Clinical question?

Specialties Emergency

Published

So, during my orientation on a new job, one of my preceptors told me to give some noncritical meds prior to a Code 3 coming into our room-5 minutes out. Because I was on orientation I did it, but ordinarily (on my own) I would be getting my room ready for what was going to be rolling in before giving a noncritical med. Was my thinking wrong? I like to have my monitor set up, IV start kits ready, flushes, primed NS bags and stuff. Maybe it was just that she knew how Codes happen at the new facility or something. I know that sometimes eta's are wrong and I like my room ready to go.

Specializes in ED, Pedi Vasc access, Paramedic serving 6 towns.

So the goal of the ER is to get them in, and get them out. if you patient receiving the Meclizine has to wait another hour plus to receive it because no one else gives it while you are tied up with your new patient you have now significantly delayed opening up a bed, not to mention vertigo totally stinks so I am sure she needed some relief. Meclizine is a PO med and should not take all that long to given anyway... I agree with giving the medication before getting tied up for a while with a potentially unstable patient.

Annie

Up Vote Up Vote ×
So...likely septic shock? Most likely on its way to arrest without RESUSCITATIVE MEASURES. This is ESI 1. Migraines are ESI 3-4.

offlabel, you are totally wrong on this one. Code 3s will always trump a migraine unless the CT shows there's something that warrants immediate measures.

A Code 3 ambulance means nothing...any ER will have a standing "set up" for any emergency that rolls or walks in. What matters is the assessment. Any experienced ER nurse will run out of fingers counting "code - 3" patients sitting in the lobby waiting to be seen... gimme a break...

Up Vote Up Vote ×
Specializes in EMS, ED, Trauma, CEN, CPEN, TCRN.

My rooms are always ready. :)

Up Vote Up Vote ×
Specializes in Adult and pediatric emergency and critical care.

In our system if an ambulance is coming in emergent the assigned primary nurse is expected to be in one of the trauma rooms and ready to take the patient.

The EMS services that bring the majority of our patients are either double medic, medic and EMT, or RN and medic; they have a ton of experience and with rare exception do not transport emergent unless the patient is truly critical.

In other areas I have had EMS crews with less education and experience for whom coming in emergent does not mean as much and wouldn't warrant the same response from ED staff. If I was working in one of those hospitals an emergent ambulance would have meant far less to me and I would have had to tease more out of their report to try to understand how sick the patient actually is.

If we are expecting a critical patient that is coming in emergent they are going to start out as 1:1. In our system we wouldn't make someone receive a critical patient and manage a full assignment. If I was assigning a nurse who already has a pod to take that patient I would either take his/her pod myself or assign another one of our nurses to do so, but this would be decided well before the bus arrived.

From an education/charge view, when we are orienting new nurses I want them to learn how to manage a pod before having them float or take emergent patients. Keeping the ED flow is much more difficult to teach than critical care.

Given the story you have presented I wouldn't have found it unreasonable for your preceptor to want you to give the meds first, but I would have expected them to be getting ready for the ambulance themselves.

I think some of what is being lost between posters is that what is an emergent transport varies in different areas, and different EDs have different flows and staffing plans. I also thing that being precepted adds a different part to this, as what we are trying to teach during parts of orientation may be different than at the end of orientation or when you are on your own. What is in a room may also vary, when I'm charge I always start out emergent patients in a trauma room and move them if they are stable so there is very little to prep in the room (our trauma rooms are really overstocked; we keep hhf/bipap/vents, central line carts, adult and pediatric code carts, pressure infusers, a plethora of infusion supplies and fluids, a giraffe, C-section trays, thoracotomy trays, cutdown trays, and the list go on and on) other EDs don't necessarily do this and you may need to bring supplies to the bedside beforehand. Depending on how busy the ED is and staffing your preceptor may also have been using you to get things done rather than function independently as well.

Long story short- what your preceptor asks you to do may not be the same as when you are on your own.

Up Vote Up Vote ×
Specializes in ED, Cardiac-step down, tele, med surg.

Thanks again for the insights. I think if my room had been ready the way I like it, giving the med helping continue the flow of the ED could have been accomplished. But I was on orientation, just learning how this department works. I think my preceptor may have been using me to help the flow as well too. It's all good-she was great to take the time to show me the ropes.

My preceptor actually has less cumulative ED experience than me but knows this department better than I do so she was teaching me how things work in this particular department. She's really great too.

PeakRN, I really like the way your department seems to be set up. That's how both ERs I've worked at prior to this one has worked. Starting a critical patient in one of the trauma rooms and moving them out accordingly depending on the level of care they require is how things should be done, so logical and efficient in my opinion.

I just wish that there was more formal training in departments I've worked in surrounding the critical care aspect of the ER. I know this is often done in large trauma centers more than smaller ERs. I think that part is more challenging for me, the critical care skills because ERs tend to put their most experienced nurses with the critical patients because it's more predictable and easier rather than trying to build skills in less experienced nurses. For me, this has resulted in incomplete development and for an ER nurse with a year and a half experience, I think I should be farther along.

I think after a year and a half an ER nurse should be able to function in a critical care assignment. I'm not sure I can yet, not enough practice.

In this particular instance during my orientation, it would have been more beneficial for me to work with this patient, but there will be other opportunities I'm hoping. I've been a nurse for many years (over 6) now and would like to start taking a more challenging assignment. Though much of my experience is an inpatient nurse, I think it still valuable.

Up Vote Up Vote ×
+ Add a Comment