jbird125

Highest BP the other night 250/150, it was the night for brain bleeds, we had 3 in over the course of the night, none of which survived till dawn. The lowest was 40/30, with a pulse of 170, she ended up being cardioverted under GA, got admitted to ccu, still dont know why, had no pmh, and only felt a bit dizzy prior, no other hx.

In the UK, at least in our department we are aloud to send patients away from triage who do not present with an emergency probelm that could either be managed by the GP (family doctor) at a later date or managed with OTC medication. On the most redicioulous thing a patient has said, we have a 4 hour wait in our departments the patients must be seen and d/c within that time, if they are not then the hosptial gets fined. I had a girl at 2am come in c/o sore feet, she had blisters on both feet in the same place from dancing the last 5 hours at a club, there was also a 4.5hr wait in A+E to see a dr, politley told patient where she could take said probem at that time in the morning, espcially as there was still a queue for triage

We have the same problem, it seams more with muslisum female patients (i am not against the religion or racist in any way), i have noticed however that if the patient is that unwell that it needs to be carried out immediatly then usually they are more than happy for you to do it. If it is less of an emergency then i am more than happy to get one of my female colleagues to do it for me. Unless there are religious or cultural reasons why i should not be performing the ECG then i will explain at length to the patient why i as a health care practitioner will do nothing different to the next, and will quite happily perform ECG's on young women.

Whilst unable to comment on the US, over in the UK we have just started introducing degree qualified paramedics, these have shown a huge improvement in the quality of treatment that patients are recieving in the prehosptial enviornment. Some of the A&E nurses in the UK do view ambulance staff as little more than stretcher bearers who bring the patient to hosptial, with little specific knowledge, whilst this view is getting less and less, there are still some examples out there of care that is definatly substandard (p211, bp 90/50, chest pain and palpatations without a priority blue light call for example, happened last week). On the whole though ambulance staff provide an important service and have skills that are not used in the emergency department, their self sufficency in the community with either little or no access to medical assistance is obviously a difference, however the emergency nurses ability to multi patinet care is in contrast to an ambulance personal's normal 1:1 ratio. It is very hard to compare two jobs, both of who look after acutly ill patients but which require such different skill sets to achieve to a high standard. One of my colleagues (in the ambulance service) believes that the inclusion of paramedics in trauma / resuss rooms would highten the care in there, whilst he has a point to a degree, being degree qualified with a masteres in ECG interpretation makes him the exception when in the ambulance service wold in the UK not the norm. There is sometimes a lack of understanding regarding the patients that ambulance staff bring to hosptial, they are often unable to safely leave at home patients who hospital staff consider a waste of time, whilst suspended's (codes in the US) it is important to remember that there is only 2 of them doing it, we have a greater number of staff at hospital. I appoligise for rambling on a bit.

I like that, although we sometimes say the opposite, when i have patients telling me i am going to hell because i am an unkind uncaring nurse because their abdo pain has to wait untill ive finished with the trauma patient. In that case i simply tell them that i am going to hell and have a suite already reserved. It always shuts them up.

Welcome to the field, although i work across the pond so to speak one of the other posters is right, focus first on geting your assessments right, then speed will come, you will find it easier to cut to the chase when taking a patients history. In our department there is a ratio of 1:6 or 1:8 if we are pushed, and in the trauma bays there is a ratio of 1:4. I found the way to start to speed up was to go into one patients room, attach them to the dynamap, set it going and go next door and take the hx of the next patient, then swop over, it is bloody hard though. Best of luck, i think you have joined the best field in nursing, although i will conceed that i am biased on that.

I agree, always act confident infront of the patients, they don't know you have just started, they have just arrived with an unexpected injury or illness and are frightened, let them think you know everything and they will trust you 100%, and it will become easier. Saying that don't be afraid to ask questions. We always say the most important thing in our department is knowing when to ask a question, whilst it is ok to bluff it infront of patients it is most certinatly not ok to bluff it infront of your work mates, while you don't always have to follow what they say, they will have years of experience for you to draw on. You will meet a nurse when you start who to you is what a nurse should be, although they were not my offical mentor ive found one and unoffically adopted them, they are what i think a good A+E nurse should be, find your own person to follow.

