added this to our practice where I work and there is a lot of confusion about what to do, in what order, etc... Any advice out there on how to accomplish this and get the patient to the unit in an orderly fashion? Thanks!

From my experience, someone can be DNR and still wish to be treated with pressors. I would never ever ever ever ever initiate a dopamine gtt w/o cardiac monitor. i check bp's q 5 mins. i titrate up to acceptable bp q 5-1o mins. generally speaking...the md order should give you all the info for titrating. "dopamine 5mcg/kg/min and titrate to b/p greater than 90 systolic"

I've been nursing for 2.5 years...and it is getting less as time goes on. I've had intermittent insomnia prior to my nursing career. I find that keeping a routine is key to me sleeping before my 12 hour shifts...even on my off days. I use benadryl regularly. I try to take a bath after dinner and get into bed early...even if i'm not sleepy. I'll watch tv or read. I recently bought a mask to wear on my eyes and that is helping, too.

Part of nursing is being a patient advocate. Any patient may choose to leave against medical advice. If the situation allows, I try to provide basic discharge instructions, including we are here 24/7 and should you change your mind, we will be happy to see you at that time. I document patient verbally understands risks associated with leaving AMA. I also document each and every interaction that lead to the AMA d/c...."pt verbalizes desire to leave prior to laboratory results/xray/etc . explained rationale for remaining in ED and encouraged pt to do so. md notified of pt's desire to leave ED."

Check out the ENA's Journal of Emergency Nursing -- (April 2006, Volume 32, Number 32) -- article "Ketamine: The Sedative of Choice in a Busy Pediatric Emergency Department" by Haley-Andrews, S. --- good info on dosing IV vs IM, etc... Good luck.

sometimes they call when i'm at work....yes, i'm already there. makes me wonder who is in charge! :) get caller id. if it's work...don't answer unless you want to go in for the night. also - there is nothing wrong with saying "i can come in tonight, but i'll need to be off on (the next day you work)" sometimes they will bargain with you. other times not. it is OKAY to say "no, not today" to staffing when they call. don't feel guilty. my ringers are turned off every night once i'm ready to be in for the night. not knowing they are calling helps alleviate any anxiety i might feel!