Several unresponsive patients at once?!

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Specializes in ER, Telemetry, Med/Surg.

I am currently in an RN-BSN program at Edison State College. For one of my projects, I have to pose a question on a nurse related website, relating to my department. One fear of mine, being an ER RN, is having several unresponsive patients arrive at one time in the ED. Yes, its highly unlikely, but If there are only 2 ED doctors on duty, how do you provide emergency care/life saving treatment to all of these people? Generally, at my facility we have 2 MD's, and around 3 PA's working,along with around 10 RNs. I was discussing this hypothetical situation to an ED RN friend of mine, she replied,'' all we can do is provide basic life support to these patients until an MD arrives. We can't give any life saving medications without a doctor's order.'' So, my question is what else can you do in this situation, without a doctor present?

By: Caitlin G. RN

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Specializes in Burn, CCU, CTICU, Trauma, SICU, MICU.

bag them, get vitals, etc... and run off of protocols, including acls protocols to keep people alive. :)

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Specializes in EMS, ED, Trauma, CEN, CPEN, TCRN.

We only have one physician in our ED at times (sometimes we have a PA, too), and one morning we had "dueling codes" -- two active cardiac arrests being worked in the field, due to arrive almost simultaneously. We created a code room next to our real code room, and ... well, it was kind of a cluster with our doc running back and forth, but we got the job done, x 2, using ACLS protocols.

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Specializes in ED.

My old ER had that happen, three codes at the same time. One doc in the first room, one in the second, a very experienced RN with New PA in third, all went as well as could be expected and I think they saved one or more of them.

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Specializes in ER, Telemetry, Med/Surg.
bag them, get vitals, etc... and run off of protocols, including acls protocols to keep people alive. :)

Thanks for the reply. All replies help give me a better understanding of the situation!

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Specializes in ER, Telemetry, Med/Surg.
bag them, get vitals, etc... and run off of protocols, including acls protocols to keep people alive. :)

We only have one physician in our ED at times (sometimes we have a PA, too), and one morning we had "dueling codes" -- two active cardiac arrests being worked in the field, due to arrive almost simultaneously. We created a code room next to our real code room, and ... well, it was kind of a cluster with our doc running back and forth, but we got the job done, x 2, using ACLS protocols.

Thanks for the reply, all personal experiences help me gain a better understanding to a situation like this!

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Specializes in ER, Telemetry, Med/Surg.
My old ER had that happen, three codes at the same time. One doc in the first room, one in the second, a very experienced RN with New PA in third, all went as well as could be expected and I think they saved one or more of them.

That's great, I can't believe that happened. I can only imagine the stress in that ED!

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Specializes in ER, education, mgmt.

Protocols that are approved, signed by the medical director, and staff are educated about would be key in this scenario. ACLS protocols as well- there have been several instances when I or another nurse had to run code until the MD got there. Another thing to consider in this scenario...

Depending on several factors such as number of patients, acuity of patients, amount of staff and their scope of practice- perhaps a mass casualty could be called. They are not just for plane crashes, fires, or hazmat situations. Of course there would be a protocol for this as well and would more than likely be an administration call.

We called a mass cas last year when we had the perfect storm of conditions including 50 patients in the lobby and an 8 hour wait time. We had people from all over the hospital down there doing all kinds of things to get things done.

Just a thought for your scenario.

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Specializes in Trauma/ED.

I agree we work off protocols and ACLS approved meds...I've had similar scenarios and I called in the next doc that was to come on so the rest of the dept didn't get too out of hand. I would also call the ICU to send at least a nurse down to help out--hopefully take one of the pt's off our hands. I'm lucky to be a charge nurse in a dept with a very supportive management who has been instrumental in getting us help in "disaster" type situations. We cover a large area with multiple counties and are 60 minutes from the closest hospital so we have to be able to flex because we NEVER go on "RED" divert which is the only divert that keeps ambulances out of our dept. We have "YELLOW" divert which only "asks" the crews to go to another hospital if possible which they don't do, this usually happens d/t bed status upstairs not because of our dept. If we go on treat and transfer, we go on yellow divert.

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Specializes in ED.

Become comfortable with your ACLS protocol, know your drugs and remember your ABC's, involve resp. therapist if available and stay calm. It is amazing how much smoother things will go if you can stay calm.

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Specializes in Management, Emergency, Psych, Med Surg.

Stay calm. Remember the golden rule. Some people won't die no matter what you do to them. Try to elevate their head some or roll them to their side to prevent aspiration if the start to vomit. Iv, cardiac monitor etc. Keep a family member with them if possible. They can be a big help. Then it becomes an issue of triage. You have to look around to see who is most sick. Who needs to be intubated. Who is breathing, who is not, etc.

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Specializes in Quality and Emergency Department.

I think if you are ACLS certified, the ACLS protocols should be able to be followed in a situation such as this. CPR and ventilation for sure but I would ask your ED leadership about ACLS guidelines in this situation.

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