R5RN

Also to clarify (because IDK if you want it this specific), but I pull back first to see if I have blood return before flushing. If nothing is working, we would also switch our access and return lines.

When I was in the ICU, we also used Prismaflex and we used the same method you are describing. Disconnect, flush, reconnect (cleaning the patient's access port with isopropyl alcohol in between). We did not have any built in method of flushing or create our own setup to prevent disconnecting. I do not know about other CRRT machines besides the Prismaflex, and I only worked ICU at one hospital. Hope that helps!

When I was pregnant at work, there was a couple of month time frame where smells were REALLY challenging for me. This was the only time I chose to wear masks. I certainly don't think it's insensitive to the patient. Sure, if you're matter-of-factly telling them "I'm wearing this mask because the smell of your stool is very offensive", that would be insensitive. But reassuring them that it's ok, it's no big deal, you just want to make sure they get all cleaned up, and are generally respectful and nice while not mentioning the mask at all, I don't see anything wrong with that. It's all in how the situation is handled, and if it is handled professionally while wearing a mask, there would be no reason for it to be considered insensitive.

Much easier solution - smear a bit of toothpaste between two masks.

Speaking with 15 years of EMS, backboards are no longer recommended and are very seldom used, though each state may have slightly different protocols/guidelines. In my state, the only time you might see EMS use a backboard is for extrication/moving purposes. After that, the patient should be removed from the backboard and transported on just the stretcher. There are also specific algorithms to assess whether or not a patient requires a C-collar. This is all evidence-based practice. I'm glad you asked here to gain insight about something you are unfamiliar with before reporting the crew.

I was in an almost identical situation (it's almost uncanny how similar our situations are) and posted about it here I asked the same questions you have. I actually posted this update on page 2, but here's what I ended up doing (copy and pasted from the post I linked to): I let my nurse manager know about my pregnancy very shortly after posting this thread, I was still in my first trimester. I let her know I was strongly committed to my position, I intended to work until delivery, and return full time from maternity leave. Her response was nothing short of amazing. She was kind, understanding, and made me feel at ease. From that point, I just worked like normal. I didn't hide my pregnancy but also didn't advertise it. As my coworkers learned I was pregnant, I am so relieved to say not one person seemed to bat an eye to it (other than offer me congratulations). I worked up until the week before my baby was born. I took the full amount of maternity leave my employer/state allowed and returned full time as I had intended. I couldn't be more happy about my position and returning to work went great. Not one single person made me feel guilty or bad about how everything transpired and I am so proud to be a nurse on my unit. If you do come across this thread and have questions because you find yourself in a similar spot, don't hesitate to reach out to me. I'd be more than happy to talk more about my experience.

Oh absolutely! Your role as a school nurse definitely varies from those in EMS. For example, in my state, our protocols would not warrant epinephrine in the way that you described your student (again, please know that I am NOT suggesting that you erroneously gave epinephrine, and I am a FIRM supporter of when in doubt, give it, regardless of whether you're a nurse or a paramedic). Just another interesting view that I totally see where you're coming from and the recommendations by FARE and ACAAI, but the paramedics may use a different source to determine their criteria for giving epi. Regardless, it sounds like you were very calm and made the right decision! And while this next comment is not addressing you or anything you've said, I've seen posts since mine that are still proving that "quarreling" between paramedics and nurses. As both a paramedic and a nurse, I shake my head every time I hear someone on either side of the fence try to argue who has more education, is smarter, is more trained, has more capabilities, etc. These are two very separate jobs with different focuses. It's important to consider the reality the other person has in their position, and not put each other down because of assumptions of the other persons chosen profession.

First, as a paramedic myself, I apologize on behalf of the *ahem* jerk of a paramedic you dealt with. It's so frustrating that there are still quarrels between RNs and paramedics (speaking on the paramedic's unprofessional behavior towards you). My background is EMS and ED nursing, and I have done many lectures on the proper use of epinephrine. One of the things I really harp on is giving epi early. I use the explanation that epi is for anaphylaxis and I try to explain that anaphylaxis and anaphylactic shock are two different things. You want to give epi at the anaphylaxis point so it doesn't BECOME anaphylactic shock. I have witnessed a paramedic coworker of mine opt not to give epi to my sister, who was experiencing anaphylaxis albeit not shock. In my area, we have been focused for the past few years on really trying to lower the threshold for giving epi. With that, I'd like to say, when in doubt, give epinephrine. And it sounds like you did just that. However, for educational purposes, it sounds like your patient did not necessarily meet the criteria for requiring epi. I do think it is important to understand when to give and when not to give epinephrine (again, I still stand by when in doubt, give it... and that paramedic should feel the same and not be rude to you about that), but the definition of anaphylaxis is when one or more of the following is met: 1. Acute onset of an illness (minutes to several hours), with involvement of the skin, mucosal tissue, or both (eg, generalized urticaria, itching or flushing, swollen lips/tongue/uvula), and at least 1 of the following: (1) respiratory compromise (eg, dyspnea, wheeze/bronchospasm, stridor, hypoxemia) or (2) reduced blood pressure or associated symptoms of end-organ dysfunction (eg, hypotonia [collapse], syncope, incontinence); OR 2. Two or more of the following that occur suddenly after exposure to a likely allergen for that patient (minutes to several hours): (1) involvement of the skin/mucosal tissue (eg, generalized urticaria, itch/flush, swollen lips/tongue/uvula), (2) respiratory compromise (eg, dyspnea, wheeze/bronchospasm, stridor, hypoxemia), (3) reduced blood pressure or associated symptoms (eg, hypotonia [collapse], syncope, incontinence), or (4) persistent gastrointestinal symptoms (eg, crampy abdominal pain, vomiting); OR 3. Reduced blood pressure after exposure to a known allergen for that patient (minutes to several hours): (1) for infants and children, low systolic blood pressure (age-specific) or greater than 30% decrease in systolic blood pressure, and (2) for teenagers and adults, systolic blood pressure of less than 90 mm Hg or greater than 30% decrease from that person's baseline. Source Remember, there are many reasons someone may develop hives that are not going to lead to anaphylaxis. If there are no other systems involved (e.g. hives with respiratory, cardiac, GI, etc. involvement), it may not be anaphylaxis. I'm a big proponent of self-reflection after situations like this, and it gives an opportunity to improve our practice. It helps to boost our confidence the next time we are faced with something similar. Take some time to research epinephrine administration and anaphylaxis/allergic reactions. And again, I apologize for the lack of professional courtesy from EMS.