Things are a litle different the other side of the pond, in my A+E we are allowed to send patients home from triage, so the ones that come in complaining the the oral abs haven't worked after one day can be sent home, along with those that think constipation for 4 hrs is a medical emergency. Had a good one last night, someone came in at 4 am and said they hadn't pu'd in the last 4 hrs. reminded pt that it is normal not to pu during the night, oh and the mother that was concerned that her baby wasn't breathing whilst they were vomiting. assured mother that this was probably a good thing really, baby looked very well.

They all got the answers right for this one, however one thing that has taken off in the UK particuly with london ambulance staff is using a leg vacum splint for the child, after all the child is not beig enough to put on an adult board (and we don't have small ones), this also makes it more comfortable for the child.

PR Bleeds anything else if fine, its just the smell. Had one the other day and had to put one of the masks that we usually use for TB patients because of the filter, it at least made it more managable.

I work in Accident and Emergency in the UK, at one of the largest hospital in London, get in touch if you would like the views of someone from across the lake.. James

Good luck to you in your change! I know when i first started in A+E (the UK version of ER) my manager said there is no point staying if you don't like it, he said their were two types of people those that loved A+E and those that hated it, there is never anything in between. I have been reading some of the other posts that have been written in this lot, some of you guys have been discussing 5-12 week orientation programmes, i know when i started i had two weeks, straight out of graduation. I am something of an anomoly though, i must have been one of the few student nurses who went through my training hating almost all fo the placements, except CCU and OB's, and loving A+E of course. BUT i went into my training knowing i was going to be an A+E nurse at the end of it, Maybe some of us a just drawn to it? maybe we are also mad?

I think you will find that the majority of them are said between members of staff, and not directly to the patient, and between members of staff on a 12 hour shift it can be what is necessary to make it just that little bit more bearable, its either laughing or crying, and one of those is much more fun than the other. It provides a certain streess relief.

can't agree more, same thing happens over this side of the atlantic, and once you have worked for a period of time in one specific area you will be the one the doctors come up to and ask, you will know what pollicies their consultant likes and then they will look good infront of their seniors and like you all the more

It is well to point out here that in business people don't very often threaten to kill you / your family / burn your house down if they don't like what you are doing. I work in accident and emergency (thats the uk version of ER) in London, England. The majority of staff in my department cover their surnames on their badges. And as for the over-blown fear, a friend of mine got assulted by one of her patients who she discharged from a small district general hosptial in the 'outback'. He is still at large, when you see and discharge 70,000 patients a year, even as a small hospital it is impossible to remember just one that might have taken a disliking to you.

one of the good ones that i've seen is an ECG rythum strip that starts off in NSR and then goes flat line with the words 'oh ****.....' under it

Here in the UK things are slightly different, we also have CDU's, jokingly refered to as the confused doctor unit, or the can't decide unit. Due to the need in the UK for the patient to spend no more than 4 hours in the department from time of admission to discharge, patients are sent to the CDU where they are no longer 'techinically' in A+E and can await blood results, tests etc or be observed. That is one of the down sides of the UK system of 4 hour waits, there are just some patients who you need to hold onto for more than four hours but arn't going to send to the ward or admit them. ---- All patients stabilise eventually

I can't agree more, when i first started my manager said don't stay in A+E and think you will settle in, you never will, you either love it or hate it. I don't know about things your side of the atlantic, but here in the UK you also have to spend a lot of time 'guiding' the new doctors, espeicially when they start in August and February, so a strong personality and the ability to stand up when you know you are right are critial. the words "shall we do this doctor..." are spoken with frequency in some A+E departments.

two pens, i will always loose one over the course of the shift, trauma scissors, pen light, calculator, and a selection of analgesia - whatever falls out of the cupboard first