Questions for ER Triage Nurses

[nursesharkbev]

Hey all,

This is my first posting and I really need some help on a question. For all of you ER triage nurses, are you required to know how to read an ekg, i.e. p, qrs, st, t waves lead II and/or 12 leads ? Are you expected to know what and why cardiac enzymes are ? Please post back ASAP.

Thanks !!!!!

[LoveMyBugs, BSN, CNA, RN]

not a nurse yet, but work in an ER, and any nurse who works in ER needs to know how to read EKGs and know their lab values and well any nurse who works critical care needs to know how to monitor for EKG changes and monitor lab values, which is something you learn in nursing school and ACLS. and in my ED the triage nurse is generally the more experienced of the nurses working as they have that "gut feeling" by just looking at the patient

[emtb2rn, BSN, RN, EMT-B]

Yes. And as stated above, if you're in the er or unit, you need to be able read rhythms at a glance as well as know your cardiac labs (among other things)

[HiHoCherry-O]

Yes, nurses need to recognize ekg abnormalities and understand lab values related to cardiac enzymes, CKMB, CK total etc., as well as factors that may result in elevated enzymes but don't necessarily mean MI i.e. pt's with history of CHF etc. All the ED's I have worked in require MD initials on every ekg to verify it has been viewed.

[nursesharkbev]

Thanks guys, where I come from you have to know EKG's and labs, just wanyed to get some validation.

Nursesharkbev:redpinkhe

[dthfytr, ADN, LPN, RN, EMT-B, EMT-I]

All the replies sound well informed, but like they've not been addressing triage. Triage orignated in wartime. Injured soldiers were classified as those who would live, those would die no matter what was done for them, and those for whom concentrating resources on would save their lives.

Patients entering an ER should first be seen by a healthcare provider and assigned a priority. Hospitals differ from here on, but my idea of the ideal triage is vital signs, cheif complaint, a brief history and physical assesment, maybe a glucometer check, and a quick gut check of how much the patient scares me.

I beleive in ordering EKG's, obvious lab (or at least start an IV and draw a lab rainbow) and xray, and respiratory care from triage. I DON'T beleive they should be done in triage. Patients needing this level of care should go to a bed where they can get proper care.

In the best trauma center I worked in I could average around a hundred patients in 12 hours, or 5 to 6 minutes per patient. Much slower than this and patients back up in the lobby, and someone could die there. Some hospitals expect triage categories without even getting vital signs. Others want the registration process and all the initial treatments included in triage. If patient flow into the ER is that slow, I'll concede these. I've just never seen an ER with patient flow that slow, and beleive triage is too critical to be a bottleneck.

[nursesharkbev]

Thanks so much for the added triage information which is what I really needed to validate. I agree, if you do anymore than screening the patient they deserve to go to the back for EKG, labs, etc. otherwise you do get the bottleneck.

nursesharkbev

[HiHoCherry-O]

Dthfytr addresses some good issues; remember, each ED is going to be different. I have worked in an ED where EKG's, x-rays and labs are ordered and done right there in triage. If a room is available, the pt goes right back; if not, and the pt does not APPEAR to need immediate care, the EKG and labs are done in triage and the pt returns to the waiting area. The triage nurse's are then the ones who track labs and notify doctors. This particular ED has nurse initiated orders, but also has a list of orders that the doctors spent a lot of time coming up with in committee's to help address the issue of long wait times that can occur.

Other ED's I have worked in do not allow this. Again. . . every place will have some variation. Know the policies.

[canoehead, BSN, RN]

Triage nurses are supposed to be some of the most experienced of the ER nurses, so yes, they need to know all that stuff. And triage backs up sometimes. We had a multi trauma out back, so I was drawing blood and doing screening EKGs in triage and then sending them out to the waiting room one night. Same night had a DKA that got a huge fluid bolus, insulin, labs and then discharged (he was young and had been vomiting) all from triage stretcher.

[dthfytr, ADN, LPN, RN, EMT-B, EMT-I]

Nice job Canoehead. I was hoping to keep it simple so as not to scare anyone.

The inner city trauma center I worked had 3 monitor chairs, and besides triaging patients every few minutes we were expected treat stuff that could be done there. For example, Asthma patients were treated and d/c'd from triage.

Only once did I ever have to really put my foot down. Did the IV, EKG, lab work, pt on monitor and O2, and a resident came into triage and told me to administer Activase to the patient! A transcript of my response would be highly censored, but I'm sure my voice is still echoing in the halls, and the resident still has my teeth marks on his, uhm, asterisk.

[ERbunny]

Where oh where do y'all work that you can get that pt "in the back " right away ?? Lucky, lucky. I know we are all struggling with packed ED's and often triage is full of waiting patients who really should be on monitors, etc. We have 3 beds, 3 recliners and 5 "chairs", plus running an obstacle course around the wheel chairs. We do everything we can to get these pts ' care started, always keeping in mind that the complaint they sign in with may be totally benign compared to what is really going on, and we don't want to be that hospital in the news with someone dying the lobby. A bit off track, but it does speak to the OP a bit: you don't just need those BASIC cardiac skills--experience and "gut " help too...

Good times !!

[Footballnut]

Our triage nurses are the most experienced ones. Our door to EKG times also need to be less than 10 minutes. Sometimes I have a room in the back, sometimes I don't. I keep a rotation through the triage stretchers for the EKGs when there are no rooms in the back and I read the EKGs. The EKGs are also read by any MD in the department so there are more than one set of eyes on them. If the EKG was normal and I don't have a high index of suspicion the patient waits their turn in the waiting area. However if anything makes me uncomfortable I push for a room.

Depending on the flow we start labs, xrays, simple meds, etc. but no IVs in the triage area. Many times these diagnostics shorten the patient's total ED time quite a bit. True, my first priority is addressing new patients as they come in and being sure everyone gets "sorted" to where they need to go but anything I can do to keep the department moving along is appreciated.