RotorRunner had a very good post at the bottom of page 3. To answer your question directly (which I know others have), you would not start CPR. I totally hear you with your rationale, but CPR is reserved for those who are pulseless, not just bradycardic (we're talking adults here. Pediatric CPR has different parameters). And because you do not have a blood pressure in this scenario, you cannot assume this patient is hypotensive. Others have mentioned cushings triad, which this patient is likely experiencing, and that would lead to INCREASED blood pressure. EMS as a whole is a lot more "down and dirty" than nursing. Especially in the instance of a trauma patient, there aren't many interventions that can happen in the field other than getting the patient to a trauma center and surgical intervention as fast as possible with managing the patient in an A-B-C (airway-breathing-circulation) order. There are plenty of times when you may not be able to get past "A" and that's ok. EMT basics have less training than paramedics, so you don't have to think about intubating in this situation, but you should be calling for ALS. In this scenario, it's about managing the patient in that same A-B-C order and you don't have to over think it. Airway - is the airway patent? Do they require suctioning? In this case, a jaw-thrust maneuver would help to open the airway and position your patient for ventilation. You would avoid a head tilt chin lift due to C-spine precautions (a collar should be placed on this patient). You note there are oral adjuncts. An OPA is certainly indicated in this scenario. An NPA is not because of the head trauma. Keep suction nearby as head injury patients frequently vomit. Breathing - you have a cheyne-stokes pattern and poor O2 sats. Go ahead and start ventilating with the BVM and high-flow O2. Remember, you have your OPA in place. Circulation - As you've noted, there is are no drugs or pacing available, so you're more or less monitoring for a loss of pulse. If you lose the pulse on this patient, then you start CPR and attach the AED. So the summation of what they're looking for: Protect the airway, jaw thrust, OPA, ventilate with the BVM and high-flow O2, start compressions if you lose the pulse. Make sure ALS is on the way and get moving fast to the closest trauma center. (I am an ICU nurse and a paramedic with 14 years of EMS experience)

I know this post is over a year old, but as the OP, I wanted to post an update in case any other nurses find themselves in my situation and come across this thread looking for advice. First, I let my nurse manager know about my pregnancy very shortly after posting this thread, I was still in my first trimester. I let her know I was strongly committed to my position, I intended to work until delivery, and return full time from maternity leave. Her response was nothing short of amazing. She was kind, understanding, and made me feel at ease. From that point, I just worked like normal. I didn't hide my pregnancy but also didn't advertise it. As my coworkers learned I was pregnant, I am so relieved to say not one person seemed to bat an eye to it (other than offer me congratulations). I worked up until the week before my baby was born. I took the full amount of maternity leave my employer/state allowed and returned full time as I had intended. I couldn't be more happy about my position and returning to work went great. Not one single person made me feel guilty or bad about how everything transpired and I am so proud to be a nurse on my unit. If you do come across this thread and have questions because you find yourself in a similar spot, don't hesitate to reach out to me. I'd be more than happy to talk more about my experience.

Chair cushions/pads. Ikea has some for super cheap.

We have techs(/CNAs/PCAs or whatever you prefer to call that roll) in our CTICU. There are two during the week, and one during nights and weekends. They are not assigned rooms, they help throughout the entire unit and they are absolutely fantastic. They help with things such as turns, bathing, ADLs, setting up rooms, doing EKGs, assisting when patients arrive from the OR, moving patients out to the floor/step down, and doing blood sugars. They do not draw blood or do I&Os, they don't really do anything that requires any type of charting and they don't act independently (i.e. they don't just go in and turn a patient without the nurse being present to assist). This does not increase our ratios, we still only have 1-2 patients.

I came across this post because it popped up under "popular" and I was surprised that calling a gown a "johnny" is a regional thing! I am from CT, too and we always call them johnnies.

An 18-year-old in 2018 isn't a millennial. Millennials are defined as being born in 1981-1996. I'm an "older" millennial and I always carry a pen. Two, actually! One nicer ballpoint pen for me to write with and one junky pen for me to give to patients/family members when they need to sign or write something.

I attended a cadaver lab in a hotel ballroom earlier this year. The floors were covered wall to wall with plastic, there was no food anywhere near the cadavers, they had a portable hand wash station (with actual soap and water) at the entrance/exit to the room with the cadavers, and everyone wears shoe covers, gowns, gloves, etc just as I have in cadaver labs I've been to that were held at universities.